March 31, 2020, e-Pearl of the Week: Charles Bonnet syndrome

Charles Bonnet syndrome

Charles Bonnet syndrome presents as visual (release) hallucinations following blindness secondary to ocular (cataract, macular degeneration) and cerebral (space occupying lesion, stroke) pathologies. Patients are around 70–85 years with no history of psychosis or delirium.1 These (release) hallucinations result from disinhibition of visual cortex due to sensory de-afferentation. Differentials include migraine aura, peduncular hallucinosis, Lewy body dementia, and medications side-effects (amantidine, beta blockers, digoxin). Resolution of symptoms depends on the reversibility of the causative factor. Atypical anti-psychotics are used in refractory cases.2

References

  1. Menon GJ, Rahman I, Menon SJ, Dutton GN. Complex visual hallucinations in the visually impaired: the Charles Bonnet Syndrome. Surv Ophthalmol 2003;48:58–72.
  2. Coletti Moja M, Milano E, Gasverde S, Gianelli M, Giordana MT. Olanzapine therapy in hallucinatory visions related to Bonnet syndrome. Neurol Sci 2005;26:168–170.

Maira Aamir, Medical Graduate, Shifa College of Medicine (Islamabad, Pakistan) and Faisal Khan, MD, DABSM, DABPN, Consultant Neurologist, Sugar Land Neurology and Sleep (Sugar Land,Texas)

Maira Aamir and Dr. Faisal Khan report no disclosures.