Tilted vision, inverted vision and other forms of illusory rotation

Tilted vision, vision at right angles and inverted vision have been described as illusions whereby the entire visual environment or objects of fixation appear to be rotated by less than 90°, by 90° or by 180°, respectively, so that the visual targets appear tilted, turned to a right angle or turned upside down. In most cases, these illusory rotations are experienced in the coronal (frontal) plane, more rarely in the sagittal or horizontal (transverse) plane.

Body planes: Terminology (see here)

One migraine sufferer records the aura symptom of tilted vision in her post to a Usenet Newsgroup thus: "And that feeling when you're drunk that everything you're looking at is kind of tilted ..."

(Anonymous, Newsgroups: alt.support.step-parents, Subject: Ever see the herringbone pattern?, September 21, 1999)

The following case observations from the internet describe inverted vision (River et al., 1998) occurring as visual migraine aura symptom, i.e. an illusory rotation by 180° in the coronal plane: "Two teenagers (ages 18 and 19) experienced intermittent episodes of reversal of vision over a period exceeding one year. The transient visual illusion was described as a 180-degree rotation of visual image in the coronal plane. The episodes were followed by moderate or severe throbbing migraine headaches."

(Neurology Reviews, November 9, 2004)

Another example of inverted or "up-side down" vision: "I experience classic migraines but I don't get headaches. My symptoms are mainly visual [affecting my left eye only], and those that relate to consciousness. During the attacks, I see zig-zag lines, flashes of light, false images, distorted images [2D images appear 3D, blurry vision, up-side down vision] false colors, distorted colors [green may appear yellow (or vice versa), etc.]. In addition, I partially lose my awareness and feel for a moment that I am 'no-where' [resembling alcohol blackouts and seizures]. My mind just goes blank. I also feel dizzy. I have a tough time speaking. I find it difficult to move the muscles on the left side of my body. The left side of my body also goes numb."

(External Network Error, Newsgroups: sci.med.vision, Subject: Migraine Aura, November 4, 2002)

Another report from the internet exemplifies the rare symptom of illusory rotation of the total environment by 180° in the horizontal plane: "When I was young, around 5 to 10 years old, I would have these 'episodes' when the world around me would instantly become a mirror image of what I was used to. It happened once when we were returning home and we were riding down the one-way street we lived on. All of a sudden, it felt as if we were now going east instead of west, all of the traffic was going in the wrong direction, and our house was now on the opposite side of the street, and at the other end of the block. Once in the house it was difficult to find my way around. Then all of a sudden things were back to normal."

(rikkus, Alice in Wonderland Syndrome, November 9, 2004)

The same illusory rotation of the total environment by 180° in the horizontal plane, which is known as a disorder of spatial orientation with apparent reversal of right and left as well as front and back, was recorded as a migraine aura symptom by a patient of Nielsen and Ingham's (1940). During her attacks, this 24-year-old sufferer experienced "a loss of sense of direction", lasting about 20 minutes. "She does not know north, south, east, or west and the building in which she happens to be seems turned wrong and the doors seem to open from the wrong direction."

References

Nielsen JM, Ingham SD. Evidence of focal vascular disturbance in migraine equivalent. Bull Los Angeles Neurol Soc 1940; 5: 113-119.
River Y, Ben Hur T, Steiner I. Reversal of vision metamorphopsia: clinical and anatomical characteristics. Arch Neurol 1998; 55:1362-1368.

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