IntroductionAnton's syndrome describes the condition in which patients deny their blindness despite objective evidence of visual loss, and moreover confabulate to support their stance. It is a rare extension of cortical blindness in which, in addition to the injury to the occipital cortex, other cortical centres are also affected, with patients typically behaving as if they were sighted.Case presentationWe present a case report of an 83-year-old white woman with cortical blindness as a result of bilateral occipital lobe infarcts. Despite her obvious blindness, illustrated by her walking into objects, the patient expressed denial of visual loss and demonstrated confabulation in her accounts of her surroundings, consistent with a diagnosis of Anton's syndrome.ConclusionsA suspicion of cortical blindness and Anton's syndrome should be considered in patients with atypical visual loss and evidence of occipital lobe injury. Cerebrovascular disease is the most common cause of Anton's syndrome, as in our patient. However, any condition that may result in cortical blindness can potentially lead to Anton's syndrome. Recovery of visual function will depend on the underlying aetiology, with cases due to occipital lobe infarction after cerebrovascular events being less likely to result in complete recovery. Management in these circumstances should accordingly focus on secondary prevention and rehabilitation.

Objectives & BackgroundSince ‘legal highs' emerged as drugs of abuse in the UK, Emergency Physicians have battled to keep up with the latest drug craze. Whilst many of these drugs present with recognisable toxidromes, the effect of new compounds or medications cannot be readily predicted. In Belfast, we have witnessed a recent increase in the number of patients presenting after recreational abuse of Pregabalin (Lyrica). Patients, state that the medication induces a state similar to drunkenness, hence the street name ‘Budweiser's’. To our knowledge this is the first case series detailing the recreational abuse of Pregabalin, a drug which has become popular in primary care.MethodsWe conducted a one year review of all patients presenting to our department after recreational drug abuse. Those who admitted to Pregabalin usage were identified and case notes were reviewed.ResultsBetween 02/12–02/13, 10 patients presented to our ED following recreational Pregabalin abuse. All were aged between 20 and 35 years of age. Dosages ranged from 500–1400 mg. Six patients presented with seizures (5 of which were ‘first' seizures). Two patients required intubation and ventilation and were admitted to the ICU. In total, nine patients were admitted for a minimum of 24 hours, whilst one patient discharged against advice.ConclusionEmergency Physicians should be aware of the current use of Pregabalin as a recreational drug. Patients are either taking tablets whole or cutting and snorting them. 60% of patients in this case series presented to the ED with seizures and 20% required ICU admission. We recommend that patients who present with potential Lyrica toxicity should be admitted for observation with the treating physician being mindful of the potential for seizure activity.

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