Charles Bonnet syndrome as first manifestation of occipital infarction

2022 ◽  
pp. 112067212110697
Author(s):  
Marta Isabel Martínez-Sánchez ◽  
Gema Bolívar
Keyword(s):  
Visual Acuity ◽  
Visual Field ◽  
Field Tests ◽  
Visual Field Loss ◽  
Visual Hallucinations ◽  
Correct Treatment ◽  
Cerebral Magnetic Resonance Imaging ◽  
Full Field ◽  
Charles Bonnet Syndrome ◽  
The Right

Purpose To describe a case of Charles Bonnet syndrome as the first manifestation of occipital infarction in a patient with preserved visual acuity. Observations We report a 78-year-old man followed in our department with a two-month-long history of visual hallucinations based on the vision of flowers and fruits intermittently, being perceived as unreal images. Best-corrected visual acuity was stable in the follow-up time being 20/20 in the right eye and 20/25 in the left eye. Extraocular muscle function testing, pupillary reflexes, biomicroscopy, fundus and optical coherence tomography examinations did not reveal any interesting findings. In order to rule out occipital pathology, orbital-cerebral magnetic resonance imaging was performed, showing an image compatible with the chronic ischemic right occipital lesion. The patient was diagnosed with Charles Bonnet syndrome secondary to occipital infarction and neurology decided that no treatment was required. 24-2 and 10-2 visual field tests showed no remarkable alterations and Full-field 120 point screening test showed nonspecific peripheral defects. Hallucinations improved over the months, being described as not annoying and increasingly infrequent. Conclusions and Importance Charles Bonnet syndrome is a condition characterized by the presence of recurrent and complex visual hallucinations in patients with visual pathway pathologic defects. Visual acuity or visual field loss is not a requirement for diagnosis. Charles Bonnet syndrome should be suspected in all patients with non-disturbing visual hallucinations, even though they present good visual acuteness. It will be essential to perform complementary explorations to identify the underlying pathology that allows the starting of a correct treatment option.

A Case Report of Charles Bonnet Syndrome – The Silent Doubt: Am i Crazy?

2016 ◽  
Vol 33 (S1) ◽  
pp. S471-S471
Author(s):  
A. Lopes ◽  
P. Sales
Keyword(s):  
Visual Acuity ◽  
Psychiatric Symptoms ◽  
Correct Diagnosis ◽  
Visual Field Loss ◽  
Antipsychotic Agents ◽  
Psychiatric Disease ◽  
Visual Hallucinations ◽  
Charles Bonnet Syndrome ◽  
Ophthalmologic Examination ◽  
Competing Interest

IntroductionThe Charles Bonnet syndrome refers to symptoms of visual hallucinations that occur in patients with visual acuity or visual field loss. These are often called release hallucinations, reflecting the most widely accepted theory about their pathogenesis. The syndrome is most found in elderly patients, 70–85 years, and this probably reflect the mean age at which the most common underlying conditions are seen. It is probably more common than is thought and because either it is misdiagnosed as psychosis and/or dementia or it is not reported by patients because they fear that the hallucinations represent psychiatric disease.Objective and methodThe authors present the clinical case of a 89-year-old woman, with no previous psychiatric disease, admitted to hospital because of visual hallucinations in form of children and animals. She experienced them during months until she told someone. No psychiatric symptoms were found. The lady had a serious cataract on the left eye with total loss of the visual acuity, as documented by ophthalmologic examination.ResultsThe patient initiated quetiapine 300 mg and will have period appointments with a neurologist. Further future information will be presented.ConclusionsA correct diagnosis is essential to treat these patients and explaining them the meaning of the hallucinations is generally relieving. Many author disagree with antipsychotic agents, while others report benefit.Disclosure of interestThe authors have not supplied their declaration of competing interest.

scholarly journals Acute Zonal Occult Outer Retinopathy with Atypical Findings

2014 ◽  
Vol 2014 ◽  
pp. 1-7 ◽  
Author(s):  
Dimitrios Karagiannis ◽  
Georgios A. Kontadakis ◽  
Artemios S. Kandarakis ◽  
Nikolaos Markomichelakis ◽  
Ilias Georgalas ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Visual Field ◽  
Clinical Symptoms ◽  
Clinical Findings ◽  
Case Presentation ◽  
Full Field ◽  
Normal Limits ◽  
Corrected Distance Visual Acuity ◽  
Light Rise ◽  
The Right

Background. To report a case of acute zonal occult outer retinopathy (AZOOR) with atypical electrophysiology findings.Case Presentation. A 23-year-old-female presented with visual acuity deterioration in her right eye accompanied by photopsia bilaterally. Corrected distance visual acuity at presentation was 20/50 in the right eye and 20/20 in the left eye. Fundus examination was unremarkable. Visual field (VF) testing revealed a large scotoma. Pattern and full-field electroretinograms (PERG and ERG) revealed macular involvement associated with generalized retinal dysfunction. Electrooculogram (EOG) light rise and the Arden ratio were within normal limits bilaterally. The patient was diagnosed with AZOOR due to clinical findings, visual field defect, and ERG findings.Conclusion. This is a case of AZOOR with characteristic VF defects and clinical symptoms presenting with atypical EOG findings.

scholarly journals Unilateral Visual Loss after a Nasal Airway Surgery

2013 ◽  
Vol 6 ◽  
pp. CCRep.S11158 ◽  
Author(s):  
J. Awad ◽  
A. Awad ◽  
Y. Wong ◽  
S. Thomas
Keyword(s):  
Visual Acuity ◽  
Visual Field ◽  
Current Literature ◽  
Local Anesthetic ◽  
Visual Loss ◽  
Visual Field Loss ◽  
Vascular Supply ◽  
Complication Rates ◽  
Nasal Airway ◽  
The Right

Septoplasty and turbinoplasty are common ear, nose, throat (ENT) operations which generally have low complication rates. A 45-year-old man had a septoplasty operation and a right turbinoplasty operation under a combined general and local anesthetic. He woke from the procedure with a reduced visual acuity in the right eye and substantial inferior visual field loss. A review of the current literature focuses on the vasospasm effects of local anesthetic, in combination with epinephrine on the intricately linked nasal and orbital vascular supply.

scholarly journals Clinical Phenotype of PDE6B-Associated Retinitis Pigmentosa

2021 ◽  
Vol 22 (5) ◽  
pp. 2374
Author(s):  
Laura Kuehlewein ◽  
Ditta Zobor ◽  
Katarina Stingl ◽  
Melanie Kempf ◽  
Fadi Nasser ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Genetic Testing ◽  
Retinitis Pigmentosa ◽  
Fundus Autofluorescence ◽  
Retinal Disease ◽  
New Drugs ◽  
Autofluorescence Imaging ◽  
Full Field ◽  
Tertiary Referral Center ◽  
The Right

In this retrospective, longitudinal, observational cohort study, we investigated the phenotypic and genotypic features of retinitis pigmentosa associated with variants in the PDE6B gene. Patients underwent clinical examination and genetic testing at a single tertiary referral center, including best-corrected visual acuity (BCVA), kinetic visual field (VF), full-field electroretinography, full-field stimulus threshold, spectral domain optical coherence tomography, and fundus autofluorescence imaging. The genetic testing comprised candidate gene sequencing, inherited retinal disease gene panel sequencing, whole-genome sequencing, and testing for familial variants by Sanger sequencing. Twenty-four patients with mutations in PDE6B from 21 families were included in the study (mean age at the first visit: 32.1 ± 13.5 years). The majority of variants were putative splicing defects (8/23) and missense (7/23) mutations. Seventy-nine percent (38/48) of eyes had no visual acuity impairment at the first visit. Visual acuity impairment was mild in 4% (2/48), moderate in 13% (6/48), and severe in 4% (2/48). BCVA was symmetrical in the right and left eyes. The kinetic VF measurements were highly symmetrical in the right and left eyes, as was the horizontal ellipsoid zone (EZ) width. Regarding the genetic findings, 43% of the PDE6B variants found in our patients were novel. Thus, this study contributed substantially to the PDE6B mutation spectrum. The visual acuity impairment was mild in 83% of eyes, providing a window of opportunity for investigational new drugs. The EZ width was reduced in all patients and was highly symmetric between the eyes, making it a promising outcome measure. We expect these findings to have implications on the design of future PDE6B-related retinitis pigmentosa (RP) clinical trials.

scholarly journals Novel Pathogenic Sequence Variants in NR2E3 and Clinical Findings in Three Patients

Genes ◽  
2020 ◽  
Vol 11 (11) ◽  
pp. 1288
Author(s):  
Saoud Al-khuzaei ◽  
Suzanne Broadgate ◽  
Stephanie Halford ◽  
Jasleen K. Jolly ◽  
Morag Shanks ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Visual Field ◽  
Visual Fields ◽  
Visual Field Loss ◽  
Clinical Findings ◽  
Sequence Variants ◽  
Childhood Onset ◽  
Distinctive Features ◽  
Targeted Ngs ◽  
Clinical Records

A retrospective review of the clinical records of patients seen at the Oxford Eye Hospital identified as having NR2E3 mutations was performed. The data included symptoms, best-corrected visual acuity, multimodal retinal imaging, visual fields and electrophysiology testing. Three participants were identified with biallelic NR2E3 pathogenic sequence variants detected using a targeted NGS gene panel, two of which were novel. Participant I was a Nepalese male aged 68 years, and participants II and III were white Caucasian females aged 69 and 10 years old, respectively. All three had childhood onset nyctalopia, a progressive decrease in central vision, and visual field loss. Patients I and III had photopsia, patient II had photosensitivity and patient III also had photophobia. Visual acuities in patients I and II were preserved even into the seventh decade, with the worst visual acuity measured at 6/36. Visual field constriction was severe in participant I, less so in II, and fields were full to bright targets targets in participant III. Electrophysiology testing in all three demonstrated loss of rod function. The three patients share some of the typical distinctive features of NR2E3 retinopathies, as well as a novel clinical observation of foveal ellipsoid thickening.

Association of Cogan-Reese Syndrome, Exfoliation Syndrome, and Secondary Open-Angle Glaucoma

2011 ◽  
Vol 22 (1) ◽  
pp. 117-120 ◽  
Author(s):  
Gábor Holló ◽  
Péter Kóthy ◽  
Anastasios G.P. Konstas
Keyword(s):  
Case Report ◽  
Visual Field ◽  
Open Angle Glaucoma ◽  
Visual Field Loss ◽  
Caucasian Woman ◽  
Exfoliation Syndrome ◽  
Open Angle ◽  
First Case ◽  
Visual Field Damage ◽  
The Right

Purpose To present a case with co-existence of Cogan-Reese syndrome and exfoliation syndrome. Case report A 72-year-old Caucasian woman presented for consultation due to uncontrolled intraocular pressure (IOP) of the right eye. Clinical examination revealed the presence of Cogan-Reese syndrome and exfoliation syndrome OD. This eye exhibited elevated IOP, open anterior chamber angle, advanced glaucomatous optic nerve head damage, and severe glaucomatous visual field loss. The left eye was completely normal without IOP elevation or visual field damage. To our knowledge this is the first case report demonstrating the coexistence of the Cogan-Reese syndrome, exfoliation syndrome, and secondary open-angle glaucoma. Since both syndromes frequently lead to secondary open-angle glaucoma, it is not feasible to determine with certainty which condition was the cause of secondary open-angle glaucoma in our case. It is conceivable that both conditions contributed to glaucoma development. Conclusions Cogan-Reese syndrome, exfoliation syndrome and secondary open-angle glaucoma may present on the same eye.

Letter Structure Factors in the Recognition of Alphabetical Arrays Presented in the Right and Left Visual Fields

1970 ◽  
Vol 31 (2) ◽  
pp. 555-559
Author(s):  
Robert Fudin
Keyword(s):  
Visual Acuity ◽  
Visual Field ◽  
Visual Fields ◽  
Structure Factors ◽  
The Right

Six-letter nonsense arrays made up of the letters H N Z D W J were tachistoscopically exposed either to the right or left of fixation at four displacements to 20 Ss. Structurally similar letters (i.e., the H and N) tended to be recognized with greater difficulty than dissimilar items. Following certain ideas about scanning (Fudin, 1969), the possible effect of letter structure was investigated separately in the first half of targets (letters 1, 2, and 3) and in the last half. This effect was almost exclusively limited to the array-half at each displacement which, because of its position in the visual field, fell in an area of greater visual acuity. Further research concerning the influence of letter structure upon recognition whenever stimuli are briefly presented seems warranted.

scholarly journals Stage of glaucoma damage before the surgery

2019 ◽  
Vol 147 (5-6) ◽  
pp. 360-363
Author(s):  
Nikola Babic ◽  
Aleksandar Miljkovic ◽  
Sava Barisic ◽  
Vladimir Canadanovic
Keyword(s):  
Visual Acuity ◽  
Visual Field ◽  
Data Collection ◽  
Open Angle Glaucoma ◽  
Visual Field Loss ◽  
Median Number ◽  
Open Angle ◽  
Data Collection Sheet ◽  
Clinical Center ◽  
Novi Sad

Introduction/Objective. The aim of study was to collect information about factors related to glaucoma damage at the time of surgery in Novi Sad, Vojvodina province, Serbia. Methods. Retrospective data collection on filtrating procedures of 38 patients with open-angle glaucoma was performed. The study was done at the University Eye Clinic, Clinical center of Vojvodina, Serbia between July 2011 and December 2014. The following variables were collected from a data collection sheet at last visit for each patient: age, sex, best-corrected visual acuity (BCVA), visual field indices (MD and PSD), number of active antiglaucoma drugs, glaucoma type, and surgical procedures. Results. The mean age was 66.21 ? 17.92 years. Among patients, 57% were female and 43% were male. Primary open angle glaucoma (POAG) was found in 60% (23/38), pseudoexfoliative glaucoma (XFG) in 37% (14/38) of patients. The median number of active antiglaucoma drugs was 2.73, ranging 1?4. More than 90% of patients were on two or more medications before surgery. Mean BCVA was 0.64 ? 0.68 and oscillated 0.1?1 (according to Snellen). IOP on last visit before surgery varied 15?42 mmHg (mean IOP 26.11 ? 13.20 mmHg). Visual filed index MD showed minor and highest absolute values from -0.82-35.25 dB (mean MD -18 dB ? 19.15). All patients had trabeculectomy with Mitomycin C procedures. Conclusion. Our survey found that the level of damage is advanced in terms of visual field loss. In most patients (52.63%), visual acuity was well preserved. POAG and XFG are the most frequent diagnosis. Women and elderly population were represented in higher number in our study. Level of IOP suggests a trend to make a surgical decision at higher pressure regardless the stage of glaucoma damage.

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