Alucinaciones visuales complejas en un paciente con déficit visual severo en ambos ojos (síndrome de Charles Bonnet)

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Abstract

Objetivo/Métodos: Describir la presencia de alucinaciones visuales complejas en una mujer de 69 años con degeneración macular bilateral y catarata unilateral. Tenía orientación y cognición normal y ningún síntoma psiquiátrico. Resultados/Conclusiones: Se presenta una paciente con sintomatología propia de un síndrome de Charles Bonnet. Varios procesos asociados con alucinaciones visuales pueden ser de relevancia para el oftalmólogo.

Translated abstract

Purpose/Methods: To report the occurrence of complex visual hallucinations in a 69-year-old female with bilateral age-related macular degeneration and unilateral cataract. Her orientation and cognition were normal and she showed no evidence of psychiatric symptoms. Results/Conclusions: A case of a patient who presented with visual symptoms characteristic of the Charles Bonnet syndrome is reported. Various conditions associated with visual hallucinations must be kept in mind by the ophthalmologist.

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Most cited references 8

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Visual hallucinatory syndromes and the anatomy of the visual brain.

A M Santhouse, R J Howard, D H ffytche (2000)

We have set out to identify phenomenological correlates of cerebral functional architecture within Charles Bonnet syndrome (CBS) hallucinations by looking for associations between specific hallucination categories. Thirty-four CBS patients were examined with a structured interview/questionnaire to establish the presence of 28 different pathological visual experiences. Associations between categories of pathological experience were investigated by an exploratory factor analysis. Twelve of the pathological experiences partitioned into three segregated syndromic clusters. The first cluster consisted of hallucinations of extended landscape scenes and small figures in costumes with hats; the second, hallucinations of grotesque, disembodied and distorted faces with prominent eyes and teeth; and the third, visual perseveration and delayed palinopsia. The three visual psycho-syndromes mirror the segregation of hierarchical visual pathways into streams and suggest a novel theoretical framework for future research into the pathophysiology of neuropsychiatric syndromes.

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The neural basis of Charles Bonnet hallucinations: a hypothesis.

Thomas Burke (2002)

To describe the hallucinations occurring as a result of a macular hole in each eye and to investigate the neural basis. Psychophysical observations including sketches of the hallucinations calibrated for size. All the hallucinations were of the geometric (patterned) type and lasted for only a few days. The observations can be explained on the basis of a "deafferentation" model, which is described in some detail. It is proposed that the hallucinations result from activation of the "blobs" of area V1 and the "stripes" of area V2 in the visual cortex. A theory is proposed to account for the disappearance of the hallucinations by a "filling in" mechanism.