Case 22 - Vivid images in the bedroom  pp. 151-155

Vivid images in the bedroom

By Michael H. Silber

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Clinical history and examination

A 24-year-old woman presented with a 5-year history of hallucinations during the night, occurring three to four times a week. On waking abruptly between 1 and 3 am, she would see vivid images in her bedroom, including brightly colored birds perched on her furniture, women who appeared taller than expected and a distorted man with half his head missing. The images were silent and remained still. She did not experience preceding dreams and had no idea why she had wakened. The hallucinations were realistic to the extent that she would initially jump out of bed, bruising her legs on a few occasions. Later, she became aware that the images were not real and she could remain in bed with less anxiety. The hallucinations would persist until she switched on her night light. She had not experienced hallucinations during the day and denied any delusional thinking.

She did not have a history of sleepwalking. She had not been observed to snore and no apneas had been noticed. She had not experienced cataplexy, sleep paralysis or restless legs. According to her bed partner, she did not talk, flail her arms or kick her legs in bed. She went to bed at 11 pm, initiated sleep without difficulty and woke at 6.45 am, feeling alert. She described feelings of anxiety, but had not experienced panic attacks or symptoms of depression. She had no significant past medical history and specifically did not have a seizure disorder or risk factors for epilepsy.

Fenelon G , Mahieux F , Huon R , Ziegler M. Hallucinations in Parkinson's disease: prevalence, phenomenology and risk factors. Brain 2000; 123: 733–45.
Kavey NB , Whyte J. Somnambulism associated with hallucinations. Psychosomatics 1993; 34: 86–90.
Manford M , Andermann F. Complex visual hallucinations. Clinical and neurobiological insights. Brain Res 1998; 121: 1819–40.
Silber MH , Hansen MR , Girish M. Complex nocturnal visual hallucinations. Sleep Med 2005; 6: 363–6.
Teunisse R , Cruysberg J , Verbeek A , et al. The Charles Bonnet syndrome: a large prospective study in the Netherlands. A study of the prevalence of the Charles Bonnet syndrome and associated factors in 500 patients attending the University Department of Ophthalmology at Nijmegen. Br J Psychiatry 1995; 166: 254–7.