ABSTRACT
Charles Bonnet syndrome (CBS) is characterised by the triad of complex visual hallucinations, ocular pathology causing visual deterioration and preserved cognitive status. We report a case of a 62-year-old man with a brief history of visual hallucinations. The patient complained of amaurosis with optic nerve atrophy in his left eye and a severe impairment of visual acuity in the right and suddenly experienced complex, vivid, elaborate and coloured visual hallucinations persisting long after eye closure and stopping during sleep. The patient maintained his insight, criticising these visions as unreal and felt distressed by them. Hallucination onset was 3 days before hospital admission. No cognitive impairment and no diseases apart from prostatic adenoma treated with alpha-lythic therapy were reported. Neurological examination and neuroimaging data were normal. Therapy with olanzapine (OLZ) 5 mg/day led to a progressive clearance of visual hallucinations in seven days and was gradually reduced and withdrawn. Three months later the visions reappeared and OLZ 5 mg/day yielded a persisting remission so that at the follow-up examination after 1 year on therapy the patient is still asymptomatic. To date, no established treatment for CBS is stated and in some patients the hallucinations fade spontaneously; in our case an antipsychotic therapy with OLZ was effective while generally anticonvulsant drugs with different mechanism of action such as carbamazepine, valproate and gabapentin are proposed.
Subject(s)
Antipsychotic Agents/therapeutic use , Eye Diseases/complications , Hallucinations/drug therapy , Vision Disorders/complications , Benzodiazepines/therapeutic use , Eye Diseases/diagnosis , Hallucinations/etiology , Humans , Male , Middle Aged , Olanzapine , Sensory Deprivation , Syndrome , Treatment Outcome , Vision Disorders/diagnosisABSTRACT
BACKGROUND: Craniopharyngiomas are epithelial tumors of the suprasellar region, unanimously defined as benign. Despite the benign histological aspect and apparent gross total resection achieved in a proportion of cases, recurrence rate remains about 30% at 10 years. The role of 7 pathological factors as predictors of recurrence and clinical outcome in craniopharyngioma patients is controversial, as well as the prognostic role of the evaluation of proliferation potential. MATERIAL AND METHODS: In the present study, the proliferation potential of 37 craniopharyngiomas was investigated by analyzing the pattern of Ki-67-MIBI immunoreactivity; the data have been analyzed in relation to age of the patient, histologic type (adamantinomatous/squamous papillary), microscopic and cytochemical features. RESULTS: Craniopharyngiomas operated in adults have a higher MIB-1-LI than those of children; the epithelial cells abutting the stromal cysts are engaged in the cell cycle, while this is not the case for the cells abutting the nervous tissue; MIB-1-LIs of adamantinomatous craniopharyngiomas are not different from those of squamous papillary craniopharyngiomas, the localization of MIB-1-positive nuclei is different in the 2 craniopharyngioma types, non-epithelial cells proliferate in the stromal component of craniopharyngiomas. CONCLUSIONS: By analyzing these data while considering all available information on the efficacy of surgery and radiotherapy, the proliferation potential of craniopharyngiomas, when evaluated by MIB-1, has no role in the outcome. The very low MIB-1-LI of the intracerebral tumor growth indicates that uncompletely resected tumor remnants do not represent an active starting point of recurrence.
