Case Report

Akinetopsia on Driving
Kengo Maeda, MD, PhD

Akinetopsia is a quite rare symptom. Two types of akinetopsia have been reported:
one is cinematographic vision, and the other is invisibility of moving objects. These
symptoms are thought to occur due to dysfunction of the MT/V5 area at the occipitoparietal region. I herein describe a 54-year-old man who collided with a car
parked on the left side of the road while driving. He complained that the parked
car looked to be moving forwards and he could not stop his car when he noticed
that it was parked. Magnetic resonance imaging disclosed the fresh infarction on
the right temporoparietal region involving the MT/V5 area. His symptom during
driving was considered cinematographic vision and it was the cause of the traffic
accident. Akinetopsia resulted in illusory kinetopsia on driving and the traffic
accident.
Key Words: Kinetopsia—Akinetopsia—Optic flow—MT/V5 area—Infarction
© 2019 Elsevier Inc. All rights reserved.

Case Report

Discussion

A 54-year-old man was transferred to the hospital due
to a traffic accident. He had noticed a slight weakness of
his left hand that morning. When he drove his car to his
work, he collided with the car parked on the left side of
the road. He complained that the parked car seemed to be
moving forward. However, when he noticed that it was
parked, he could not stop the car. He was mentally normal. Homonymous hemianopsia or left hemispatial
neglect was not observed. There was neither hemiparesis,
sensory disturbance, nor cerebellar ataxia. Magnetic resonance imaging revealed fresh cerebral infarction in the
right frontal and temporo-occipital lobes (Fig 1). The
objective tests such as eye tracking test were not available.
Treated with antiplatelet agent, he did not note any visual
symptom afterward.

From the Department of Neurology, National Hospital Organization Higashi-ohmi General Medical Center, Higashi-ohmi, Shiga,
Japan.
Received January 10, 2019; revision received February 7, 2019;
accepted February 23, 2019.
Address correspondence to: Kengo Maeda, Department of Neurology, National Hospital Organization Higashi-ohmi General
Medical Center, 255 Gochi, Higashi-ohmi, Shiga 527-8505, Japan.
E-mail: maeda.kengo.sb@mail.hosp.go.jp
1052-3057/$ - see front matter
© 2019 Elsevier Inc. All rights reserved.
https://doi.org/10.1016/j.jstrokecerebrovasdis.2019.02.036

e102

The cause of his traffic accident was considered visual
illusory motion perception due to cerebral embolism.
Three interpretations for his symptom were considered.
First, the patient’s complaint that the car parked on the
left side of the road looked to be moving forward indicates kinetopsia when simply accepted. Only two epilepsy
patients have been reported to show kinetopsia.1,2 The
causative epileptic focus was located on the right occipitoparietal region involving the MT/V5 area, which is a part
of the dorsal stream of the visual perception pathway and
plays a key role in visual motion detection.3 However,
this is the case when the patient is not moving. Secondly,
in the situation involving this patient (driving a car), the
surrounding stationary objects were moving from the
front to the back. In his visual field, things were moving
radially from the center to the periphery, becoming bigger. This radial movement of the stationary objects is
called “optic flow”.4 If a car is running at the same speed
as his car, it looks stationary. For this patient driving a
car, the parked car might not have moved radially like
other objects, and it made him feel that it was moving forward. In that sense, his symptom is akinetopsia. Two
types of akinetopsia are known: cinematographic vision
and invisibility of moving objects.5 Akinetopsia results
from disturbance of MT/V5. Thirdly, human neuroimaging studies have demonstrated that the ventral intraparietal area is the most likely candidate for the area that

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why other stationary objects in his left visual field did not
show cinematographic vision was unclear. However, in
the case of epileptic kinetopsia, automatic motion was
limited to some objects in the field, not all objects move
spontaneously.1,2

References

Figure 1. Diffusion-weighted magnetic resonance images of the patient’s
brain. Fresh infarction is detected in the right frontal lobe and temporooccipital lobe. The latter (arrowheads) is considered associated with the
patient’s complaint.

integrates visual information related to self-motion and
vestibular information.4 However, his infarctions were
located at the right temporo-occipital lobe involving MT/
V5. Taken together, the patient’s symptom on driving
indicates transient cinematographic vision. The reason

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