Closed-Eye Visualizations in the Setting of Hyponatremia

Abstract

Purpose To report a case of closed-eye visualizations and to clarify the different types of hallucinations and their etiologies. Methods Retrospective case report of a patient with closed-eye visualizations secondary to hyponatremia. Clinical findings, physical exam, laboratory assessment, treatment, and disease course from the patient's hospitalization were used in creating this report. Follow-up data after discharge were also obtained. Results Closed-eye visualizations were diagnosed as secondary to hyponatremia, as they did not occur with the eyes open, and potential alternate causes were excluded. Serum sodium nadir was 119 mEq/L. Symptoms resolved with correction of hyponatremia via fluid resuscitation and electrolyte replenishment. There has been no recurrence of the symptoms. Conclusion This patient had hallucinations exclusively with the eyes closed, which must be differentiated from the release hallucinations seen with the eyes open in Charles Bonnet syndrome. This patient had no visual loss or retinal disease, which should be suspected in open eye hallucinations.

Closed-Eye Visual Hallucinations Preceding Severe Alcohol Withdrawal

“…The closed-eye visual hallucinations reported by our patient are similar to the ones previously described in a few limited cases, distinct from the visual hallucinations described in Charles Bonnet syndrome or psychotic disorders [ 3 - 8 ]. Additional research is required to elucidate the mechanism, etiologies, and clinical implications of this curious phenomenon.…”

“…Charles Bonnet syndrome is a known condition in which visual hallucinations occur due to visual sensory deprivation caused by vision loss and is most prevalent in elderly patients [ 2 ]. Previously published case reports describe a novel type of visual hallucination occurring primarily with eye closure and are distinct from the visual hallucinations associated with Charles Bonnet syndrome [ 3 - 8 ]. We present a case of closed-eye visual hallucinations with onset before severe alcohol withdrawal.…”

A Rare Case of Visual Hallucinations Associated With Hyponatremia

“…Thus, gathering a comprehensive medical history is crucial, paying close attention to the nature of the hallucinations, whether they are simple or complex, the specific content involved, any distortion present, any associated triggers, and the patient's insight into their reality. Examining these details allows for a more focused exploration of the potential causes of hallucinations [ 5 ].…”

“…Hypnagogic hallucinations are caused by increased thalamus activation and spontaneous discharges resulting from cortical differentiation [ 10 ]. Peck et al suggested that hyponatremia may increase excitatory influences in the brain, leading to hallucinations [ 5 ].…”

“…Among patients with serum sodium below 120 mEq/L, 0.5% report experiencing hallucinations [ 5 ]. Recognizing these visualizations as a symptom of an electrolyte abnormality is crucial, as correcting the imbalance can resolve the hallucinations.…”