Disclosures: Brandon Jacob Smith, MS4: Nothing to disclose

Case Description: This case describes a 74-year-old female who developed Anton’s Syndrome secondary to a bilateral posterior cerebral artery stroke. She presented with cortical blindness but denied her visual deficits and began confabulating to describe her surroundings. Keppra was started after an EEG suggested low threshold for focal seizure. In the acute rehabilitation unit, her care was complicated by her premorbid bilateral sensorineural hearing loss, post-stroke neuropathic pain, significant apraxia and excessive drowsiness. We tapered the Keppra to help with drowsiness, and at the same time, she began developing visual hallucinations. Repeat EEG ruled out possible seizures. By exclusion she was diagnosed with Charles Bonnet Syndrome (CBS) to which she was predisposed by her impaired visual and auditory sensory.

Setting: Acute rehabilitation unit in a tertiary care hospital.

Patient: 74-year-old female with Anton’s Syndrome.

Assessment/Results: Her drowsiness improved after Keppra was tapered off. Also, her vision started to become partially restored. Gabapentin was initiated to improve her visual hallucinations and neuropathic pain with good results. She progressed well in her therapies and was transferred to a transitional care unit.

Discussion: The patient originally presented with key features of Anton’s Syndrome, denial of visual loss and confabulation. However, she started to develop complex visual hallucinations, a main characteristic of CBS, which gradually worsened with lack of sensory input. This patient was at high risk for developing this syndrome due to her cortical blindness and hearing loss. Her symptoms of CBS improved with gabapentin as well as increased sensory input secondary to her partial vision restoration.

Conclusion: Visual hallucinations are a common complaint among those with Anton’s Syndrome, and can significantly interfere with their rehabilitation. It is important to create a differential to assess for other causes for these hallucinations, as treatment and rehabilitation outcomes may vary based on etiology.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/confabulations-become-hallucinations-a-case-of-charles-bonnet-syndrome/