Complex visual hallucinations in a Parkinson patient: don't blame James if it's Charles's fault

2012 ◽  
Vol 25 (3) ◽  
pp. 505-506
Author(s):  
Kurt Segers
Keyword(s):  
Visual Impairment ◽  
Vision Loss ◽  
Peripheral Vision ◽  
Visual Hallucinations ◽  
Impaired Vision ◽  
Charles Bonnet Syndrome ◽  
History Of ◽  
Potential Alternative ◽  
Parkinson Patient ◽  
History Of Parkinson’S Disease

ABSTRACTA patient with a history of Parkinson's disease and severe bilateral peripheral vision loss due to vitreous hemorrhages had complex visual hallucinations that persisted for three days and appeared every morning on awakening. The persistent nature of these hallucinations, the patient's preserved insight, and the presence of severe visual impairment was suggestive for Charles Bonnet syndrome rather than Parkinson-related hallucinations. A treatment with carbamazepine was started and proved to be successful. Physicians treating Parkinson patients should be familiar with Charles Bonnet syndrome and consider it as a potential alternative etiology for visual hallucinations, especially when the patient has severely impaired vision and when the hallucinations are sustained during wakefulness.

Charles bonnet syndrome (CBS): Successful treatment of visual hallucinations due to vision loss with trazodone in three cases

2011 ◽  
Vol 26 (S2) ◽  
pp. 378-379 ◽  
Author(s):  
H.C. Hsu ◽  
T.C. Chen ◽  
Y.S. Huang ◽  
W.X. Fan
Keyword(s):  
Visual Impairment ◽  
Vision Loss ◽  
Low Vision ◽  
Body Weight Gain ◽  
The Elderly ◽  
Visual Hallucinations ◽  
Charles Bonnet Syndrome ◽  
Lower Body Weight ◽  
Number Of Patients ◽  
Image Position

BackgroundCBS becomes more prevalent as the population ages and the number of patients with low vision increases. Clinical features of CBS have been described as complex visual hallucinations with insight due to the vision loss or visual ability decrease in patients who’re otherwise mentally normal. We describe three typical CBS patients whose visual hallucinations developed after bilateral severe visual impairment due to diabetic retinopathy. They responded well to treatment with trazodone. The effectiveness of trazodone in these patients adds to evidence implicating serotonergic pathways in the pathogenesis of visual hallucinations.Case reportThe characteristics of 3 patients and their reactions are listed in table 1.DiscussionThis is the first report describing the effectiveness of trazodone in treating typical CBS patients. It indicates that trazodone is an safer option for the treatment of CBS, especially in the elderly, diabetic population. In addition to having fewer interactions with comedications, trazodone has fewer adverse effects and relative lower body weight gain risk compared to anticonvulsants and neuroleptics. CBS is a condition that many clinicians aren’t very familiar with, yet it’s a surprisingly high prevalence rate (10%-30%) among the visually impaired. Clinicians must therefore keep in mind and ask elderly people with visual impairment whether they’ve hallucinations.

Charles Bonnet Syndrome (CBS): Successful Treatment of Visual Hallucinations Due to Vision Loss with Agomelatine in Three Cases

2017 ◽  
Vol 41 (S1) ◽  
pp. S172-S172 ◽  
Author(s):  
H.C. Hsu ◽  
Y.S. Huang ◽  
W.X. Fan ◽  
T.C. Chen
Keyword(s):  
Visual Impairment ◽  
Vision Loss ◽  
Psychiatric Symptoms ◽  
Elderly Person ◽  
The Elderly ◽  
Visual Hallucinations ◽  
Charles Bonnet Syndrome ◽  
Competing Interest ◽  
Guilty Feeling ◽  
The Individual

BackgroundCBS becomes more prevalent as the population ages. CBS is characterized by the triad of impairment of vision, complex visual hallucinations with insight, mentally normal people. Although visual hallucinations in the elderly are often associated with dementia with Lewy body, Alzheimer's disease and delirium, they are excluded from the diagnosis of typical CBS. Here, we describe three typical CBS patients whose visual hallucinations developed after bilateral severe visual impairment due to diabetic retinopathy. The effectiveness of agomelatine adds to evidence implicating serotonergic and melatoninergic pathways in the pathogenesis of visual hallucinations.Case reportThe average age of these three patients (2 males and 1 female) is 71. Except for the visual hallucinations, all patients showed no psychiatric symptoms or cognitive decline or neurological focal signs. They were frequently upset by the fact of hallucinating, fearing that they are losing their minds. They lived in fear of impending insanity, guilty feeling, unhappy mood, insomnia. The frequency of visual hallucinations stopped with agomelatine 25 mg/day for 3 weeks in these cases.DiscussionTo our knowledge, this is the first report describing the effectiveness of agomelatine in treating typical CBS patients and indicates that agomelatine is an safer option for the treatment of CBS, especially in the elderly, diabetic population. Therapeutic options for CBS still remain poor and of uncertain benefit for the individual patient. CBS has a high prevalence rate (0.4%–30%) among the visually impaired. Clinicians must ask elderly people with visual impairment whether they have hallucinations. Firm reassurance that the syndrome is not related to mental illness is a major relief to an elderly person burdened already with failing vision.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Charles Bonnet syndrome: Successful treatment of visual hallucinations due to vision loss with Yi-gan san

2009 ◽  
Vol 33 (2) ◽  
pp. 382-383 ◽  
Author(s):  
Tsuyshi Miyaoka ◽  
Michiharu Nagahama ◽  
Keiko Tsuchie ◽  
Maiko Hayashida ◽  
Akira Nishida ◽  
...  
Keyword(s):  
Successful Treatment ◽  
Vision Loss ◽  
Visual Hallucinations ◽  
Charles Bonnet Syndrome

scholarly journals Visual hallucinatory syndromes: past, present, and future

2007 ◽  
Vol 9 (2) ◽  
pp. 173-189 ◽  
Keyword(s):  
Clinical Significance ◽  
Current Approach ◽  
Visual Illusions ◽  
The Other ◽  
Visual Hallucinations ◽  
Charles Bonnet Syndrome ◽  
Relevant Today ◽  
History Of

In 1936, two clinical reviews, one by de Morsier, the other by L'Hermitte and de Ajuriaguerra, formulated an approach to visual hallucinations that continues to this day. Breaking with previous traditions, the papers championed visual hallucinations as worthy of study in their own right, de-emphasizing the clinical significance of their visual contents and distancing them from visual illusions. De Morsier described a set of visual hallucinatory syndromes based on the wider neurological and psychiatric context, many of which remain relevant today; however, one-the Charles Bonnet Syndrome-sparked 70 years of controversy over the role of the eye. Here, the history of visual hallucinatory syndromes and the eye dispute is reviewed, together with advances in perceptual neuroscience that question core assumptions of our current approach. From a neurobiological perspective, three syndromes emerge that relate to specific dysfunctions of afferent, cholinergic and serotonergic visual circuitry and promise future therapeutic advances.

scholarly journals Charles bonnet syndrome due to cerebral venous thrombosis

2020 ◽  
pp. 8
Author(s):  
Rafaela Ianisky ◽  
Thaise Wrubleski ◽  
Jean Tafarel ◽  
Maria Figueroa Magalhães ◽  
Vitor Dias
Keyword(s):  
Venous Thrombosis ◽  
Cerebral Venous Thrombosis ◽  
Vision Loss ◽  
Cortical Lesion ◽  
Psychotic Symptoms ◽  
Magnetic Resonance Imaging Scan ◽  
Visual Hallucinations ◽  
Charles Bonnet Syndrome ◽  
First Case ◽  
The Right

IntroductionCharles Bonnet Syndrome (CBS) is characterized by visual hallucinations, preserved awareness of unreal visions and absence of psychotic symptoms. There are limited cases reported on CBS after ischemic stroke and just one describing CBS due to cerebral venous thrombosis (CVT). Our aim is to describe the clinical course of the first case of CBS after CVT without optic nerve atrophy or vision loss in a patient admitted with intense headache and acute onset of visual hallucinations. The patient has signed the consent form and were only used the medical records for the case.Case ReportA fifty-nine years old healthy man was admitted with complaints of recurrent episodes of headache in the last month and subsequent visual hallucinations, specifically prosopometamorphopsia - he reported seeing distorted images of faces and objects -. It was not associated with any sensory or motor complaints. General medical and neurological examination on admission was intact. He had no meningismus. Blood work revealed an alteration in C-reactive protein and cerebrospinal revealed lymphocytic pleocytosis. Brain computed tomography scan showed an ill-defined hypodense cortical lesion in the right temporal and occipital region. Magnetic resonance imaging scan confirmed the presence of a cerebral venous thrombosis in the right sigmoid and transverse sinuses. He was treated with heparin followed by warfarin, but the visual hallucinations remained. It was opted to start corticosteroid. The patient had excellent recovery a few weeks after admission and was regularly followed up. Later, he was found to be positive for the mutation in the prothrombin gene.ConclusionsCerebral venous thrombosis can be presented with different neurological symptoms but does not typically present with hallucinations. For this reason, illusions should be added to the already broad spectrum of presenting features of CVT. This diagnosis may be, still, considered in patients presenting with new auditory hallucinations and illusions, particularly in the context of accompanying headache and conventional risk factors for venous thrombosis.

Looking at Charles Bonnet Syndrome: Prevalence and Experiences of Patients Attending a Vision Rehabilitation Clinic

2018 ◽  
Vol 112 (5) ◽  
pp. 488-496 ◽  
Author(s):  
Lisa M. Ord ◽  
Amy Henderson ◽  
Robert M. Christiansen
Keyword(s):  
Vision Loss ◽  
Visual Impairments ◽  
Anticholinergic Medication ◽  
Visual Hallucinations ◽  
Professional Literature ◽  
Living Situation ◽  
Charles Bonnet Syndrome ◽  
Medical Diagnoses ◽  
Vision Rehabilitation ◽  
Rehabilitation Clinic

Introduction The objective of this study was to determine the prevalence of Charles Bonnet syndrome in a population of patients seen in a vision rehabilitation clinic and to gain deeper insight into the content of visual hallucinations that are experienced. Methods This investigation was a retrospective review of medical record vision rehabilitation evaluations from 100 adult patients who were seen consecutively in a vision rehabilitation clinic. Data collected included age, gender, eye condition, current medications, other medical diagnoses, current living situation, and responses to questions about Charles Bonnet syndrome symptomatology. Results Eight participants were excluded from analysis due to diagnosis of cognitive impairment or a current anticholinergic medication. A total of 25.0% (n = 23) of eligible patients with visual impairments reported visual hallucinations that met the definition of Charles Bonnet syndrome. Images of people (35%) were the most common hallucinations reported by participants, followed by images of animals (26%). Discussion The occurrence of this syndrome in our study is near the mid-range of estimated prevalence in the professional literature. Implications for practitioners Individuals with this syndrome are hesitant to disclose that they are experiencing hallucinations for fear of being seen as having dementia or psychosis. An important concept for vision professionals, especially those offering visual rehabilitation, is integrating screening for Charles Bonnet syndrome into their care planning. Demonstrating that the syndrome is not a rare occurrence helps raise awareness of it in people with vision loss, thus explaining it as not so unusual and facilitating a discussion between patients and professionals that will reduce the apprehension that many individuals with visual impairments have that these hallucinations are a sign of more concerning conditions.

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