Alternating Hemi-auto-prosopometamorphopsia (Cerebral Asthenopia) of Kith and Kin Mirror Hallucinations.

Introduction: Obligate mirror alternating hemi-prosopometamorphopsia has not heretofore been described. Such a case is presented. Methods: Case Report: A 37 year old right handed female, with schizoaffective disorder, bipolar subtype, described that at times, when looking at herself in the mirror, she noted that her face was vertically split with half of her face being her own face, and the other half being that of another person, either of her mother or her father or a friend. Such images, depending upon the day, would alternate in terms of sides either right or left. But once presenting there, would persist for that day. She believed that the spirit of the respective person was also present inside her body. Results: Mental Status Examination: Hyperverbal, grandiose with expansive affect, poor insight and judgment. Recalls 3 out of 4 objects in 3 minutes and all 4 with reinforcement. Discussion: Vision from the right visual field projects to left occipital hemisphere and crosses the splenium of corpus callosum projecting to the right fusiform facial area as well as right temporal lobe. Alternatively, from the left visual field, projections proceed to the right occipital hemisphere and then ipsilaterally to the right fusiform facial area and the right temporal lobe. In schizophrenia, there is a reduction in the gray matter volume in anterior and posterior fusiform gyrus. Diurnal variation of side suggests involvement of the hypothalamus or Reticular Activating System regulation. Implication: In those who suffer from alternating hemi-autoprosopometamorphasia, evaluation for such intracranial processes is warranted.