Syndromes and disorders may teach a significant amount about what it means to be human. Some disorders such as the one described below traverse several fields including philosophy, neuroscience and psychology.
Charles-Bonnet syndrome is a well-recognised phenomenon arising with age-related optic degeneration. This syndrome presents with moderately simple geometric hallucinations all the way to exceedingly complex hallucinations involving people and scenes.
Occasionally this syndrome has also led some to mistakenly believe that a patient has some sort of dementia, for example, Alzheimer’s. I was browsing the literature on Google Scholar when I came across an interesting case study of a child who developed Charles-Bonnet syndrome (Mewasingh et al, 2002).
Here I present a summary along with the article at the end for the interested reader to gain a fuller view of the case. I will also leave a couple of resources so that the reader may find out more about this fascinating syndrome.
Symptoms for the child (from here on we’ll refer to as A) began at age 7 when there was total blindness of the left eye along with poor vision in the right. Investigation revealed hypopituitarism and a suprasellar craniopharyngioma (a brief description of these terms at the end of the summary.
The treatment plan included removing the tumour and hormone replacement therapy.
Our story picks up at around age 9 when A began to see things and experience visual hallucinations. The hallucinations consisted of scorpions and mammals as well as reptiles. These images evolved into complex scenes with animated characters. Only eye closure was sufficient to halt the hallucinations.
One might ask how this affected A. At first, he reported being frightened rather unsurprisingly, but after a while, his relationship with these hallucinations developed his interest and he became piqued by these apparitions.
A few months after the development of these hallucinations, A developed apathy and a certain degree of abulia. I’ll avoid the technical details of the paper, but the visual issues were related to ongoing issues with brain topography. Carbamazepine was started and the frequency of the hallucinations decreased to about once a month.
It’s important to note that while the images can be disturbing, insight is usually maintained and the patients experiencing Charle-Bonnet Syndrome generally know they are hallucinating and this was observed in this young patient too.
Abulia: Refers to a general lack of will or inability to decideCarbamazepine: Anti-convulsant drug used especially in epilepsyHypopituitarism: A failure of the pituitary gland to produce hormonesSuprasellar Craniopharyngioma: Tumours that grow near the pituitary gland
References and further reading:
Mewasingh, L.D., Kornreich, C., Christiaens, F., Christophe, C. and Dan, B., 2002. Pediatric phantom vision (Charles Bonnet) syndrome. Pediatric neurology, 26(2), pp.143-145.