Visual Hallucinations and Ischemic Stroke: Review of 5 Cases

Background: Charles Bonnet syndrome (CBS) presents with complex, vivid, repetitive visual hallucinations that occur in people who have lost some of their vision. The most common cause is senile macular degeneration. CBS can occur, rarely, in patients whose visual pathways are affected. We present five patients with complex visual hallucinations who had occipital lobe lesions after ischemic stroke. Case report: The patients included four men and one woman with a mean age of 71.8 ± 13.08 years. The neurological examinations showed left homonymous hemianopsia in four patients and right homonymous hemianopsia in one, plus there was hemiparesis in two patients and ataxia in one patient. An acute ischemic lesion was seen in the posterior cerebral artery territory in all patients on diffusion-weighted magnetic resonance imaging (MRI). Visual hallucinations in the hemianopic area occurred within the first 48 h of the stroke and lasted from a few minutes to half an hour. Electroencephalography (EEG) taken while symptomatic or shortly thereafter showed mild bioelectrical slowing in the right hemisphere in one patient, while the EEGs of the other patients were normal. During follow-up, the visual hallucinations disappeared in all patients within 3 months, without special treatment. Conclusion: The correct diagnosis of CBS, and treatment if necessary, are important and require an evaluation by a multidisciplinary team that includes neurologists, ophthalmologists, and psychiatrists.