Three Cases with Visual Hallucinations following Combined Ocular and Occipital Damage

Abstract

Charles Bonnet syndrome is an underrecognized disease that involves visual hallucinations in visually impaired patients. We present the cases of three patients who experienced complex visual hallucinations following various pathomechanisms. In two cases, diagnosis showed coexistence of occipital lobe damage with ocular damage, while in the third case it showed occipital lobe damage with retrobulbar optic neuritis. Theories of pathogenesis and the neuroanatomical basis of complex visual hallucinations are discussed and supported by literature review.

Melatonin-Responsive Complex Nocturnal Visual Hallucinations

“…Complex visual hallucinations have been described in a number of conditions, including visual impairment (Charles-Bonnet syndrome, seen with macular degeneration, cataracts, diabetic retinopathy, glaucoma, etc. ), 2,3 brainstem disorders (peduncular hallucinosis), parietal 4 and occipital lobe lesions, 5 neurodegenerative conditions such as treated Parkinson and untreated Lewy body dementia, 1 epilepsy, 6 psychiatric conditions such as schizophrenia, 7 with medication use (especially beta blockers and dopaminergic agents), and with alcohol and hallucinogen use. 7,8 Although hallucinations in most of these conditions occur during both day and night (with a tendency to occur during situations of low illumination in Charles Bonnet syndrome), the term "complex nocturnal visual hallucinations" generally refers to hallucinations occurring exclusively or predominantly at night, usually during periods of abrupt awakening from sleep; the third edition of the International Classification of Sleep Disorders classifies them as a parasomnia.…”

Benefit of psychiatric evaluation on anxiety in patients with Charles Bonnet syndrome

“…Open access or figures), repetitive and disappear when the eyes are closed, and there are no hallucinations affecting other sensory modalities. [5][6][7][8][9][10][11][12][13] The current literature states that there are many different hypotheses about pathophysiology of CBS. VH may result from disorders in the visual cortex, visual perceptual disorders, overactivity in cortical areas or ageing.…”

“…[2][3][4][5][6] Georges des Morsier gave the name 'Charles Bonnet syndrome' (CBS) to VH, which occur in elderly, mentally fit patients. 6 Much later, different authors suggested that VH in patients with CBS occur due to vision loss caused by ophthalmological diseases, such as age-related macular degeneration (AMD), other retinal diseases, cataract or glaucoma. 4 5 7 Literature about CBS shows a large scale of diagnostic, inclusion and exclusion criteria.…”