Stressful afterimage?

February 6, 2012 6:25 PM

Who has experience with palinopsia and how can it be treated/managed?

My girlfriend has been experiencing really distressing visual symptoms for three weeks. An eye exam revealed nothing wrong. Since she also has physical symptoms commonly associated with stress, and is dealing with legitimately stressful shit, a visit to a general practitioner resulted in her being told her visual symptoms were stress-related.

She describes, in detail, having images of what she sees persist after turning away, and this is exacerbated by poor lighting. She's also experiencing photosensitivity. No history of neurological problems. She says the symptoms most closely resemble palinopsia.

YANMD, I understand, and she will be seeing one again soon. In the meantime, I am quite worried. What I would like to know is whether you have experienced similar symptoms, and whether stress is a plausible cause.

posted by kengraham to health & fitness (12 answers total)

Is she taking any medications (prescription or OTC), supplements, or using any recreational drugs? Blood pressure medications and antihistamines can both have effects on vision, even if she has used the same meds without side effects before.

It also sounds like she might want to be evaluated for migraine. I have afterimages as part of my migraine auras sometimes, and photosensitivity is a classic migraine symptom.

So sorry she is experiencing this! Visual disruptions can be scary.
posted by Sidhedevil at 8:08 PM on February 6

I don't believe in labeling symptoms as "stress related" unless all physical causes have been ruled out. So, it may be plausible later, but it's not now.
posted by SLC Mom at 8:37 PM on February 6 [1 favorite]

Thanks!

1. She takes Wellbutrin (by prescription)
3. She does have frequent headaches, although not of the intensity either of us associates with a migraine, but thank you for mentioning this possibility, Sidhedevil. Have you experienced or heard of a migraine for which the head agony aspect is the less serious part, or for which the phase leading up to the serious pain is very long?
posted by kengraham at 9:04 PM on February 6

Is there any history of seizure disorder in her or in her family? Wellbutrin is known for aggravating all kinds of seizures and what you're describing could be some form of seizure. Just a thought.

Hope this gets taken care of shortly - it sounds nerve-wracking. And I second the idea that "stress-related" is a catchall for anything they haven't figured out yet - I wouldn't accept that without eliminating everything else first.
posted by aryma at 10:24 PM on February 6

My experiences with visual migraine auras aren't like what you describe your girlfriend experiencing, but yes, it is possible to have migraines where the headache is not all that bad, or never comes at all. For me, the visual disturbances are a sparkly grey cloud drifting in and blocking my vision until it moves across. This lasts about 5-10 minutes generally, the headache shows up about five minutes later and may or may not need a couple of Tylenol 3. When I was pregnant the visual disturbances were much more frequent than usual, lasted much longer (the longest was about 40mins), and there was no headache at all.

Please get this checked out properly, "stress related" could be true, but right now it sounds like a brush-off. I was given a neurologist appointment and offered an MRI and other tests when pregnancy changed my migraines, and we were already 99.9% certain what they were.
posted by crabintheocean at 11:56 PM on February 6

Also, just so we're clear - palinopsia is a symptom or experience, not a condition or a diagnosis. If a doctor told you it was palinopsia, you should say "yes, but what is causing it?"
posted by crabintheocean at 11:59 PM on February 6

I just sent you a MeMail.
posted by mothershock at 4:50 AM on February 7

kengraham: "Have you experienced or heard of a migraine for which the head agony aspect is the less serious part"

Oh yes, absolutely. My (very lucky) mom's migraines have progressed to the point to where she almost exclusively gets the aura but no pain.
posted by IndigoRain at 8:23 AM on February 7

Have you experienced or heard of a migraine for which the head agony aspect is the less serious part...

Yes. Migraines can occur without the head pain, just visual or other symptoms, and some even mimic strokes (scary!).

Many of my migraines have pain that could be described like a regular headache, but which are accompanied by other symptoms like nausea, exhaustion, or dull mental functioning. Sometimes they're just a dull or dull and throbbing pain which, although not near as bad as I've had at times, just will. not. go. away. and are accompanied by lethargy and exhaustion far in excess of what they seem they ought to have.

(The damnable part is trying to figure out if it's a regular headache or a migraine, because the longer I wait on taking the migraine meds, the less effective they are, but I don't want to take migraine meds if an OTC med will take care of it because of the side effects.)
posted by telophase at 10:10 AM on February 7

I've had scores of migraines without pain, and only one with (and the pain was mild).

From reading that article, I might also have a couple of aspects of paloinopsia.

About one in ten nights when I need to get up to go to the bathroom and don't turn on any light, I see a detailed image of the bedroom as it was just before we turned out the light, later when I open my eyes in the total darkness. I can move my eyes and look at different parts of the room just as if I were really seeing it, except that some texture is missing. It's creepy when the image includes my partner, frozen in place, but I can feel her lying in bed beside me. However, the worst of it is that it's not in register with reality and doesn't change as I get up and move in the room, yet somehow it blocks me from orienting myself in the house even when I'm touching an object I recognize. Then I usually have to get down on my hands and knees and crawl into another room (so I won't wake her up) and fumble along a wall to a light switch, and the light dispels it. Once after a head trauma, I had the same image stuck in my head for six months of the room I slept in the night before the trauma.

I also often see motion long after I stop looking at it. For example, three hours after watching a basketball game, most of the time if I look at a blank wall I will see the motion of dribbling, jumpshots, rebounding, and etc., but not the players who were doing it, just the motion itself, abstracted from any physical object. It's like the waterfall illusion, but it will continue indefinitely without fading, although it's gone the next morning.

Neither of these seem to be getting any worse, and I've had them for at least twenty years now.

Stress has nothing to do with it in my case.
posted by jamjam at 6:56 PM on February 7

Thanks, everyone. She had a neurological exam at the ER, which found nothing abnormal, and has a referral to a neurologist. They seemed to think it was some type of migraine, from what I could tell. We'll see, but this seems consistent with some of your answers.
posted by kengraham at 12:07 PM on February 8

Well, this post could have been about me a couple of years ago. Unfortunately your girlfriend could be entering the no-man's land of modern neurology. Tell her not to stress out about it too much if she doesn't get any clear diagnoses from neurologists. I've had my palinopsia for about two and a half years now and I think I'm actually becoming fond of it.

Don't worry too much about the doctors' stress diagnoses. If you don't believe in mind/body dualism, then it doesn't make sense to say that a physiological symptom is caused only by "psychologic stress." We are organisms of flesh and blood, and there are always mechanisms that produce these changes in our neural chemistry. But when doctors don't know the mechanisms, they tend say it's "just stress," instead of "We don't know yet." That's pretty lazy science.

I hope your girlfriend gets to the bottom of this, but she might not. Good luck and fair warning! Memail me if you have questions or want my story.
posted by sunnichka at 10:13 AM on February 9