Charles Bonnet Syndrome Associated With Recurrent Hypertensive Crisis

Abstract

Charles Bonnet syndrome (CBS) is a disorder of visual hallucinations in psychologically normal patients with ocular disease or damage to visual pathways. The etiology of CBS is not fully understood. It is associated with various triggers, with age-related macular degeneration the most common; other triggers are systemic diseases such as stroke, multiple sclerosis, and anemia as well as lighting issues, fatigue, and medical or surgical eye treatments. Visual disturbances such as decreased visual acuity, visual field deficits, or visual hallucinations are common in association with hypertensive encephalopathy. We describe a patient with episodic CBS triggered by recurrent hypertensive crises, which resolved with blood pressure management in the hospital setting.

Commentary: Psychiatric Symptoms Related to Somatic Illness

“…Balsara et al2 present a case of an 81-year-old man with no known psychiatric history and a medical history significant for poorly controlled hypertension, type 2 diabetes, and multiple ophthalmic issues who presented to the emergency room with visual hallucinations of figures and faces which he did not report as distressing. Psychiatry was consulted.…”

“…In this issue, we present two cases of hallucinations due to nonpsychiatric causes, including a case of a semicircular canal dehiscence causing auditory hallucinations 1 and a case of visual hallucinations in Charles Bonnet syndrome caused by hypertensive episodes. 2 Kasle et al 1 report on a 42-year-old man who presented with auditory disturbances accompanied by vertigo and tinnitus. He had a significant psychiatric history of severe posttraumatic stress disorder, traumatic brain injury, and depression and suicidality and was medicated with sertraline (100 mg/d), quetiapine (100 mg/night), and clonidine (0.1 mg twice daily).…”

“…In reality, however, patients with visual hallucinations and even auditory hallucinations may have an underlying organic disease that is causing the symptoms. In this issue, we present two cases of hallucinations due to nonpsychiatric causes, including a case of a semicircular canal dehiscence causing auditory hallucinations1 and a case of visual hallucinations in Charles Bonnet syndrome caused by hypertensive episodes 2…”