Visual hallucinations (Charles Bonnet syndrome) as the presenting sign of pituitary adenoma

Ahn

et al. 2016

Psychiatry Investig

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.

Section: Discussionmentioning

confidence: 98%

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

Ahn

et al. 2016

Psychiatry Investig

Case Reports in Psychiatry

“…Generally, patients with defects of the visual pathways, eye abnormality affecting the transmission of light, and diseases of the neuroretina may be concerned by this pathology [ 1 ]. To our knowledge, pituitary adenoma is rarely reported as an etiology of CBS [ 2 , 8 – 10 ]. Park et al [ 2 ] described a case of CBS that manifested in the first postoperative day after transsphenoidal adenomectomy for pituitary adenoma in a 46-year-old man.…”

Section: Discussionmentioning

confidence: 99%

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

Ghabi

Mâamri

Hajri

et al. 2023

According to the International Statistical Classification of Diseases and Related Health Problems 11th Revision (ICD-11) definition, “Charles Bonnet Syndrome” (CBS) refers to the experience of complex visual hallucinations in a person who has experienced a partial or complete loss of vision. Pituitary adenoma is a rare situation that may be associated with CBS. We report a case of CBS in a Tunisian 44-year-old female with pituitary macroadenoma. The patient reported visual hallucinations which persisted after transsphenoidal adenomectomy. She had no prior psychiatric history. She did not take any medication that could produce hallucinations. After Olanzapine initiation, hallucinations were completely resolved. It is the first Tunisian case of CBS reported in English language. This peculiar condition seems to be under-recognized in our country. Clinicians should be aware that visual hallucinations may concern patients without psychiatric disorders.

Middle East Afr J Ophthalmol

“…The hallucinations often resolve with recovery of visual acuity or visual fields, such as after pituitary adenomectomy. [4] However, resolution of the hallucinations can occur spontaneously, even in the absence of visual improvement.…”

Section: Discussionmentioning

confidence: 99%

Visual hallucinations (Charles Bonnet syndrome) associated with neurosarcoidosis

Zhang

Waisbren

Hashemi

et al. 2013

Self Cite

The Charles Bonnet syndrome (CBS) refers to lucid and complex visual hallucinations in cognitively normal patients with acquired vision loss. It can be associated with any type of vision loss including that related to macular degeneration, corneal disease, diabetic retinopathy, and occipital infarct. Neurosarcoidosis, a multi-systemic inflammatory granulomatous disease affecting both the central and peripheral nervous systems, is rarely associated with CBS. We report a patient with biopsy-confirmed neurosarcoidosis who experienced visual hallucinations following the development of a right seventh-nerve palsy, right facial paresthesia, and bilateral progressive visual loss. This case highlights the importance of recognizing that the CBS can occur in visual loss of any etiology.