Complex visual hallucinations in a Parkinson patient: don't blame James if it's Charles's fault

Abstract

A patient with a history of Parkinson's disease and severe bilateral peripheral vision loss due to vitreous hemorrhages had complex visual hallucinations that persisted for three days and appeared every morning on awakening. The persistent nature of these hallucinations, the patient's preserved insight, and the presence of severe visual impairment was suggestive for Charles Bonnet syndrome rather than Parkinson-related hallucinations. A treatment with carbamazepine was started and proved to be successful. Physicians treating Parkinson patients should be familiar with Charles Bonnet syndrome and consider it as a potential alternative etiology for visual hallucinations, especially when the patient has severely impaired vision and when the hallucinations are sustained during wakefulness.