Charles Bonnet Syndrome Following Trans-Sphenoidal Adenomectomy without Optic Nerve Atrophy

Charles Bonnet syndrome (CBS) can develop after trans-sphenoidal adenomectomy (TSA); however, the neural mechanisms remain unknown. Sensory deprivation and releasing phenomenon are both hypothetical explanations for this condition; however, there is no definite evidence that strongly supports either supposition. We report the first case of CBS after TSA without optic nerve atrophy. Postoperatively, the patient's vision seemed to be relatively well preserved, apart from the left-side hemianopsia in the right eye. Distinctive visual hallucinations only appeared when his eyes were closed, and these responded to quetiapine in a dose-dependent manner. Dose dependent change in colors and formation of hallucination was reported. Two weeks after quetiapine initiation, the patient's CBS was completely resolved. This unique case suggests that blocking sensory input from the periphery is more critical than neural damage of the bottom-up connection to the visual association cortex. In addition, quetiapine should be considered as a specific treatment for CBS.

An unusual presentation of visual hallucinations with zolpidem: a case report.

Zolpidem is a hypnotic drug with rapid -onset and short duration of action. It is popularly used for the induction and maintenance of sleep in adults suffering from insomnia. It supersedes benzodiazepines with better tolerability and has fewer side effects such as less residual sedation and the potential for rebound insomnia and dependence is also less. Adverse neuropsychiatric reactions such as visual hallucinations, amnesia, sleepwalking and nocturnal eating are known to occur with zolpidem. Literature suggests higher incidence of visual hallucinations with zolpidem when used along with selective serotonin reuptake inhibitors. Furthermore, visual hallucinations are one of the causes for drug withdrawal. We are reporting a case of zolpidem induced visual hallucinations when used alone and also which disappeared with proper assurance to the patient in subsequent use.

Herpes Simplex Encephalitis Showing Prominent Spatial Disorientation with Visual Hallucination

A 58-year-old woman was admitted to hospital due to memory impairment and visuospatial dysfunction. Brain MRI revealed high signal lesions on both the temporal and inferior frontal lobes. She was diagnosed as having herpes simplex encephalitis based on her clinical and laboratory findings. Twelve months later she still presented with spatial disorientation, although her amnesia was improved. Neuropsychological testing revealed multiple cognitive impairments, and especially visuospatial dysfunction. This patient represents a case of herpes simplex encephalitis associated with spatial disorientation even when the amnesia had disappeared.

Charles Bonnet Syndrome Following Bilateral Occipital Infarction

No abstract available.

Diagnosis and Management of Dementia with Lewy Bodies

Dementia with Lewy bodies (DLB) is considered the second most common cause of neurodegenerative dementia. It is characterized with clinical and pathological feature that distinguish it from Alzheimer's disease (AD). These characteristics include fluctuating cognition, visual hallucination, and spontaneous feature of parkinsonism. DLB is commonly accompanied by neuropsychiatric symptoms and recent literature suggests that behavioral and psychological symptoms of dementia (BPDS) are frequently associated with DLB. So, psychiatrist caring for older adults may need a greater awareness of the clinical presentations of DLB in order to make a timely diagnosis. Also geriatric psychiatrist need to increase knowledge in order to raise awareness about the risks and benefits of medications in patients with DLB and to provide practical information and support for caregivers. This article reviews the clinical syndrome of DLB and its management.

Síndrome de Charles Bonnet: a propósito de um caso / Charles Bonnet syndrome: regarding a case

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.

Quetiapine Therapy for Visual Hallucinations Caused by Charles Bonnet Syndrome / 대한정신약물학회지

The case of a 77-year-old man with Charles Bonnet syndrome was presented. This patient lost his vision due to glaucoma, and he subsequently developed complex visual hallucinations. No other psychotic symptoms (e.g., delusions, perceptual disturbances) and no evidence of cognitive impairment or neurological diseases were reported. The visual hallucinations disappeared after treatment with quetiapine, an atypical antipsychotic, without any side effects. The visual hallucinations reappeared after quetiapine was discontinued. Treatment with a small dose of quetiapine has been maintained to prevent the exacerbation of symptoms.

Investigations on prevalence and risk factors of visual hallucination in patients with Parkinson' s disease / 上海第二医科大学学报

Objective To investigate the prevalence and characteristics of visual hallucination among patients with Parkinson's disease (PD), and analyse the potential risk factors. Methods One hundred and twenty-eight patients with PD were administered self-prepared visual hallucination questionnaires, and prevalence of visual hallucination was surveyed. The differences in sex, age, disease duration, Mini Mental State Exam (MMSE) scores, Hoehn & Yahr stage, types of medicine used and levodopa equivalent doses (LDE) were compared between the patients with visual hallucination and those without visual hallucination. The prevalence of rapid eye movement sleep behavior disorder (RBD) was investigated in patients with visual hallucination. Results Eighteen patients (14.06%) experienced visual hallucination, among whom 10 (55.56%) experienced visual hallucination no less than one time per day, 11 (61.11%) "saw" the shadow of human figure and 15(83.33%)were complicated with RBD. There were significant differences in MMSE scores, Hoehn & Yahr stage, female proportion and usage of dopamine agonists between patients with visual hallucination and those without visual hallucination(P<0.05). Conclusion Visual hallucination is a common non-motor symptom among patients with PD, and cognitive function, disease severity and usage of dopamine agonista may be related to visual hallucination.

A Case of Charles Bonnet Syndrome After Resection of a Meningioma

PURPOSE: To report a case of Charles Bonnet syndrome that developed after resection of a meningioma. CASE SUMMARY: The authors reviewed the medical record, brain magnetic resonance image, and Goldmann visual field test of a 56-year-old male patient who was diagnosed with a meningioma in the right parietal and occipital lobe and underwent resection of the tumor. The preoperative Goldmann visual field test showed homonymous left inferior quadrantanopsia. Subtotal resection of the mass in the right parietal and occipital lobe was performed, and postoperative histopathologic examination confirmed the diagnosis of a meningioma. Postoperatively, the patient complained of visual hallucination in an area of the eye with visual field defects. However, his consciousness and orientations were intact, and other cognitive functions were also normal. CONCLUSIONS: Visual hallucination can manifest in an area with visual field defects after resection of abrain tumor. In such a case, a diagnosis of Charles Bonnet syndrome should be considered.

Dementia With Lewy Bodies Diagnosed by Cognitive Fluctuation After Anticholinergic Medication

Dementia with Lewy bodies (DLB) usually presents with progressive cognitive decline and parkinsonism. We report a 68-year-old man who showed parkinsonism including resting tremor and mild cognitive decline. After anticholinergic medication, he showed recurrent visual hallucination. Neuropsychological tests revealed frontal and memory impairments. PET showed hypometabolism in the primary visual and visual association cortices. It is necessary to consider the possibility of DLB as well as anticholinergic side effect when visual hallucination occurs during the treatment of parkinsonism.

A Case of Charles Bonnet Syndrome Following Cerebral Infarction in the Right Occipital Lobe

Charles Bonnet syndrome is characterized by relatively preserved cognitive functions with the exception of complex visual hallucinations caused by injury to the visual system. We report the case of a 68 year-old woman presenting with colored, dynamic and organized visual hallucinations in the left visual field, which suddenly developed about 3 months ago. Brain MRI showed chronic infarction in the right occipital lobe. Treatment with olanzapine reduced the visual hallucinations. This is a rare case of Charles Bonnet syndrome following an occipital lobe infarction.

Features of hallucination in schizophrenia

The hallucination are common and have an important role in diagnosing schizophrenia. Objectives: To describe and to follow up the evolution of the hallucination in schizopprenia. 40 patients with schizophrenia met to ICD.10 criteria and have hallucination were treated by anti-psychotic drugs in National Institute of Mental Health from September 1999 to November 2000. Methods: cross - sectional study. Results: The hallucination symptoms in the patients were: 92.5% had auditory hallucination, 12.5% had visual hallucination and 2.5% had olfactory hallucination. Most of auditory hallucination was comments located in head. 91.6% hallucinations were disappeared when the patients were treated by anti-psychotic drugs. Conclusions: Most of hallucinations are auditory, visual and olfactory. Hallucinations are likely sensitive to anti-psychotic drug.

Clinical Characteristics of Dementia with Lewy Bodies

The dementia with Lewy bodies which was common next to the Alzheimer's dementia had been oftenly misdiagnozed as vascular dementia. The pathologic diagnosis of dementia with Lewy bodies was increasing with the development of immunocytochemical techniques, and it also drew much interest recently. The clinical criteria included core symptoms such as fluctuation of cognitive function, well-formed visual hallucination and extrapyramidal symptoms. For the pathologic criteria, presence of brainstem or cortical Lewy bodies were essential, besides of other pathology. However, it was difficult to obtain satisfactory consensus between investigators about the clinical and pathologic criteria of the dementia with Lewy bodies. There were several reports which suggested good response to the cholinesterase inhibitors.

A Case of Probable Diffuse Lewy Body Dementia

A case of Lewy body dementia in a 71 year-old male patient was reported and related articles were also reviewed. He has been ill with Parkinsonism since 1988, and referred to the neuropsychiatrist because of depression since 1989. Episodically he has experienced dizziness, falls and low blood pressure. Mild cognitive decline including memory, attention, language, and visuospatial ability accompanied by occasional fluctuation of consciousness, confusion, visual hallucination and disorientation was developed on February 9th in 2000. Such symptoms were repeated thereafter, and responded on donepezil in addition to the antiparkinsonian drugs.

Visual Hallucinations in Schizophrenic Patients / 신경정신의학

OBJECTIVE: The purpose of this study was to investigate actual visual hallucinations as perceived by 40 schizophrenic patients and, subsequently, to explore their psychopathology in order to assist clinicians in more effectively evaluating and treating the visual hallucination. METHODS: With the authors guidance, the content and meaning of pictures drawn, according to their perceptions, by 40 schizophrenic patients were evaluated in conjuction with an examination of the patient's emotional reaction and associated behavior. The results from the visual hallucination group were analyzed and then compared with non-visual hallucinatory control group using the Brief Psychiatric Rating Scale(BPRS) On this basis, the authors investigated the correlations between patients' strength of confidence non-visual hallucination, frequency of visual hallucination, mean duration of an episode and the score of BPRS, and the correlation between meaning of visual hallucination and the tripe of patient's delusion. finally the authors attempted to derive correlation among the items of BPRS. RESULTS: 1) The content of visual hallucination was mostly non-human and mythologically exhibiting anthropomorphic qualities while its meaning was frequently persecutory. In addition, the visual hallucinations experienced by the subjects were most often close to or within the patients' ordinary visual range with mean duration of halluinatory episodes ranging from 1 to 5 minutes. The most frequent reaction of patients is a negative emotional response and the most frequent overt behavior was either verbal or restricted physical activity. 2) There was a positive correlation between the meaning of the visual hallucination and the type of patients' delusion. 3) The group having visual hallucinations had more frequent anxiety, hallucinatory behavior and unusual thought content compared to the non-visual hallucination group. 4) There were positive correlations between patients' strength of confidence in visual hallucination and halluculatory behavior and among anxiety, tension, motor retardation and mean duration of episodes of visual hallucination. 5) There were positive correlations between hallucinatory behavior and anxiety, hallucinatory behavior and mannerism and posturing, hallucinatory behavior and excitement, and hallucinatory behavior and motor retardation. Also, there were positive correlations between motor retardation and tension, blunted affect and tension, and between emotional withdrawal and tension among each item of BPRS in the visual hallucination group. CONCLUSION: In this study of visual hallucinations in schizophrenics, the authors concluded that it is helpful for clinicians to evaluate how schizophrenic patients experience their visual hallucination.

Atenolol Induced Visual Hallucination in Patients with Underlying cerebral Infarction / 대한정신약물학회지

Atenolol is a beta1-selective adrenoreceptor blocking agent which is generally thought of as cardioselective, with little CNS action, because it has hydrophilic solubility rather than lipophilic. But recently, it has been reported that atenolol also can cause CNS side effect, especially in the patient with past neuropsychiatric history, old age, or underlying cerebral lesion. This 59-year-old female case demonstrated that atenolol could be an etiological agent of visual hallucination in a elderly patient with cerebral infarction.