Disclosures: Paul Chan, MD: Nothing to disclose

Case Description: The patient presented to the emergency department (ED) for the second time within 1 month for several days of blurry vision and intermittent confusion. She initially presented to the ED for transient confusion and was then discharged after CT head showed chronic right PCA territory infarcts. On subsequent presentation, MRI revealed acute infarcts, left greater than right, of bilateral PCA territory. On admission, workup revealed cortical blindness and visual anosognosia. Initial descriptions of confusion were deemed to be poor memory, hallucinations, paranoia, agitation, and delusions.

Setting: Acute Inpatient Rehabilitation Hospital

Patient: 63-year-old woman who presents with blurry vision.

Assessment/Results: She was started on aspirin, clopidogrel, atorvastatin, and recommended for outpatient loop recorder placement. She was discharged to acute inpatient rehabilitation unit. Her only strength limitations were secondary to pain due to chronic osteomyelitis in right lower extremity, which necessitated use of axillary crutch premorbidly. She required maximal assistance with lower body dressing and bathing and moderate assistance for transfers with maximal verbal cues. Her ability to ambulate, transfer, dress self, and perform toileting all improved as her cognition improved to require minimal verbal cues. Significant agitation, confusion, and hallucinations affected therapy sessions but improved with seroquel and depakote. She was discharged to skilled nursing facility with supervision for ambulation, transfers, and ADLs with use of axillary crutch.

Discussion: Cortical blindness combined with visual anosognosia make up the description of Anton Syndrome. Anosognosia complicates the rehabilitation process because the patient does not acknowledge any deficits and therefore has decreased motivation to participate in therapies. Our patient’s visual deficits were frequently emphasized which helped combat her anosognosia.

Conclusion: Treatment of this rare syndrome is difficult because of lack of insight. There is no universally agreed upon rehabilitation approach, but frequent reorientation and emphasis of existing visual deficits can improve lack of insight and lead to functional recovery.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/rehabilitation-of-a-patient-with-cortical-blindness-and-visual-anosognosia-a-case-report/