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Abstract #47668 Published in IGR 13-4
Case of bimodal charles bonnet syndrome and dementia
El-Hagrassy M; Akfirat GAnnals of Neurology 2011; 70: 59-60
Case: 72 year old hearing impaired male with glaucoma, aggression toward hallucinations. Visual hallucinations followed blindness. He saw silent children, animals for months, recently heard familiar music. Sometimes had insight. Was admitted to Medicine after trying to fight with images for first time. Positive findings: disorientation, impaired short term memory, calculation. Anemia, prerenal acute kidney injury. No history of dementia. Denied images, mentioned spirits, paranoid about witchcraft to make him look mad and get him locked up, implying pension would be stolen. He was hydrated, given Aricept, Seroquel, became calmer. He was discharged with diagnosis of Alzheimer's dementia, bimodal CBS (Charles Bonnet Syndrome), possible resolved delirium and dehydration. Discussion: CBS involves complex visual hallucinations with partial or full insight; auditory variant rarely reported with visual, both associated with sensory deprivation. Patients often hide hallucinations, as our patient did. Management includes anticonvulsant, antipsychotic, and antidepressant trials, also reassurance, increasing sensory stimulation and socialization. CBS was suggested as early marker for dementia, particularly Alzheimer's and Lewy Body dementias. Conclusion: Suggest screening blind or deaf patients for CBS; closely follow for signs of dementia if positive. Further studies to ascertain positive predictive value and if earlier diagnosis leads to improved outcomes.
M. El-Hagrassy. New York, United States.
Classification:
9.4.15 Glaucoma in relation to systemic disease (Part of: 9 Clinical forms of glaucomas > 9.4 Glaucomas associated with other ocular and systemic disorders)
