Charles Bonnet Syndrome Following Trans-Sphenoidal Adenomectomy without Optic Nerve Atrophy

Abstract

Charles Bonnet syndrome (CBS) can develop after trans-sphenoidal adenomectomy (TSA); however, the neural mechanisms remain unknown. Sensory deprivation and releasing phenomenon are both hypothetical explanations for this condition; however, there is no definite evidence that strongly supports either supposition. We report the first case of CBS after TSA without optic nerve atrophy. Postoperatively, the patient's vision seemed to be relatively well preserved, apart from the left-side hemianopsia in the right eye. Distinctive visual hallucinations only appeared when his eyes were closed, and these responded to quetiapine in a dose-dependent manner. Dose dependent change in colors and formation of hallucination was reported. Two weeks after quetiapine initiation, the patient's CBS was completely resolved. This unique case suggests that blocking sensory input from the periphery is more critical than neural damage of the bottom-up connection to the visual association cortex. In addition, quetiapine should be considered as a specific treatment for CBS.

Charles Bonnet Syndrome Related to a Pituitary Adenoma: A Case Study in a Tunisian Woman

“…The release theory and the sensory deprivation theory are the two most known mechanisms [ 4 ]. According to the first theory, visual hallucinations are due to a neural defect in the visual pathways [ 2 ]. False signals caused by the abnormal signal transmission may result in complex visual hallucinations when they are associated with normal visual activity [ 2 ].…”

“…Charles Bonnet Syndrome (CBS) is defined by the association of four conditions: (1) persistent or repetitive complex visual hallucinations, (2) insight into the hallucinations, (3) no other types of hallucinations, and (4) no primary or secondary delusions [ 1 ]. CBS associated to pituitary macroadenoma is rarely reported in the literature [ 2 ]. We report a case of CBS in a Tunisian 44-year-old female with pituitary macroadenoma.…”

Visual Hallucinations with Disembodiment and Self-Motion Illusion on Eye Closure after Brain Cyst Drainage: A Case Report

“…Previous cases of visual hallucinations occurring on eye closure have been reported following hip surgery under general anaesthesia [1], local anaesthesia with lidocaine [2,3], atropine administration [4], cardiovascular surgery [5,6], traumatic subdural hematoma in the left occipital region [7], trans-sphenoidal adenomectomy [8] and posterior callosal stroke [9]. The triggering of hallucinations by eye closure can be linked to the "cortical release phenomenon" due to visual Visual Hallucinations with Disembodiment and Self-Motion Illusion on Eye Closure after Brain Cyst Drainage: A Case Report deafferentation in Charles-Bonnet Syndrome [7].…”

“…We report the first documented case of visual hallucinations associated with disembodiment and self-motion illusion, observed after brain cyst drainage. Visual hallucinations on eye closure have been previously reported [1][2][3][4][5][6][7][8][9], but never with disembodiment nor self-motion illusion.…”

“…DTI-based tractography of bilateral cingulum (pink) and of the corpus callosum segmented according to connected areas8 : prefrontal (green), premotor and supplementary motor (cyan), motor (blue), sensory (red), occipital, parietal and temporal (yellow). Cyst contours are shown in violet.…”