Charles Bonnet Syndrome — SCE Neurology MCQ

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ModerateNeuro-ophthalmologyCharles Bonnet SyndromeSCE Neurology

A 40-year-old woman with a right occipital lobe AVM presents with a left homonymous hemianopia with macular sparing. She also has formed visual hallucinations in the left visual field — she sees geometric patterns and coloured shapes. She is fully aware these are not real. What are these hallucinations called?

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Correct answer: A — Charles Bonnet syndrome visual hallucinations

Charles Bonnet syndrome (CBS) describes complex formed visual hallucinations occurring in the context of visual field loss (from any cause — macular degeneration, stroke, optic nerve disease). The patient retains full insight that the hallucinations are not real. They result from deafferentation of the visual cortex, which generates spontaneous activity in the absence of normal visual input. CBS hallucinations are benign and do not indicate psychiatric disease or dementia. B: Migraine aura is typically brief (20–60 minutes) with specific visual features. C: Epileptic visual phenomena from the occipital lobe are usually simple (flashing lights). D: The patient has full insight. E: Anton syndrome is denial of cortical blindness.

Reference: ABN Neuro-ophthalmology Guidelines; Teunisse et al. Charles Bonnet Syndrome