Disclosures: Douglas Hunter, MD: No financial relationships or conflicts of interest

Case Diagnosis: Charles Bonnet Syndrome After an Occipital Stroke

Case Description or Program Description: A 53-year-old male was admitted to inpatient rehabilitation following a right occipital stroke, with left sided weakness and left homonymous hemianopsia. He began reporting positive complex visual phenomenon within his visual field deficit, only when his eyes were open. He reported seeing adults, children, and rehabilitation equipment (e.g., wheeled walkers), disappearing after attempting to place the image in his intact visual field. He described these hallucinations as “watching an old black-and-white movie,” lasting from seconds to minutes. During this time, he did not exhibit any seizure-like activity, was not taking medications known to cause visual hallucinations, and had complete insight into his hallucinations.

Setting: Inpatient rehabilitation hospital

Assessment/Results: After discussion with neuro-ophthalmology, he was diagnosed with a Charles Bonnet Syndrome (CBS). Due to his insight and lack of distress about the visual hallucinations, he deferred pharmacologic interventions for symptom management, continuing to make significant functional improvement while in rehabilitation.

Discussion (relevance): CBS is defined as complex visual hallucinations following an insult to any location within the visual system, in a patient without any known psychiatric cause. CBS is typically diagnosed in patients with ophthalmic disease, with reports of occurrence after occipital lobe stroke. This case details a typical case of CBS after an occipital stroke, with positive visual hallucinations within the visual field deficit. There is currently no recommended treatment for CBS. Several medications, typically antipsychotics, have been trialed off-label with variable success. However, pharmacologic intervention is not required, especially if the hallucinations are not causing distress.

Conclusions: Patients who develop CBS following an occipital stroke present a difficult diagnostic and treatment scenario in the rehabilitation setting. Once a diagnosis of CBS has been made, pharmacologic intervention is not always necessary if the patient has insight, especially considering the medication side effect profile of treatment options.

Level of Evidence: Level V

« Back to AAPM&R Annual Assembly 2022

PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/non-pharmacologic-management-of-charles-bonnet-syndrome-after-an-occipital-stroke-a-case-report/