Charles Bonnet syndrome in a child with congenital glaucoma

CASE REPORT

The case is presented of a 12 year-old boy with congenital glaucoma and low visual acuity diagnosed with Charles Bonnet syndrome. This consisted of the acute onset of complex, repetitive, persistent, and with visual hallucinations (people, brooms and coffeemakers) of self-limited evolution without treatment. The patient was diagnosed with congenital glaucoma at 3 years of age, and subjected to a trabeculectomy in right eye, and trabeculectomy and keratoplasty in his left eye.

DISCUSSION

Charles Bonnet syndrome symptoms have been described in adults, but their presence in children is poorly reflected in literature, with unknown characteristics and prevalence.

[Charles Bonnet syndrome. A 45-case series]

INTRODUCTION

Charles Bonnet Syndrome (CBS) is a condition characterised by the presence of visual hallucinations, mainly complex, in patients with significant vision loss and without cognitive impairment. The rise in CBS cases is due to an increased life expectancy and to the development of age-related pathologies such as age-related macular degeneration (AMD).

PATIENTS AND METHODS

We herein analyse the main characteristics present in 45 patients diagnosed with CBS at the Neuro-ophthalmology Unit in Hospital Clinico San Carlos. The patients were referred from the macular pathology, glaucoma and ocular surface units, as well as from AE, where they were diagnosed with CBS and later confirmed at the Multidisciplinary Unit formed by the ophthalmology, neurology and psychiatry services of the hospital.

RESULTS

Women (66.66%) over 80 constituted 68.88% of the patients and mainly had AMD (37.77%). The most prevalent hallucinations described by the patients were of people and faces (35.55%), in colour (66.66%), in movement (80%), had developed over a period of 6 to 12 months (26.66%), had a frequency of 3 episodes per day (35.55%) and lasted between 3 to 5 minutes (35.55%).

CONCLUSIONS

CBS is a complex disorder that requires a multidisciplinary approach from neurologists, psychiatrists, general practitioners and ophthalmologists. New studies are needed in order to understand its clinical presentation and behaviour, and thus improve its management.

[Paradoxical cessation in a case of Charles Bonnet syndrome]

CASE REPORT

78-year-old male patient diagnosed with Charles Bonnet syndrome (CBS) showing secondary visual deficit toward end-stage glaucoma. He progressed to amaurosis, with an abrupt disappearance of hallucinations in parallel to the loss of residual vision.

DISCUSSION

The paradoxical cessation of CBS occurs when the patient loses residual vision and progresses to amaurosis. The lack of stimulation, both in the corresponding retina and the cortex, lead to the disappearance of hallucinations because the desafferented and hyper-excited neurons lose the necessary stimulus that triggers CBS.

Non-arteritic anterior ischemic optic neuropathy as first manifestation of antiphospholipid syndrome in a young patient

CASE REPORT

We report the case of a young patient with unilateral anterior ischemic optic neuropathy, with no known cardiovascular risk factors and visual acuity preserved with positive anticardiolipin antibodies as a unique find.

DISCUSSION

Non-arteritic anterior ischemic optic neuropathy in the context of antiphospholipid syndrome is an uncommon finding, but it must be considered in the diagnosis of the atypical anterior ischemic optic neuropathy.

Simultaneous optic and vestibulocochlear syphilitic neuropathy in a patient with HIV infection

BACKGROUND

The purpose of this report is to present a case of optic and vestibulocochlear neuropathy as a manifestation of concurrent HIV and syphilis coinfection. This is an interventional case report of a 37-year-old man who complained of blurry central vision in his left eye and hearing loss in his left ear over the past 2 weeks.

FINDINGS

Visual acuity was 20/20 in both eyes, and the anterior segment was normal in both eyes without relative afferent pupillary defect. Fundoscopy revealed swelling of the left optic disc. Optic coherence tomography and the Heidelberg retina tomograph confirmed and quantified the oedema of the left optic disc. An audiometry showed a left sensorineural deafness. Serological examinations disclosed confirmed HIV and syphilis infection. Magnetic resonance imaging of the brain showed no abnormalities. Properly treated with intravenous penicillin, the lesions resolved.

CONCLUSIONS

Simultaneous optic and auditive involvement can be the first manifestation of syphilitic and HIV coinfection. To our knowledge, this report is the first to describe the rare occurrence of syphilitic optic neuritis and ipsilateral affectation of the vestibulocochlear nerve.