ABSTRACT
Charles Bonnet syndrome(CBS)refers to hallucinations resulting from visual pathway damage in individuals without neuropsychiatric disorders. CBS patients typically have insight into the unreality of their hallucinations, and the disorder may be episodic, periodic, or chronic. The condition's prevalence varies from 0.4% to 30% due to the absence of agreed diagnostic criteria for CBS and some patients' reluctance to acknowledge hallucinations. Massive studies have demonstrated an association between CBS and ocular diseases, such as age-related macular degeneration and glaucoma. Additionally, there have been reports of CBS occurring after ophthalmic surgery or medication. Therefore, clinicians should be vigilant in diagnosing CBS promptly and reassuring patients. There is a lack of literature on CBS in ophthalmology, and further research is needed to explore its pathogenesis and diagnostic and therapeutic options. This article reviews some of the studies related to CBS in recent years.
ABSTRACT
La alucinosis peduncular es el término utilizado para describir una forma rara de alucinaciones visuales complejas, vívidas, coloridas y generalmente recurrentes que ocurren en relación a lesiones del tronco encefálico y el tálamo. Es una patología infrecuente y su fisiopatología es controvertida. Describimos el caso de una mujer de 38 años con alucinosis peduncular asociada a compresión extrínseca del tronco encefálico secundaria a un schwannoma vestibular. Analizamos las características clínicas y los mecanismos fisiopatológicos subyacentes.
Peduncular hallucinosis is a clinical condition characterized by vivid, colorful, complex visual hallucinations that often recur in time and are described in association with midbrain and thalamic lesions. It is a rare phenomenon and its precise pathophysiology is unknown. We describe the case of a 38-year-old woman who developed peduncular hallucinosis in relation to extrinsic compression of the midbrain secondary to a vestibular schwannoma. Clinical features and underlying pathophysiological mechanisms are discussed.
A alucinose peduncular é o termo usado para descrever uma forma rara de alucinações visuais complexas, vívidas, coloridas e geralmente recorrentes que ocorrem em relação às lesões do tronco encefálico e do tálamo. É uma patologia infreqüente e sua fisiopatologia é controversa. Descrevemos o caso de uma mulher de 38 anos de idade com alucinose peduncular associada à compressão extrínseca do tronco encefálico secundária ao schwannoma vestibular. Analisamos as características clínicas e os mecanismos fisiopatológicos subjacentes.
Subject(s)
Humans , Female , Adult , Visual Pathways/physiopathology , Brain Stem/physiopathology , Neuroma, Acoustic/complications , Hallucinations/etiology , Neuroma, Acoustic/diagnostic imaging , Constriction, Pathologic/complicationsABSTRACT
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. .
Objetivo: 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. .
Subject(s)
Adult , Aged, 80 and over , Female , Humans , Male , Middle Aged , Hallucinations/diagnosis , Vision Disorders/diagnosis , Diagnosis, Differential , Hallucinations/physiopathology , Macular Degeneration/diagnosis , Macular Degeneration/physiopathology , Risk Factors , Syndrome , Time Factors , Visual Acuity , Vision Disorders/physiopathologyABSTRACT
El síndrome de Charles Bonnet constituye un trastorno muy poco reportado. En Cuba, que se conozca, no hay referencia de casos publicados hasta este momento. Se caracteriza por la presencia de alucinaciones visuales complejas en individuos con pérdida visual, mentalmente sanos y con conciencia crítica de la naturaleza irreal de sus alucinaciones. Se presentan cuatro casos con este síndrome relacionados con déficit visual secundario a atrofia óptica...
Charles Bonnet syndrome is an underreported disorder. As far as we know, there are no publicized references in Cuba up to the present time. This syndrome involves complex visual hallucinations in visually impaired individuals, who are mentally healthy and have intact cognition of the unreal nature of their hallucinations...
Subject(s)
Humans , Female , Middle Aged , Hallucinations/physiopathology , Optic Atrophy/complications , Diplopia/diagnosis , Case ReportsABSTRACT
Recent studies have demonstrated that nondemented patients with Parkinson's disease with visual hallucinations had lower scores on frontal-executive tasks than parkinsonian patients without hallucinations, most likely due to defective cholinergic circuitry. The aim of the present study is to investigate whether development of visual hallucinations in patients with Alzheimer's disease may also be related to more severe frontal dysfunctions. In the present study, 36 patients were included who were affected by probable Alzheimer's disease (18 with visual hallucinations and 18 without) and 38 patients affected by idiopathic Parkinson's disease (19 with visual hallucinations and 19 without). Patients completed a neuropsychological test battery and a short questionnaire to collect information about hallucination types and features. Multivariate analysis showed that patients with Alzheimer's disease scored significantly lower than patients with Parkinson's disease and that patients with hallucinations scored significantly lower than patients without hallucinations. Within both the Alzheimer's disease group and the Parkinson's disease group, patients with visual hallucinations scored significantly lower than patients without visual hallucinations, particularly on tests evaluating frontal-executive functions. These results demonstrate that patients with visual hallucinations show a significant impairment on tests tapping frontal-executive functions in Alzheimer's disease, as previously demonstrated (and verified here) in Parkinson's disease. On this basis it seems likely that analogous cognitive mechanisms underlie development of visual hallucinations in both degenerative diseases. Moreover, we may speculate that a defective circuitry of the prefrontal cortex is crucial for the genesis of hallucinations.
Subject(s)
Humans , Alzheimer Disease , Hallucinations , Parkinson Disease , Prefrontal Cortex , Neuropsychological Tests , Surveys and QuestionnairesABSTRACT
A literatura, clássica ou recente, sobre os transtornos de percepção nos idosos é revisada. A utilidade do conceito de Síndrome de Charles Bonnet, um epônimo originalmente proposto para descrever as alucinações visuais nos idosos na ausência de prejuízos cognitivos e de oftalmopatia periférica é contestada, principalmente devido à síndrome ter sido progressivamente ampliada. Descrevemos três casos representativos de pacientes idosos que desenvolveram diferentes tipos de transtornos de percepção visual. Propomos a condução de estudos sistemáticos da frequência de tais transtornos nos idosos e de quais outras patologias, particularmente cognitivas e visuais que possam estar associadas a eles.
A review is presented here of the classical and recent literature on perception disorders in the elderly. The author contests the usefulness of the concept of the Charles Bonnet syndrome, a category first proposed to describe visual hallucinations in elderly persons in the absence of cognitive damage or peripheral ophthalmopathy. This objection is brought up mainly because the concept has been progressively broadened. We describe here three representative cases of elderly patients who developed different types of disorders in visual perception. Systematic studies are now needed on the frequency of such disorders in the elderly and on the question as to what other pathologies, especially of the cognitive and visual type, may be associated with them.
Cet article présente une révision de la littérature classique et récente sur les troubles de la perception des personnes âgées. L'utilité du concept du syndrome de Charles Bonnet, un éponyme proposé à l'origine pour décrire des hallucinations visuelles chez les personnes âgées sans troubles cognitifs, ni d'ophtalmopathie périphérique, est contestée, surtout à partir du fait que ce syndrome a été progressivement élargi. Nous décrivons trois cas représentatifs de patients âgés qui ont développé de différents types de troubles de perception visuelle. Nous suggérons des études systématiques sur la fréquence de ces troubles chez les personnes âgées et sur les autres maladies, en particulier cognitives et visuelles, qui peuvent y être associées.
Se revisa la literatura clásica o reciente sobre los trastornos de percepción en viejos. Se cuestiona la utilidad del concepto de Síndrome de Charles Bonnet, un epónimo, originalmente propuesto para describir las alucinaciones visuales en viejos en ausencia de prejuicios cognitivos y de oftalmopatologia periférica, principalmente por causa de una ampliación progresiva de ese síndrome. Se describen tres casos representativos de pacientes de edad que desarrollaron diferentes tipos de trastornos de la percepción visual. Proponemos la conducción de estudios sistemáticos de la frecuencia de esos trastornos en viejos y de cualquier otras patologias, particularmente cognitivas y visuales que puedan estar asociadas a ese síndrome.
Subject(s)
Humans , Hallucinations , Visual PerceptionABSTRACT
En la medida que crece la población y aumenta el número de personas de la tercera edad con trastornos de la visión, se necesita cada vez más hacer conciencia del Síndrome de Charles Bonnet entre los oftalmólogos, psiquiatras y neurólogos. El propósito de la presente revisión es ofrecer una visión actualizada sobre sus aspectos clínicos, fisiopatológicos, epidemiológicos junto con las estrategias de manejo más razonables. Para ello se emprendió una búsqueda exhaustiva de la literatura más relevante, con el fin de comprender estos aspectos. El síndrome de Charles Bonnet es una entidad subreportada y subdiagnosticada que aparece en personas de la tercera edad, visualmente comprometidas. Estos pacientes por lo general tienen un estado cognoscitivo intacto aunque algunos autores sostienen que puede ser más frecuente en casos de deterioro cognoscitivo leve. Su fisiopatología aún es tema de debate pero las teorías mas aceptadas, hasta el momento, son la teoría de la denervación y el fenómeno de liberación. Los reportes de casos aislados señalan la posibilidad de intervenciones farmacológicas. Sin embargo, asegurar al paciente y tratar la patología visual son las piezas principales del tratamiento, no obstante, se necesitan más investigaciones que permitan aumentar las opciones terapéuticas eficaces.
As population grows, the number of older people with impaired vision does too.That is why ophthalmologists, psychiatrists and neurologists urgently require familiarization with the most important characteristics of Charles Bonnet syndrome. The purpose of this review is to give an update on its clinical aspects, pathophysiology, epidemiology and more reasonable management strategies of this syndrome. Accordingly, we carried out an exhaustive search of the relevant literature, in order to understand these issues. Charles Bonnet syndrome is a sub reported and sub diagnosed entity in visually impaired older people. These patients usually have an intact mental status although some authors claim that may be more common in cases of mild cognitive impairment. Its pathophysiology is still debated but most accepted theories are the deafferentation theory and the phenomenon of liberation. Isolated case reports point to the possibility of pharmacological interventions, however reassuring the patient and treating visual diseases are the main parts of treatment, more research is needed to allow the possibility of effective treatment options.
Subject(s)
Humans , Hallucinations , Denervation , Mentally Ill Persons , Mental Disorders , Vision DisordersABSTRACT
We report a case of a 43-year-old woman with brainstem encephalitis in the third trimester of pregnancy. She presented complex visual and auditory hallucinations in the acute disease phase (hearing opera arias and seeing room furniture upside-down). Hallucinations resolved with antiviral treatment.
Caso de uma mulher de 43 anos, gestante, que apresentou lucinações visuais e auditivas (árias de ópera e visão de móveis do quarto de cabeça para baixo) associadas a fase aguda de encefalite de tronco cerebral. Os sintomas desapareceram com resolução do quadro.
Subject(s)
Humans , Female , Middle Aged , Brain Stem , Confusion , Encephalitis , Hallucinations , Brain Injuries, TraumaticABSTRACT
El síndrome de Charles Bonnet se caracteriza por alucinaciones visuales que se presentan en personas con una pérdida de visión severa y, generalmente, enpersonas de edad avanzada, con un estado mental normal. En este artículo se analizan las características de este síndrome, como la etiología, la fisiopatología y el diagnóstico diferencial, y se dan conocer criterios de diagnóstico para tener en cuenta en la práctica diaria, en especial para los optómetras, quedeben estar familiarizados con los signos y síntomas de este síndrome, ya que este grupo de pacientes casi siempre acude primero a la consulta optométrica. Aunque la condición se hizo pública en la comunidad médica hace más de doscientos años atrás, es muy poco diagnosticada por el desconocimiento existente sobre ella. En la práctica optométrica, se debe sospechar del síndrome de Charles Bonnet, especialmente en los grupos de pacientes que presentan alucinaciones visuales y debilidad visual o ceguera, evitando un diagnóstico psiquiátrico equivocado.
The Charles Bonnet Syndrome is characterized by visual hallucinations that occur in people with severe sight loss and usually in elderly people with a normal mental state. This article discusses the characteristics of this syndrome as the etiology, pathophysiology and differential diagnosis, and is known diagnostic criteria for consideration in daily practice. Especially for optometrists be who sould be familiar with the signs and symptoms of this syndrome, as this group of patients almost always come first to consult optometrists. Even though the condition was published in the medical community for over 200 years ago, it has been rarely diagnosed due to the lack of knowledge about it. In optometric practice, it is suspected Charles Bonnet Syndrome especially in this age group with visual hallucinations and visual weakness or blindness, avoiding a psychiatric diagnosis wrong.