hallucinations

May be associated with temporal lobe injury, epilepsy or electrical stimulation May be associated with disturbances of the Hun or Heart Fire with phlegm

**Brain Injury/Electrical Stimulation:**
-buzzing -clicking -ticking -humming -whispering -ringing most of which are localized as coming from opposite side of the room.
 * Sounds**

Associated with **Heschyl's gyrus** Tumors involving this area also give rise to similar, albeit transient hallucinations, including tinnitus. Patients may complain that sounds seem louder and/or softer than normal, closer and/or more distant, strange or even upleasant. There is often a repetitive quality which makes the experience even more disagreeable. In some instances the hallucination may become meaningful. These include the sound of footsteps, clapping hands, or music, most of which seem (to the patient) to have an actual external source.


 * Musical Hallucinations**
 * superior temporal gyrus (esp. right side)**

Patients with tumors and seizure disorders, particularly those involving the right temporal region, may also experience musical halluciantions. Frequenty the same melody is heard over and over. In some instances patients have reported the sound of singing voices and individual instruments may be heard.

Conversely, it has been frequently reported that lesions or complete surgical destruction of the right temporal lobe significantly impaires the ability to name or recognize melodies and musical passages. It also disrupts time sense, the perception of timbre, loudness, and meter.

-single words -sentences -commands -advice -distant conversations that can't quite be made out
 * Auditory verbal hallucinations**

seem to occur with right or left temporal destruction or stimulation --although left temporal involvement is predominant. According to Hecaen and Albert, verbal hallucinations may precede the onset of an aphasic disorder, such as due to a developing tumor or other destructive process. Patients may complain of hearing "distorted sentences", "incromprehensible words" etc.

Although the majority of auditory neurons respond to auditory stimuli, approximately 25% also respond to visual stimuli, particularly those in motion. In fact, Penfield and Perot (1963) were able to trigger visual responses from stimulation in the superior temporal lobe. In addition, these neurons are involved in short-term memory, as lesions to the superior temporal lobe can induce short-term memory deficits. Conversely, electrical stimulation not only induces visual responses, but complex auditory responses. Penfield and Perot (1963) report that electrical stimulation can produce the sound of voices, and the hearing of music. These neurons will also respond, electrophysiologically, to the sound of human voices, including the patient's own speech (Creutzfeldt, et al., 1989). Conversely, injury to the left and right superior temporal lobe can result in an inability to correctly perceive or hear complex sounds; a condition referred to as pure word deafness, and if limited to the right ear, agnosia for environmental and musical sounds (see below). In fact, right temporal injuries can disrupt the ability to remember musical tunes or to create musical imagery.

VISUAL HALLUCINATIONS
The functional integrity of the temporal lobes, the inferior regions in particular, are highly important in regard to the memorization and recollection of various auditory, visual, olfactory, and emotional experiences. When destroyed, disconnected from sources of input, or compromised in some fashion, the ability to store information and to draw visual-verbal mnemonic imagery from memory is severely attenuated. Conversely, when the temporal lobes and/or the limbic nuclei buried within its depths (i.e. the amygdala and hippocampus) are artificially or abnormally activated it sometimes occurs that visual-auditory imagery as well as a variety of emotional reactions are evoked involuntarily. These may take the form of complex hallucinations, dream-like states, confusional episodes, or may involve the abnormal attribution of emotional significance to otherwise neutral thoughts and external experiences.

HALLUCINATIONS & THE INTERPRETATION OF NEURAL "NOISE". Hallucinations may occur secondary to tumors or seizures involving the occipital, parietal, frontal, and temporal lobe (Gloor, 1997; Halgren, 1992; Penfield & Perot, 1963), or arise secondary to toxic exposure, high fevers, general infections, exhuastion, starvation, extreme thirst, partial or complete hearing loss including otosclerosis, and with partial or complete blindness such as due to glacoma (Bartlet, 1951; Flournoy 1923; Lindal et al. 1994; Pesme, 1939; Rhein, 1913; Ross et al., 1975; Rozanski & Rosen, 1952; Semrad, 1938; Tarachow, 1941). Interestingly, when secondary to peripheral hearing loss, frequently individuals report hearing certain songs and melodies from their childhood --melodies which they had usually long forgotten. In addition, individuals suffering from cortical blindness, i.e. Anton's syndrome (Redlich & Dorsey, 1945) and deafness (Brown, 1972), as well as those recovering from Wernicke's aphasia, frequently experience hallucinations. In general, hallucinations secondary to loss of visual or auditory input appears to be secondary to the interpretation of neural noise. That is, with loss of input various brain regions begin to extract or assign meaningful significance to random neural events, or to whatever input may be received. Thus we find that subjects will hallucinate when placed in sensory reduced environments or even when movement is restricted (Lilly, 1956, 1972; Lindsley, 1961; Shurley, 1962; Zuckerman & Cohen, 1964). Conversely, hallucinations can occur due to increased levels of neural noise as well. For example, if an area of the neocortex is abnormally activated that area in turn may act to interpret its own neural activity, and/or as a function of the activation of "feature detectors." For example, those neurons that subserve facial recognition, and word recognition, and object recognition, may become simultaneously activated--as well as all associated memories--and in consequence, the brain attempts to interpret what it experiences. However, the degree of interpretative activity depends on the type of processing performed in the region involved. In this regard we find that hallucinations become increasingly complex as the disturbance expands from primary to association areas and as involvement moves from the occipital to anterior temporal regions (Critchley, 1939; Penfield & Perot, 1963; Tarachow, 1941) --which is one of the major interpretive regions of the neocortex (Gibbs, 1951; Gloor 1990, 1992; Halgren 1992; Penfield & Perot, 1963). That is, in the primary regions, neural noise is given a simple interpretation (simple hallucinations), whereas in the association and multi-associational areas, the individual begins to hallucination secondary to "feature detector" activation, such that they may see faces, chairs, trees, hear voices, music, and so on, all of which is experienced as a mosaic of something real. For example, tumors or electrical stimulation of the occipital lobe produce simple hallucinations such as colors, stars, spots, balls of fire, flashes of light, whereas with superior temporal involvement the patient may experience crude noises, such as buzzing, roaring sounds, bells, and an occasional voice or sounds of music. However, these same neurons become activated when presented with colors, spots, flashes of light, bells, and so on. However, with anterior and inferior temporal abnormalities, the hallucinations become increasing complex consisting of both auditory and visual features, including faces, people, objects, animals, etc. (Critchley, 1939; Penfield & Perot, 1963; Tarachow, 1941). This is because there is a ventral stream of visual experience which becomes increasingly complex as information is transmitted from the primary to secondary to association, to multi-modal areas in the temporal lobes where neurons fire in response to complex objects, including faces. The anterior-inferior temporal regions, therefore, give rise to the most complex forms of imagery because cells in this area are specialized for the perception and recognition of specific forms. Moreover, structures such as the amygdala and hippocampus become activated and in consequence, memories and emotions may also be evoked, such that the experience may also become personally meaningful and include real individuals and real events that are produced from memory (Gloor, 1997; Penfield & Perfot, 1963). It has frequently been reported that as compared to other cortical areas, the most complex and most forms of hallucination occur secondary to temporal lobe involvement (Critchley, 1939; Malh et al., 1964; Horowitz et al., 1968; Penfield & Perot, 1963; Tarachow, 1941) and that the hippocampus and amygdala (in conjunction with the temporal lobe) appear to be the responsible agents (Gloor 1990, 1992, 1997; Gloor et al., 1982; Horowitz et al., 1968; Halgren et al., 1978). For example, Bancaud et al. (1994), Halgren et al., (1978), and Horowitz and colleagues (1968) note that hippocampal stimulation was predominatly associated with either fully formed and/or memory-like hallucinations including feelings of familiarity, and secondarily dream-like hallucinations. However, stimulation limited to the neocortex generally failed to produce complex hallucinations unless the amygdala became activated (Gloor et al., 1982). In this regard, it appears that limbic activation, and activation of the amygdala in particular (Gloor, 1997) is necessary in order to bring to a conscious level percepts which are being processed in the temporal lobes. LSD. This does not mean, however, that neocortical involvement is not necessary for frequently it is the interpretive interaction of the temporal lobe which gives rise to certain types of hallucinations; i.e. bringing them to a conscious level. That is, although the amygdala (perhaps acting on the hippocampus) may be responsible for the hallucination, the hallucinaton requires an interactions between the amygdala, hippocampus, and the neocortex, for it is only when the "hallucination" envelops the neocortex of the temporal lobe that the individual becomes "conscious of them." For example, it is well known that the ingestion of LSD will trigger the formation of vivid and complex auditory and visual hallucinations. Following LSD administration electrophysiological abnormalities are noted in the amyugdala and hippocampus (Chapman et al., 1963). However, if the temporal lobes are surgically removed there is a significant decrease (with unilateral removal, Serafetinides, 1965) or complete abolishion (with bilateral temporal lobe removal) of LSD induced hallucinatory activity (Baldwin et al., 1955)--even when the amygdala and hippocampus are spared. That is, if the overlying neocortex is destroyed the individual will fail to hallucination--or at least to become conscious of the hallucination. Of course, if the overlying temporal lobe is destroyed the amygdala and hippocampus also become disconnected, and cannot help but be injured. Nevertheless, studies with LSD and temporal lobe neocortical resection suggest that the neocortex is associated with consciousness and the limbic system with the unconscious, and if the pathways between them are destroyed, hallucinations cease to be experienced consciously. Interestingly, the hallucinatory effect of LSD appears to be greatest in the right temporal lobe (Serafetinides, 1965). That is, destruction of the right temporal lobe abolishes LSD-induced hallucinations, where with left temporal destruction, the individual continues to hallucination. Likewise, Penfield and Perot (1963) report that the most vivid hallucination tend to be triggered from the right not the left temporal lobe.

Tumors: associated with the development of auditory and visual hallucinations, dreamy states, and alterations in emotional functioning--particularly as the lesion encroaches on the inferior regions. Electrical stimulation also initiates the development of complex hallucinations and alterations in consciousness.
 * Middle Temporal Lobe**

Occipital Lobe
Electrical stimulation, tumors, seizures, or trauma involving the striate cortex may produces simple visual hallucinations -Sparks -Tongues of flames -Colors and flashes of lights -Objects may seem to become exceedingly large (macropsia) or small (micropsia) -Blurred in terms of outline -Stretched out in a single dimension -Colors may become modified or even erased -Sometimes simple geometric forms may be reported.
 * Striate Cortex (broadmann's area 17)**

Usually the hallucination is restricted to one half of the visual field. That is, if the seizure is in the right occipital lobe, the hallucination will appear in the left visual field.

Electrical stimulation of or lesions involving areas 18 and 19 can produce complex visual hallucinations -Images of men, animals, various objects and geometric figures -Liliputian-type individuals, including micropsias and macropsias -Objects may seem to become telescoped/far away, or, when approached, objects may seem to loom and become exceedingly large.
 * Visual Association Areas (broadmann's Areas 18 & 19) **

Complex hallucinations are usually quite vivid and fully formed and the patient may think what he sees is a real. <span style="font-family: 'Times New Roman',serif; font-size: 11pt;">Example: Person hallucinated a butterfly then attempted to catch it when area 19 was electrically stimulated.

<span style="font-family: 'Times New Roman',serif; font-size: 11pt;">Complex hallucinations, although usually associated with tumors or abnormal activation of the visual association area, have also been reported with parietal-occipital involvement, occipital-temporal, or inferior-temporal damage, or with lesions of the occipital pole and convexity.

<span style="font-family: 'Times New Roman',serif; font-size: 11pt;">Laterality: <span style="font-family: 'Times New Roman',serif; font-size: 11pt; line-height: 1.5;">although simple hallucinations are likely following damage to either hemisphere, complex hallucinations are usually associated with right rather than left cerebral lesions.

-GV-20->GB-18, HT-4, LR-8, LR-5
 * Acupuncture Points: Shen: Mental-Emotional Aspects of Chinese Medicine**
 * Auditory Hallucinations: ** TW-19, TW-17
 * Visual Hallucinations: ** SI-6, GB-37
 * Olfactory Hallucinations: ** LI-20, ST-44
 * Gustatory Hallucinations: ** Hai Quan, CV-7
 * Tactile Hallucinations: ** PC-6, ST-40