Palinopsia

What is palinopsia?

Palinopsia is where you continue seeing something in your field of vision even after it’s no longer there or see it doing something it isn’t still doing. The name “palinopsia” comes from ancient Greek and means “seeing again.” The lingering image appears in your vision spontaneously, well after what you saw is gone, or it might affect and distort what you’re seeing right now.

While palinopsia affects what you see, it isn’t happening because of your eyes. It happens because of disruptions or unusual activity in areas of your brain that process what your eyes see. The area most often affected is the occipital lobe at the back of your head, where most vision processing happens, but it can also affect other areas that play a role in vision. Palinopsia can — in very rare cases — be a symptom of a stroke.

Are there different types of palinopsia?

Experts group palinopsia into two main categories: hallucinatory and illusory. Each contains four possible symptom forms:

• Hallucinatory: This is when areas of your brain that involve visual memory are too active or fire too easily. It usually causes reappearance of something you’ve seen in the past. What you see could come from something you saw just minutes ago, or it could be from years ago. It varies from person to person.
• Illusory: This is when the visual pathways in your brain don’t work like they should. It usually involves changes in how you perceive something you’re seeing at the moment (like a “comet tail” effect on something moving in your field of vision).

Hallucinatory palinopsia symptom forms

The hallucinatory symptom forms of palinopsia include the following:

• Formed image perseveration. This is a single object that isn’t moving and remains in your field of view. It’s clear and vivid enough that some people try to touch the formed image. It usually lasts only seconds but can last hours or days in unusual cases.
• Scene perseveration. This is like formed image perseveration but with a wider perspective. It can involve objects or people that move. It’s usually a brief, ordinary action like someone touching their face. It can appear over and over several times. And some people with a visual field defect (like a blank spot or gap in their vision) might see the scene in or overlaid on the area of the defect.
• Categorical incorporation. This is when you see an item or a physical characteristic (like facial hair) repeatedly. They’ll usually appear in the same place that matches the context, like seeing the same facial hair on multiple people.
• Pattern visual spread. This is where a pattern or something similar spreads from one object to surrounding ones. An example would be seeing a houndstooth pattern on a jacket that spreads and overlays itself onto other things around the jacket.

Illusory palinopsia symptom forms

The illusory symptom forms of palinopsia include the following:

• Prolonged afterimage. This is an image that lasts much longer than you’d expect. It usually happens after seeing a bright light or something illuminated by one.
• Light-streaking. This is when either you or a light are moving relative to each other and the light appears to leave behind a bright streak (like a comet tail).
• Visual trailing. This is like light-streaking, but the effect happens on an object rather than a light source.
• Variant image perseveration. This is similar to formed image perseveration, but the images you see can fade after a few seconds. They can also appear as black shapes or seem partially see-through (translucent).

What are the most common causes of palinopsia?

Palinopsia happens when something disrupts vision-related processing in your brain. Many conditions and circumstances can cause that. The most common causes include:

• Migraines. Palinopsia is a possible symptom of migraines, especially migraines with auras.
• Seizures and epilepsy. Focal seizures that affect part of the brain involved in vision processing can cause palinopsia.
• Infections that affect your brain function. An example of this would be posterior reversible encephalopathy syndrome (PRES) that can happen due to COVID-19.
• Other conditions that affect vision processing. An example of one such condition would be visual snow syndrome.
• Drugs (see below for more about the types that can cause this).
• Stroke and transient ischemic attack (TIA). These disrupt blood flow to parts of the brain. Disruptions in arteries that supply the occipital lobe at the back of your head can cause palinopsia.
• Brain lesions.
• Tumors (benign and cancerous).
• Concussion and traumatic brain injury (TBI).
• Brain bleeds.
• Idiopathic (unknown cause).

Drugs that can cause palinopsia

Drug use, either medical or nonmedical, is among the most common causes of palinopsia. And multiple types of drugs can cause it. The most common drug causes include:

• Antidepressants. This includes trazodone, nefazodone and the tetracyclic antidepressant mirtazapine.
• Antiseizure medications. The most common cause under this type is topiramate, which also sees use for treating migraines.
• Clomiphene. This medication boosts fertility. It’s meant to make a person with ovaries more likely to ovulate.
• Birth control pills (oral contraceptives).
• Antipsychotic medications. The most likely of these is risperidone.
• Nonmedical drugs. This is especially possible with hallucinogens like LSD or mescaline.

How is palinopsia treated?

The treatment for palinopsia depends on many factors, especially the underlying cause. Because so many conditions can cause it, the treatment varies widely. Your healthcare provider is the best person to tell you about the treatment options for your case and which they recommend.

What can I do at home to treat palinopsia?

Palinopsia isn’t a condition you should self-diagnose or self-treat if you’ve never had it before. This is because palinopsia is a possible symptom of stroke, a medical emergency that needs immediate treatment. Delays in treatment for stroke can lead to permanent brain damage or death.

Palinopsia that happens briefly may also need emergency medical care. That’s because a transient ischemic attack (TIA) can also cause palinopsia. A TIA is sometimes called a mini-stroke, but it’s more like a temporary version of a stroke. Having a TIA means you have a much higher risk of having a stroke within the coming days, which is why medical treatment is essential even if palinopsia symptoms go away.

If you have a condition that causes palinopsia that isn’t life-threatening, like seizures or migraines, your neurologist or another healthcare provider can guide you on when you need medical attention. But when in doubt, you should always seek medical attention. Doing so could save your life and spare you from permanent brain damage and loss of abilities.

Can palinopsia be prevented?

Some causes of palinopsia are preventable or avoidable. The best things you can do to avoid it include:

• Wear safety equipment as needed. Head injuries, especially concussions and traumatic brain injuries, can lead to conditions that have palinopsia as a symptom. Wearing safety equipment — especially helmets, head-protecting gear and safety restraints like seatbelts — is vital.
• Manage your chronic conditions. Some conditions like seizures and epilepsy can cause palinopsia. Take your antiseizure medications as prescribed to reduce the chances of having palinopsia or other seizure-related symptoms.
• Take prescription drugs exactly as directed and avoid nonmedical drug use. If you experience palinopsia after taking a prescribed medication, tell the provider who prescribed it. They can help determine if you need a medication change or another adjustment. And always avoid nonmedical drugs like LSD or mescaline.

When should palinopsia be treated by a doctor or healthcare provider?

Since palinopsia might be a symptom of a stroke, you should reach out to a healthcare provider the first time you experience it — even if it’s only temporary. If you have palinopsia along with other stroke symptoms — like a drooping face, muscle weakness or difficulty speaking — you should call 911 (or your local emergency service number) or seek emergency care.

If a healthcare provider diagnoses you with a non-life-threatening condition that can cause it, like seizures or migraines, they can give you specific guidance. Some causes of palinopsia are ones you can self-treat with as-needed (rescue) or daily preventive medications.

But even if you have one of those conditions, you might experience palinopsia in a way that’s unexpected or severe. If that happens, it’s best to be cautious and get immediate medical attention.

Is there a test for palinopsia?

There isn’t a test for palinopsia, specifically. A healthcare provider can determine if you have this symptom based on questions they ask you. They may also want to know more about your medical history and any recent happenings that might be contributing.

Imaging tests like magnetic resonance imaging (MRI) and CT scans (computed tomography scans), and brain activity tests like electroencephalogram (EEG), may help with diagnosing whatever’s causing your palinopsia. They can do that either by detecting brain changes and activity that might indicate palinopsia, or by ruling out other conditions that could cause it. But the tests can vary depending on your symptoms. Your provider can tell you more about the possible causes they suspect and what tests they recommend.

What’s the difference between palinopsia and an afterimage?

Afterimages are a normal effect of how your eyes communicate with your brain. Palinopsia isn’t normal, and it sometimes means something is affecting the part of the brain that processes vision.

An afterimage is a visual illusion that happens when you stare at something directly for a short time (usually a period of 20-30 seconds) and then stop suddenly by blinking or closing your eyes. You’ll continue to “see” a faint afterimage when your eyes are closed. The image fades within moments.

Afterimages are often “negative,” meaning dark and light areas are reversed. Others may appear with reversed complementary colors. Red will appear cyan, yellow will appear blue and green will appear magenta, or vice versa. (Optical illusions often take advantage of this effect.)

Palinopsia appears differently. The images you see are clearer and more vivid than an afterimage, and they’re almost always the same color as the original cause. They can happen immediately or at varying times after you saw the original source of the recurring image.

A note from Cleveland Clinic

If you have palinopsia, it might seem confusing or alarming at first. But it’s a very real symptom set that experts recognize. It can happen with many conditions, a small number of them dangerous. If you experience it and have never had it before, you should consider getting immediate medical attention. While it could be a symptom of something that isn’t dangerous, it’s best to err on the side of caution.