Complex visual hallucinations (Charles Bonnet syndrome) in visual field defects following cerebral surgery

2004 ◽  
Vol 101 (5) ◽  
pp. 846-853 ◽  
Author(s):  
Thomas M. Freiman ◽  
Rainer Surges ◽  
Vassilios I. Vougioukas ◽  
Ulrich Hubbe ◽  
Jochen Talazko ◽  
...  
Keyword(s):  
Visual Field ◽  
Visual Hallucination ◽  
The Other ◽  
Visual Field Defects ◽  
Neurosurgical Procedures ◽  
Visual Hallucinations ◽  
Content Type ◽  
Charles Bonnet Syndrome ◽  
Fine Print ◽  
Field Defects

✓ The development of visual hallucinations after loss of vision is known as the Charles Bonnet syndrome. This phenomenon was first described in 1760 by Charles Bonnet and others during their observations of elderly patients with degeneration of the retina or cornea. To date a clear association between visual hallucinations and neurosurgical procedures has not been reported. Because of their clear demarcation, however, surgical lesions in the cerebrum offer a unique opportunity to determine the pathoanatomical aspects of visual hallucinations. During a 3-year period, 41 consecutive patients who acquired visual field defects after neurosurgery were examined for the occurrence of visual hallucination. Postoperatively, four of these patients experienced visual hallucinations. In two of them an upper quadrantanopia developed after the patients had undergone selective amygdalohippocampectomy. In the other two patients a complete hemianopia developed, in one case after resection of a parietal astrocytoma and in the other after resection of an occipital glioblastoma multiforme. The visual hallucinations were transient and gradually disappeared between 4 days and 6 months postoperatively. The patients were aware of the fact that their hallucinations were fictitious and displayed no psychosis. Electroencephalographic recordings were obtained in only two patients and epileptic discharges were found. Deafferentiation of cortical association areas may lead to the spontaneous generation of complex visual phenomena. In the present series this phenomenon occurred in approximately 10% of patients with postoperative visual field defects. In all four cases the central optic radiation was damaged between the lateral geniculate nucleus and the primary visual cortex. The complex nature of the visual hallucination indicates that they were generated in visual association areas.

Intracavitary brachytherapy of cystic craniopharyngiomas

1992 ◽  
Vol 77 (4) ◽  
pp. 545-550 ◽  
Author(s):  
J. Herbert van den Berge ◽  
Gerhard Blaauw ◽  
Wout A. P. Breeman ◽  
Ali Rahmy ◽  
Rinia Wijngaarde
Keyword(s):  
Visual Acuity ◽  
Visual Function ◽  
Cyst Formation ◽  
Primary Treatment ◽  
Intracavitary Brachytherapy ◽  
Visual Field Defects ◽  
Content Type ◽  
Fine Print ◽  
Field Defects

✓ Visual function, endocrinological status, and radiological outcome are reported in 31 patients harboring a cystic craniopharyngioma, who underwent 35 intracavitary brachytherapy procedures with yttrium-90. In 26 of these patients intracavitary brachytherapy was the primary treatment. The follow-up period ranged from 2 to 80 months (41 ± 22 months, mean ± standard deviation). Five patients died from tumor-related causes. Endocrine recovery was modest. Prior to brachytherapy, visual acuity was diminished in 38 eyes and field defects were present in 46. Funduscopy before treatment revealed optic atrophy in 47% of the eyes. Visual acuity improved in 29% of the eyes studied, remained stable in 13%, and deteriorated in 58%. Visual field defects improved in 28% of the eyes studied, remained stable in 20%, and deteriorated in 52%. The possible causes for deterioration in visual function are discussed. Complete resolution of 10 cysts was noted. In 12 patients the size of the cyst decreased; however, in three of these patients new cyst formation took place. The cyst size stabilized in six cases and increased in three. Although there is still a substantial degree of visual function deterioration following intracavitary brachytherapy, morbidity is otherwise low, making this treatment modality a reasonable alternative to craniotomy.

scholarly journals Effectiveness of long-term cabergoline treatment for giant prolactinoma: study of 12 men

2007 ◽  
Vol 156 (2) ◽  
pp. 225-231 ◽  
Author(s):  
Ilan Shimon ◽  
Carlos Benbassat ◽  
Moshe Hadani
Keyword(s):  
Visual Field ◽  
The Other ◽  
Serum Prolactin ◽  
Visual Field Defects ◽  
First Line ◽  
Giant Prolactinoma ◽  
First Line Therapy ◽  
Line Therapy ◽  
Giant Prolactinomas ◽  
Field Defects

Objective: To review our experience with cabergoline, a D2-selective dopamine agonist, for the treatment of giant prolactinomas. Design: A retrospective case series; descriptive statistics. Methods: The study group included 12 men aged 24–52 years (mean 39.2 years) treated for giant prolactinoma at our centers from 1997 to 2006. Cabergoline was started at a dose of 0.5 mg/three times a week and progressively increased as necessary to up to 7 mg/week. Patients were followed by hormone measurements, sellar magnetic resonance imaging, and visual examinations. Results: In ten patients, cabergoline served as first-line therapy. The other two patients had previously undergone transsphenoidal partial tumor resection because of visual deterioration. Mean serum prolactin level before treatment was 14 393 ± 14 579 ng/ml (range 2047–55 033 ng/ml; normal 5–17 ng/ml). Following treatment, levels normalized in ten men within 1–84 months (mean, 25.3 months) and decreased in the other two to 2–3 times of normal. Tumor diameter, which measured 40–70 mm at diagnosis, showed a mean maximal decrease of 47 ± 21%; response was first noted about 6 months after the onset of treatment. Nine patients had visual field defects at diagnosis; vision returned to normal in three of them and improved in five. Testosterone levels, initially low in all patients, normalized in eight. There were no side effects of treatment. Conclusion: Cabergoline therapy appears to be effective and safe in men with giant prolactinomas. These findings suggest that cabergoline should be the first-line therapy for aggressive prolactinomas, even in patients with visual field defects.

Treatment of intracavernous and giant carotid aneurysms by combined internal carotid ligation and extra- to intracranial bypass

1980 ◽  
Vol 52 (1) ◽  
pp. 1-10 ◽  
Author(s):  
Benjamin R. Gelber ◽  
Thoralf M. Sundt
Keyword(s):  
Blood Flow ◽  
Internal Carotid ◽  
Neurological Deficits ◽  
Visual Field Defects ◽  
Content Type ◽  
Bypass Procedure ◽  
Carotid Aneurysms ◽  
Base Of The Skull ◽  
Fine Print ◽  
Field Defects

✓ Ten patients with intracranial internal carotid artery (ICA) aneurysms were managed by combining ICA ligation with an extracranial to intracranial bypass procedure. Nine of these grafts were proven patent by angiogram. One patient was unable to return for postoperative angiograms; his graft had appeared patent on physical examination. Seven aneurysms were intracavernous, two were giant carotid-ophthalmic aneurysms, and one aneurysm was at the intracranial bifurcation of the ICA. Despite occlusion cerebral blood flow (CBF) measurements of 20 ml/100 gm/min or less in six patients, only one patient was unable to tolerate ICA ligation. Three patients developed transient aphasia, but there were no permanent neurological deficits associated with the carotid occlusion. Seven patients had improvement in pre-existing extraocular palsies or visual field defects. Others remained stable. The combination of an extracranial to intracranial microvascular bypass procedure with ICA ligation seems to be an effective method of treatment for aneurysms near the base of the skull that cannot be obliterated by a direct intracranial approach. The addition of the bypass procedure permits ICA ligation in patients who would not otherwise have tolerated occlusion of that vessel. Intraoperative xenon CBF measurements are an important adjunct to the operation.

Posterior approach for cervical intramedullary arteriovenous malformation with diffuse-type nidus

1999 ◽  
Vol 91 (1) ◽  
pp. 105-111 ◽  
Author(s):  
Kenji Ohata ◽  
Toshihiro Takami ◽  
Alaa El-Naggar ◽  
Michiharu Morino ◽  
Akimasa Nishio ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Poor Prognosis ◽  
Posterior Approach ◽  
The Other ◽  
Anterior Spinal Artery ◽  
Neural Element ◽  
Feeding Artery ◽  
Diffuse Type ◽  
Content Type ◽  
Fine Print

✓ The treatment of spinal intramedullary arteriovenous malformations (AVMs) with a diffuse-type nidus that contains a neural element poses different challenges compared with a glomus-type nidus. The surgical elimination of such lesions involves the risk of spinal cord ischemia that results from coagulation of the feeding artery that, at the same time, supplies cord parenchyma. However, based on evaluation of the risks involved in performing embolization, together with the frequent occurrence of reperfusion, which necessitates frequent reembolization, the authors consider surgery to be a one-stage solution to a disease that otherwise has a very poor prognosis. Magnetic resonance (MR) imaging revealed diffuse-type intramedullary AVMs in the cervical spinal cords of three patients who subsequently underwent surgery via the posterior approach. The AVM was supplied by the anterior spinal artery in one case and by both the anterior and posterior spinal arteries in the other two cases. In all three cases, a posterior median myelotomy was performed up to the vicinity of the anterior median fissure that divided the spinal cord together with the nidus, and the feeding artery was coagulated and severed at its origin from the anterior spinal artery. In the two cases in which the posterior spinal artery fed the AVM, the feeding artery was coagulated on the dorsal surface of the spinal cord. Neurological outcome improved in one patient and deteriorated slightly to mildly in the other two patients. Postoperative angiography demonstrated complete disappearance of the AVM in all cases. Because of the extremely poor prognosis of patients with spinal intramedullary AVMs, this surgical technique for the treatment of diffuse-type AVMs provides acceptable operative outcome. Surgical intervention should be considered when managing a patient with a diffuse-type intramedullary AVM in the cervical spinal cord.

scholarly journals Central Visual Field Defects in Patients with Distinct Glaucomatous Optic Disc Phenotypes

2021 ◽  
Vol 223 ◽  
pp. 229-240
Author(s):  
Eren Ekici ◽  
Sasan Moghimi ◽  
Huiyuan Hou ◽  
James Proudfoot ◽  
Linda M. Zangwill ◽  
...  
Keyword(s):  
Visual Field ◽  
Optic Disc ◽  
Visual Field Defects ◽  
Central Visual Field ◽  
Field Defects
Sign in / Sign up

Export Citation Format

Share Document