ABSTRACT
ABSTRACT Objective: Age-related macular degeneration (AMD) is the most prevalent cause of irreversible visual loss in the developed world. In late stages, it may lead to extremely low visual acuities, especially when associated with geographic atrophy or choroidal neovascularization. According to recent literature, Charles Bonnet syndrome (CBS) may be a rather common feature of late AMD. Methods: One hundred patients with late-stage age-related macular degeneration were actively asked whether they had symptoms of Charles Bonnet syndrome. Those that answered positively underwent a comprehensive questionnaire about the details of the visual hallucinations. Results: The following factors were significantly associated with Charles Bonnet syndrome: older age (+6.3 years; p=0.003), lower visual acuity in the better eye (Charles Bonnet Syndrome Group: 0.11; Non-Charles Bonnet Syndrome Group: 0.42; p=0.005) and female sex (Charles Bonnet Syndrome Group: 88%; Non-Charles Bonnet Syndrome Group: 43%; p=0.02). The visual hallucinations occurred mainly straight ahead (n=5), once per day (n=4), at no particular time (n=6), lasted some minutes (n=5), and disappeared after blinking (n=3) or looking away (n=3). The majority of patients lived alone (n=7), had not told anyone about the hallucinations (n=6), and associated the episodes with severe distress (n=5). Conclusion: Charles Bonnet syndrome was fairly prevalent in this late-stage age-related macular degeneration population. Our sample shows the importance of directly asking subjects about Charles Bonnet syndrome since they are often reluctant to admit to having visual hallucinations. Reassurance about its benignity is crucial to improve their quality of life.
RESUMO Objetivo: A doença macular ligada à idade (DMI) é a causa mais prevalente de perda visual irreversível nos países desenvolvidos. Em estadios avançados, esta doença pode levar a acuidades visuais extremamente baixas. De acordo com literatura recente, a Síndrome de Charles Bonnet (SCB) pode acontecer de forma relativamente comum na DMI tardia. Métodos: Cem doentes com degeneração macular da idade avançada foram interrogados ativamente sobre terem sintomas da síndrome de Charles Bonnet. Os que responderam de forma positiva foram submetidos a um questionário oral detalhado sobre os pormenores das alucinações visuais. Resultados: Os seguintes fatores foram significativamente associados à síndrome de Charles Bonnet: idade avançada (+6,3 anos; p=0,003), menor melhor acuidade visual corrigida no melhor olho (Grupo com Síndrome de Charles Bonnet: 0,11; Grupo sem Síndrome de Charles Bonnet: 0,42; p=0,005) e sexo feminino (Grupo com Síndrome de Charles Bonnet: 88%; Grupo sem Síndrome de Charles Bonnet: 43%; p=0,02). As alucinações visuais ocorriam principalmente em frente (n=5), uma vez por dia (n=4), em qualquer altura do dia (n=6), duravam alguns minutos (n=5) e desapareciam após pestanejo (n=3) ou desvio do olhar (n=3). A maioria dos doentes vivia sozinha (n=7), não tinha partilhado sua condição com ninguém (n=6) e associava os episódios a uma sensação angustiante (n=5). Conclusão: A síndrome de Charles Bonnet teve prevalência relativamente alta nessa população de degeneração macular da idade. Nossa amostra sublinha a importância de questionar diretamente sobre síndrome de Charles Bonnet, uma vez que os doentes se sentem muitas vezes relutantes em admitir alucinações visuais. A reafirmação da benignidade da situação é crucial para aumentar a qualidade de vida desses indivíduos.
Subject(s)
Humans , Male , Female , Aged , Aged, 80 and over , Charles Bonnet Syndrome/etiology , Charles Bonnet Syndrome/epidemiology , Hallucinations/etiology , Hallucinations/epidemiology , Macular Degeneration/complications , Portugal/epidemiology , Visual Acuity , Vision, Low , Prevalence , Surveys and QuestionnairesABSTRACT
ABSTRACT Objective: To report a case of recurrent isolated sleep paralysis (RISP), a benign parasomnia with worrisome and frightening sleep paralysis episodes. Case description: We describe a case of RISP in a sixteen-year-old girl who seeks medical attention for anxiety symptoms. The sleep paralysis and associated auditory and tactile hallucinations began three years before with worsening in the last year, causing fear of sleeping. The episodes were intensely frightening causing negative impact in patient's sleep, school performance and social function. Medical conditions were excluded, and she started treatment with a selective serotonin reuptake inhibitor with complete resolution of symptoms. Comments: Sleep complaints are often devalued. Therefore, clinicians should actively ask their patients about their sleep during health assessment.
RESUMO Objetivo: Relatar um caso de paralisia do sono isolada e recorrente (PSIR), uma parassonia benigna com episódios inquietantes e assustadores de paralisia do sono. Descrição do caso: Descreve-se um caso de PSIR de uma adolescente de dezesseis anos que buscou cuidados médicos devido a sintomas de ansiedade. A paralisia do sono e as alucinações auditivas e táteis associadas haviam começado três anos antes, com agravamento no último ano, causando medo de dormir. Os episódios eram extremamente perturbadores, gerando um impacto negativo no sono, desempenho escolar e vida social da paciente. Condições médicas foram excluídas e começou um tratamento com um inibidor seletivo da recaptação de serotonina, com resolução completa dos sintomas. Comentários: Queixas relacionadas ao sono são frequentemente subvalorizadas. Portanto, os médicos devem perguntar aos seus pacientes sobre problemas relacionados com o sono durante a avaliação clínica.
Subject(s)
Humans , Female , Adolescent , Sleep Wake Disorders/diagnosis , Sleep Paralysis/complications , Sleep Paralysis/psychology , Fear/psychology , Anxiety/etiology , Anxiety/psychology , Recurrence , Sleep Wake Disorders/etiology , Social Change , Administration, Oral , Treatment Outcome , Fluvoxamine/administration & dosage , Fluvoxamine/therapeutic use , Selective Serotonin Reuptake Inhibitors/administration & dosage , Selective Serotonin Reuptake Inhibitors/therapeutic use , Sleep Paralysis/diagnosis , Sleep Paralysis/drug therapy , Diagnosis, Differential , Academic Performance/psychology , Hallucinations/etiology , Hallucinations/psychologyABSTRACT
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/complicationsSubject(s)
Adult , Female , Humans , Male , Middle Aged , Young Adult , Electric Stimulation Therapy/methods , Electric Stimulation Therapy/psychology , Schizophrenia/therapy , Schizophrenic Psychology , Antipsychotic Agents/therapeutic use , Hallucinations/etiology , Hallucinations/therapy , Psychiatric Status Rating Scales , Schizophrenia/complicationsABSTRACT
The Charles Bonnet Syndrome (CBS) is typically characterized by visual hallucinations in elderly people without cognitive defects. This article presents the case of an 80-year-old male patient with a one-year history of visual hallucinations, secondary to glaucoma, in both eyes. Neither a dopamine agonist nor cholinesterase inhibitor therapy improved his symptoms. In this case, the hallucinations were gradually improved after administration of a GABAergic drug, pregabalin, for diabetic polyneuropathy. Placebo-controlled clinical trials would be needed to support this effect of pregabalin, as suggested by this association.
Subject(s)
Aged, 80 and over , Analgesics/therapeutic use , Diabetic Neuropathies/complications , Diabetic Neuropathies/drug therapy , Glaucoma/complications , Hallucinations/diagnosis , Hallucinations/drug therapy , Hallucinations/etiology , Humans , Male , Severity of Illness Index , Syndrome , Vision Disorders/etiology , Vision Disorders/physiopathology , gamma-Aminobutyric Acid/analogs & derivatives , gamma-Aminobutyric Acid/therapeutic useABSTRACT
Cerebral thromboembolism is a potential, although rare, complication of coronary angiography. An elderly woman presented with visual hallucinations, features of bilateral third nerve palsy, impaired vertical and horizontal gaze and mild motor weakness of the left upper limb, following diagnostic coronary catheterization. These findings suggested the anatomical location of the lesion to lie in the caudal midbrain, which was confirmed on computed tomography of the brain. Peduncular hallucinosis following cardiac catheterization, to the best of our knowledge, has only been described once in the literature. Awareness of this entity and its clinical presentation is essential for appropriate investigation and management.
Subject(s)
Aged , Coronary Angiography/adverse effects , Female , Hallucinations/etiology , Humans , Vertebrobasilar Insufficiency/etiologyABSTRACT
Idosos com déficit visual por vezes apresentam alucinações visuais relacionadas à síndrome de Charles Bonnet. O surgimento destas alucinoses frequentemente causa ansiedade ao paciente e gera dificuldade diagnóstica e de conduta. Neste artigo descrevemos o caso de uma senhora de 82 anos de idade que se queixou de alucinações visuais complexas e revimos a literatura a respeito da síndrome de Charles Bonnet; condição que promove alucinação visual em pessoas mentalmente saudáveis.
Visually handicapped elderly people sometimes experience visual hallucinations associated with Charles Bonnet syndrome. The appearance of these hallucinosis often causes anxiety to the sufferer and can be difficult for the diagnosis and management. In this article, we report an 82-year-old woman that suddenly complained of complex visual hallucinations, and review the literature on the Charles Bonnet syndrome, a condition involving visual hallucinations in a mentally normal person.
Subject(s)
Humans , Female , Aged, 80 and over , Vision Disorders/diagnosis , Vision, Low , Fantasy , Charles Bonnet Syndrome/diagnosis , Hallucinations/etiology , Magnetic Resonance ImagingABSTRACT
Para poder comprender tanto la realidad de la percepción como la de la alucinación es necesario partir de conceptos que, poniendo en cuestión los "de sentido común", hagan posible: a) reconocer la estructura psíquica esencialmente diferente de los fenómenos imaginarios alucinatorios (Henri Ey habla de: "heteronomía"), y b) comprender que esa heteronomía expresa la desorganización del acto perceptivo. Así se evidencia que la alucinación es una "falsa percepción" y no una forma de "más percepción" como se entiende en la serie de los DSM. Por eso Ey dice que la alucinación es esencialmente "fáctica" en el doble sentido de la palabra, de ser un hecho clínico y de caracterizarse por ser una irrupción de irrealidad.
To be able to understand the reality of perception as much as the reality of hallucinations, it is necessary to start from notions that, placing in doubt those of "common sense", make possible: a) recognize the psychic structure essentially different from the imaginary phenomena of hallucination (Henri Ey talks about "heteronomy"), and b) understand that heteronomy express the desorganization of the perceptive act. Thereby, it is showed that the hallucination is a "false perception" and not a way of "further perception", as it is deduced from the series of DSM.
Subject(s)
Humans , Hallucinations/etiology , Delirium/etiology , Perceptual Disorders , PsychopathologyABSTRACT
En este artículo se presentan dos casos de pacientes con el síndrome de Charles-Bonnet, entidad que tiende a ser subdiagnosticada en el ámbito de la salud, dada su rareza y desconocimiento por parte del personal médico. A partir de estos casos se presentan las características clínicas del síndrome y se brindan pautas para tener en cuenta en la fisiopatología, evaluación clínica, factores de riesgo, diagnóstico diferencial y tratamiento.
In this paper two cases of patients with Charles Bonnet syndrome are presented. This entity tends to be subdiagnosed in the scope of the health, giving to its peculiarity and ignorance on the part of the medical personnel. From these cases the clinical characteristics of the syndrome shows and guidelines offer to consider the physiopathology, clinical evaluation, risk factors, differential diagnosis and treatment.
Subject(s)
Humans , Male , Female , Middle Aged , Hallucinations/diagnosis , Hallucinations/etiology , Mentally Ill Persons , Psychic Symptoms , Vision Disorders/diagnosis , Vision Disorders/etiology , Visual Perception , Diagnosis, Differential , Prevalence , Risk FactorsABSTRACT
En áreas rurales se presentan casos de pacientes intoxicados con semillas de la planta Datura stramonium, conocida popularmente como "chamico", la que tiene efectos anticolinérgicos potentes, lo que se reconocen con una anamnesis y examen físico exhaustivo.
Subject(s)
Humans , Male , Child, Preschool , Datura stramonium , Plant Poisoning/diagnosis , Hallucinations/etiology , Plant Poisoning/therapy , Rural Areas , Treatment Outcome , Psychomotor Disorders/etiology , Consciousness Disorders/etiologyABSTRACT
Charles Bonnet syndrome is an entity including vivid and complex visual hallucination and has been well known in patients with visual problem. A middle-aged Afghan female refugee with the diagnosis of major depressive disorder who had episodic complex and well formed visual hallucinatory periods with open eyes will be described.She also experienced auditory and olfactory hallucinations associated with visual hallucination. Hallucinatory experiences described in Charles Bonnet syndrome may exist concurrently with psychiatric disorders such as major depressive disorder. Olfactory hallucination as a symptom of Charles Bonnet syndrome is reported for the first time in our case
Subject(s)
Humans , Female , Syndrome , Hallucinations/etiology , Middle AgedABSTRACT
Os autores relatam caso de uma paciente portadora de epilepsia que desenvolveu sintomas psicóticos e depressivos associados a essa patologia, discutindo-o em relação a seus aspectos psicopatológicos.
Subject(s)
Humans , Female , Adult , Delirium , Epilepsy , Psychotic Disorders/etiology , Schizophrenia, Paranoid , Epilepsies, Partial , Hallucinations/etiology , Diagnosis, Differential , Psychotic Disorders/diagnosisABSTRACT
Peduncular hallucinations are formed visual images often associated with sleep disturbance and are caused by lesions in the midbrain, pons and diencephalon. In present case report, a four year child, who was operated for midline posterior fossa medulloblastoma developed peduncular hallucinations on 3rd post operative day. Traction trauma or the compression of mid brain was thought to be the most possible cause of hallucinations.
Subject(s)
Cerebellar Neoplasms/complications , Child, Preschool , Hallucinations/etiology , Humans , Magnetic Resonance Imaging , Male , Medulloblastoma/complications , Postoperative Complications/psychologyABSTRACT
Las alucinaciones visuales formes son frecuentemente un signo de alteración en la vida de relación o psicopatología aguda aunque también pueden presentarse en individuos con debilidad visual. El síndrome de Charles Bonnet es una entidad poco reportada en la literatura y frecuente en sujetos con disminución de la función visual por diferentes causas, pudiendo manifestarse en cualquier edad y sexo. Es importante que el oftalmólogo conozca y sospeche esta entidad especialmente en sujetos de la tercera edad con alucinaciones visuales formes desarrolladas en un breve periodo posterior a la pérdida de la función visual con el fin de proporcionar, en su caso, un adecuado tratamiento médico, además de informar y tranquilizar al enfermo respecto a la génesis de esta patología disminuyendo su ansiedad y evitando errores diagnósticos
Subject(s)
Humans , Eye Diseases , Hallucinations/etiology , Diagnosis, Differential , Vision Disorders/diagnosis , Vision Disorders/etiologyABSTRACT
La alteración aguda de las funciones cerebrales superiores del hemisferio derecho suelen pasar inadvertidas o ser inadecuadamente interpretadas en pacientes en edad pediátrica. Se presenta una niña de 9 años, zurda, sana, que durante las dos semanas previas a la consulta padeció episodios de parestesias, una convulsión clónica del miembro superior izquierdo y cambios progresivos en su conducta con irritabilidad, llanto o risa inmotivados, coprolalia, copopraxia e insomnio. Al examen se hallaba temerosa, agresiva, verborrágica. Refería "verse hinchada como un globo", "los objetos se agrandaban o se movían rápidamente" y veía "príncipes y brujas de pelo verde y ojos color púrpura". Utilizaba exclusivamente el miembro superior derecho sin detectarse anormalidades del sistema motor, sensitivo o en la coordinación. Podía leer y realizar cálculos matemáticos, pero no escribir, dibujar ni realizar construcciones con cubos. E.E.G.: ondas lentas en hemisferio derecho; L.C.R.: 9 linfocitos, resto s/p; TC y RNM normal. Serología para virus negativa. F.A.N., anti-ADN, prot. Creativa, células L.E., test del látex [-]. C3: 65 mg por ciento [V.N.: 150 ñ 30 mg por ciento]; C.I.C.: 33 por ciento [V.N.: 14 ñ 5 por ciento]. Además del tratamiento con oxcarbacepina, se adicionaron esteroides, con lo cual mejoró la sintomatología. Al año de seguimiento se hallaba asintomática y los exámenes inmunológicos eran normales. Conclusión: El compromiso predominante de la región parietooccipital derecha explicaría la sintomatología referida. Una vasculitis hipocomplementémica sería la probable etiología