A case of Charles Bonnet syndrome following syphilitic optic neuritis

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  • Ogata Hidenori
    Department of Neurology, Neurological Institute, Graduate School of Medical Sciences, Kyushu University
  • Shigeto Hiroshi
    Department of Neurology, Neurological Institute, Graduate School of Medical Sciences, Kyushu University
  • Torii Takako
    Department of Neurology, Neurological Institute, Graduate School of Medical Sciences, Kyushu University
  • Kawamura Nobutoshi
    Department of Neurology, Neurological Institute, Graduate School of Medical Sciences, Kyushu University
  • Ohyagi Yasumasa
    Department of Neurology, Neurological Institute, Graduate School of Medical Sciences, Kyushu University
  • Kira Jun-ichi
    Department of Neurology, Neurological Institute, Graduate School of Medical Sciences, Kyushu University

Bibliographic Information

Other Title
  • 梅毒性視神経炎に合併したＣｈａｒｌｅｓ　Ｂｏｎｎｅｔ症候群の１例
  • 症例報告 梅毒性視神経炎に合併したCharles Bonnet症候群の1例
  • ショウレイ ホウコク バイドクセイ シシンケイエン ニ ガッペイ シタ Charles Bonnet ショウコウグン ノ 1レイ

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Description

Charles Bonnet syndrome refers to visual hallucinations in patients with visual acuity loss or visual field loss without dementia. We report a case of Charles Bonnet syndrome following syphilitic optic neuritis. A 62-year-old man was admitted to our hospital suffering acute bilateral visual loss in a few months. On admission, he was almost blind and his optic discs were found to be atrophic on fundoscopy. In addition to increased cell counts and protein concentration in cerebrospinal fluid (CSF), serum and CSF rapid plasma reagin tests were positive. A diagnosis of syphilitic optic neuritis was made and he was treated with intravenous penicillin G (24 million units per day for 14 days) without any recovery. After treatment finished, he began to experience complex, vivid, elaborate and colored visual hallucinations. He recognized these visions as unreal and felt distressed by them. No cognitive impairment was observed on several neuropsychological tests. We diagnosed the patient as suffering from Charles Bonnet syndrome. Brain MRI revealed diffuse mild atrophy of the cerebral cortex and multiple T2 high signal intensity lesions in the deep cerebral white matter. Single photon emission computed tomography revealed decreased regional cerebral blood flow in bilateral medial occipital lobes. Administration of olanzapine resulted in a partial remission of visual hallucinations.<br> Charles Bonnet syndrome following syphilitic optic neuritis is rare. In the present case, visual loss and dysfunction of bilateral medial occipital lobes may have triggered the visual hallucinations, which were alleviated by olanzapine.<br>

Journal

  • Rinsho Shinkeigaku

    Rinsho Shinkeigaku 51 (8), 595-598, 2011

    Societas Neurologica Japonica

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