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Introduction: We report an epileptic patient who experienced hallucinatory visual experiences of autobiographical memories from her past. These visual experiences were confined to the lower left quadrant of her visual field. Methods: We carried out a single-case study that used brain-imaging, EEG and behavioural methods to study this patient. Results: We found that this patient had an incomplete left inferior homonymous quadrantanopia due to a lesion of right occipital cortex, and also that she showed neurological abnormalities in right temporal cortex, a region that is part of the brain's autobiographical-memory circuit. Conclusion: We attribute the occurrence of this patient's autobiographical-memory hallucinations to the combination of degraded visual input to right temporal cortex plus hyperexcitability of that region. [ABSTRACT FROM AUTHOR]

Visual hallucinations after central or peripheral impairment, commonly called Charles Bonnet syndrome, are often highly distressing and with few available treatment options. Here we report a case where an adolescent developed severely distressing visual hallucinations after hypoxic damage to the occipital cortex following a suicide attempt. The patient received active and sham occipital continuous theta-burst stimulation (cTBS) in a single-case experimental research design and a subsequent open phase, to evaluate cTBS as a Charles Bonnet treatment. The visual hallucinations seemed to decrease more during active than sham cTBS in the blind phase, and in the following week of repeated five daily treatments they almost disappeared. A normalization of increased activity in the lateral visual network after cTBS was observed on a functional magnetic resonance imaging resting-state analysis compared with 42 healthy controls. Visual evoked potentials stayed largely unchanged both in the sham-controlled blind phase and the subsequent open phase. During the two weeks after the open phase with repeated cTBS sessions, the visual hallucinations gradually reappeared and almost returned to the baseline level. Our findings suggest that active cTBS over the primary visual cortex can reduce visual hallucinations through modulation of downstream visual regions, though the effect is temporally limited. [ABSTRACT FROM AUTHOR]

Background: To determine the prevalence of visual hallucinations and to report its associations with demographic and clinical factors in a population-based survey in India.Methods: Prevalence of visual hallucinations was determined as a part of a large prospective, cross-sectional, population-based study that was carried out in two districts of Telangana, namely Khammam and Warangal. Multi-stage cluster random sampling was used in this study. The administration of the questionnaire preceded the clinical examination of the subjects. Associations with factors such as age, sex, education level and visual impairment categories were studied using univariate analysis and multiple logistic regression.Results: Out of the 6,000 subjects who were enumerated from the 120 clusters in Khammam and Warangal districts, a total of 4,936 (82.3 per cent) responded. The mean age of the participants was 55.6 ± 11.8 years. Only the older age group (> 70 years of age) was associated with visual hallucinations on univariate analysis (p < 0.001). On multiple logistic regression, subjects with moderate visual impairment were found to have higher odds of experiencing visual hallucinations (odds ratio 1.48; 95% confidence interval 1.12-1.96, p = 0.006) and those who were older also had higher odds (odds ratio 1.35, p = 0.06).Conclusion: The prevalence of visual hallucinations among those with visual impairment in this population-based study was 13.8 per cent. The older age group and moderate visual impairment were noted to be the associated factors among individuals experiencing visual hallucinations. [ABSTRACT FROM AUTHOR]

Charles Bonnet Syndrome (CBS) is a condition of the visually impaired, in which hallucinations – or, more appropriately, visions – of geometric patterns, people, and objects appear within the visual field. Most people with CBS are older adults, a function of increased likelihood of visual deterioration in later life, but the condition can occur at any age. Diagnostic criteria vary among professions, but generally includes awareness that the visions are not real, the absence of other accompanying sensory hallucinations, and the absence of dementia or other neurological condition. The mechanism by which the phenomenon occurs is not well understood, although some speculation exists that it is akin to phantom limb syndrome. Although there has recently been increasing awareness about the condition, many in the fields of medicine, optometry, and social work have not heard of it. As front-line providers for clients, it is important that social workers be well informed about the condition to alleviate anxiety our clients may have about expressing their experiences with the condition. [ABSTRACT FROM AUTHOR]

Complex visual hallucinations can occur in visually impaired individuals with no underlying psychiatric disorder. This phenomenon is known as Charles Bonnet syndrome (CBS). It is more common in elderly patients who are suffering from impaired vision due to ocular or neurological disease processes, resulting in sensory deprivation. We report a case of CBS in an elderly female with marked ptosis, which was exacerbated following a knee replacement surgery under general anaesthesia. Her CBS symptoms persisted until surgical correction of the ptosis, with a rapid and dramatic resolution of her hallucinations. Although CBS is typically a chronic condition, unusually in this case it was acute and reversible. [ABSTRACT FROM AUTHOR]

A 69-year-old male experienced monocular formed visual hallucinations after occlusion of the right eye following resection of eyelid basal cell carcinoma and reconstruction with a Hughes procedure (tarsoconjunctival flap). His symptoms included recurrent, well-defined, organized, complex, formed images of small children playing in the snow. These visual phenomena occurred only in the occluded eye, began several hours after surgery, and recurred intermittently several times daily for 4 days, lasting several minutes with each occurrence. The patient retained insight into the false nature of the images throughout the duration of his symptoms, and the hallucinations resolved spontaneously while the flap was still in place. To our knowledge, this is the first reported case of Charles Bonnet Syndrome (CBS) following a Hughes procedure in a patient with normal visual acuity in the non-occluded fellow eye. Unlike other reported cases of acute onset CBS following transient monocular occlusion, hallucinations in the occluded eye remitted prior to restoration of vision in the occluded eye. Ophthalmologists should be aware of the potential for CBS following even transient monocular occlusion and should consider warning patients about its potential to occur. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the prevalence of visual hallucinations in Charles Bonnet Syndrome (CBS) among patients at a Low Vision Clinic. To determine whether Low Vision Rehabilitation (LVR) intervention results in a decrease of these visual hallucinations. Methods: We surveyed 50 consecutive new patients in a low vision clinic to determine whether they had experienced visual hallucinations consistent with CBS. All patients were: questioned about the presence of visual hallucinations; given an educational handout that described CBS and reassured them of the benign nature of these hallucinations; and administered Folstein's Mini Mental Status Examination (MMSE). During their low vision examination, all patients received low vision aids to improve their visual function. At follow-up patients who had symptoms of CBS were administered a second survey to evaluate whether they had experienced any change in the frequency of their visual hallucinations. Results: Of the 50 patients surveyed, 12 of 50 (24%) had visual hallucinations typical of CBS. 6 of these 12 patients (50%) had daily recurring hallucinations. At mean follow-up of 34.9 +/-30 days, a second survey was administered to 11 of the 12 patients diagnosed with CBS. One patient was lost to follow-up. Three of the 11 patients (27.3%) experienced a decrease in the frequency of their hallucinations by 43.33% +/-30.55%. Eight of 11 patients (72.7%) did not note a change in their symptoms. Conclusions: It is important to include direct questions regarding visual hallucinations in the case history of a low vision examination. LVR may decrease the frequency of CBS hallucinations in some patients. Rehabilitation strategies should include low vision devices that allow for improved visual function and patient education to provide needed reassurance. [ABSTRACT FROM AUTHOR]

The authors review current literature on hallucinations in Parkinson's disease (PD). Recent neuropathological studies showed that hallucinations occur in synucleinopathies and are a significant predictor of Lewy Body depositions. Therefore, hallucinations are a hallmark of PD and of dementia with Lewy Bodies. Visual hallucinations are mostly complex and kinematic; preserved or disturbed insight on the nature of hallucinations is a major prognostic factor, although eventually all hallucinators will present with reduced insight. Current theories on the origin of hallucinations point to visual dysfunction, dream overflow and cognitive impairment, yet objection can be raised on each one of the putative models of hallucinations. Understanding of the origin of hallucinations is required in order to develop treatments: all treatment evaluations were focused in general on psychosis, and only clozapine obtained positive evidence-based ratings on efficacy. However, it is likely that cholinesterase inhibitors, antipsychotics and anti-5-hydroxytryptamine3 agents and drugs acting on sleep regulation will have different and perhaps opposite effects on different types of hallucinations, whether they are accompanied by disturbed insight, sleep disorders or other psychotic features. Further studies will try to separate phenomenology and responses to treatment and will investigate the relevance of concomitant sleep disorders and abnormality of frontoparietal networks involved in the attention process. [ABSTRACT FROM AUTHOR]

Charles Bonnet syndrome (CBS) is a disorder in which complex visual hallucinations occur in persons without mental disorders but with visual loss or an early stage of an unreality of perceptions. We report 6 cases of CBS who presented in our neuro-ophthalmology clinic. All patients had severe visual loss bilaterally (visual acuity < 0.2), and bilateral optic neuropathies or retinopathies. Their ages ranged from 52 to 79 years, and they reported various types of hallucinations that remained for 5 months to 13 years. We conclude that patients with the Charles Bonnet syndrome are not uncommon in a neuro-ophthalmology clinic, and clinicians should consider this syndrome in patients with hallucinations. [ABSTRACT FROM AUTHOR]

We report the case of a 58-year-old female without a history of psychosis or epilepsy presenting with abrupt late-onset persistent visual hallucinations that had prominent epileptiform discharges with a diffuse sharp and slow wave complex on electroencephalography. Except for the visual hallucinations, other psychotic symptoms and epileptic seizures, such as disturbance of consciousness and convulsion, were not observed. The epileptiform discharge disappeared within 20 days after initiation of treatment with sodium valproate. Clinical improvement commenced after the electroencephalography improvement was complete. The cause remains obscure, but it was suggested that there were some organic factors in the aetiology of this late-onset visual hallucination. [ABSTRACT FROM AUTHOR]

We report a patient with visual hallucinations and illusions along with an associated visual field defect after bilateral ischemic damage to his occipital visual cortex. These hallucinations were long-standing and of both simple and complex (well-formed) type. Application of low frequency (1 Hz) repetitive Transcranial Magnetic Stimulation (rTMS) to the occipital cortex led to a complete cessation of visual hallucinatory symptoms. The use of TMS to probe the neurophysiology, and possibly alleviate, visual hallucinatory experiences is discussed. [ABSTRACT FROM AUTHOR]

Charles Bonnet syndrome (CBS) is characterised by recurrent vivid visual hallucinations in the presence of normal cognition. We present a case of CBS secondary to eye patching following Pars Plana Vitrectomy with an unusually acute onset in a 48-year-old woman. She presented with formed visual hallucinations that started less than 30 min after patching of her left eye. The patch was removed after 2 d, and these hallucinations persisted 2 d following eye patch removal. It is important that the ophthalmic surgeon be aware of the potential for development of CBS and offer appropriate referral and reassurance should it occur. [ABSTRACT FROM AUTHOR]

A correction is presented to the article on "Playthings of the Brain": Phantom Visions in Charles Bonnet Syndrome" which to be appeared on the 2019 issue.