Charles Bonnet syndrome: characteristics of its visual hallucinations and differential diagnosis

Abstract

Objective: To present an eight-case serie of patients with Charles Bonnet syndrome (CBS). Method: All patients were initially evaluated by an ophthalmologist and then submitted to a neurologic evaluation with exclusion of alternative psychiatric and neurologic diagnoses. Results: Five patients were male (62.5%) and the mean age was 52.3+16.0 years. Two patients suffered from severe myopia and glaucoma, three had retinitis pigmentosa, one had anterior ischemic optic neuropathy, one had age-related macular degeneration and one had toxoplasmic retinochoroiditis. Mean visual acuity in the right eye was 1,12 logMAR and in the left eye 0.57 logMAR. A mean delay of 41.7 months occurred until diagnosis. All hallucinations were complexes and mostly ocurred on a weekly-basis (62.5%) and lasted for seconds (87.5%). Conclusions: Physicians who care for low vision patients should be aware of CBS and appropriately diagnose its hallucinations after exclusion of psychiatric and neurologic diseases.Keywords: Charles Bonnet syndrome, visual hallucinations, sensory hallucinations, dementia, low vision. RESUMOObjetivo: Apresentar uma série de oito casos da síndrome de Charles Bonnet (SCB). Método: Todos os pacientes foram avaliados por um oftalmologista e por um neurologista, tendo sido excluídos diagnósticos alternativos neurológicos e psiquiátricos. Resultados: Cinco pacientes eram homens (62,5%) e a média de idade foi de 52,3±16,0 anos. Do total de pacientes: dois tinham miopia grave e glaucoma, três retinose pigmentar, um neuropatia óptica isquêmica anterior, um degeneração macular relacionada à idade e um retinocoroidite toxoplásmica. A acuidade visual média no olho direito foi de 1,12 logMAR e no olho esquerdo foi de 0.57 logMAR. Houve um atraso de 41,7 meses, em média, para o diagnóstico. Todas as alucinações eram complexas, ocorriam, em sua maioria, semanalmente (62,5%) e duravam segundos (87,5%). Conclusão: Médicos que lidam com pacientes com baixa visão devem saber distinguir as características peculiares da SCB, após exclusão de doenças neurológicas e psiquiátricas.Palavras-chave: síndrome de Charles Bonnet, alucinações visuais, alucinações sensoriais, demência, baixa visão.

Visual Hallucinations in an Old Patient after Cataract Surgery and Treatment

“…A single photon emission computed tomography study showed occurring hyperperfusion areas in the lateral temporal cortex, striatum and thalamus during the hallucinations [11]. In differential diagnoses of CBS, many aetiologies (drugs, uraemia, toxic materials, neurodegenerative and psychiatric conditions) need to be ruled out [5]. In the literature, individuals having visual hallucinations after different ophthalmologic surgeries [12,13] have been reported.…”

“…Visual hallucinations may occur in a wide-range of organic and psychiatric conditions such as eye diseases, Alzheimer's disease, Parkinson's disease, Dementia with Lewy Bodies, delirium, sensory and sleep deprivation, psychosis and migraine [1,2]. Between 10% and 60% of the patients having age-related eye diseases involving retina, cornea and the lens, commonly with macular degeneration experience complex visual hallucinations depending on the severity of visual problems [3][4][5]. Sensory visual pathologies, accompanying simple or complex visual hallucinations that occur in visually-impaired individuals due to ophthalmologic or brain pathologies related to visual pathways in mentally normal individuals, are defined as Charles Bonnet syndrome (CBS) [5,6].…”

“…Between 10% and 60% of the patients having age-related eye diseases involving retina, cornea and the lens, commonly with macular degeneration experience complex visual hallucinations depending on the severity of visual problems [3][4][5]. Sensory visual pathologies, accompanying simple or complex visual hallucinations that occur in visually-impaired individuals due to ophthalmologic or brain pathologies related to visual pathways in mentally normal individuals, are defined as Charles Bonnet syndrome (CBS) [5,6]. Here we report an 83-year-old female, who was referred to our psychiatry outpatient clinic by the department of ophthalmology, with the complaint of permanently seeing burning candles in the visual field of both eyes that emerged after having a left eye cataract surgery.…”

Charles BonnetSyndrome: A Case Report (Turkish)

“…CBS'de görme varsanýlarýný açýklayan nörofizyoloji aydýnlatýlamamýþtýr (15). Güncel olarak kabul edilen teori: görme kaybýnýn, görme assosiasyon korteksinde görsel duyusal deafferentasyonuna yol açtýðýný ve bunun da disinhibisyona ve daha sonra da görsel kortikal bölgelerin spontan ateþlemesine neden olduðudur (15).…”

“…Güncel olarak kabul edilen teori: görme kaybýnýn, görme assosiasyon korteksinde görsel duyusal deafferentasyonuna yol açtýðýný ve bunun da disinhibisyona ve daha sonra da görsel kortikal bölgelerin spontan ateþlemesine neden olduðudur (15). Görsel bilgi (input) yokluðundaki beyin aktivitesi, hayali uzuv veya hayali aðrý (phantom) sendromlarýna benzetilmiþtir (15 …”