Diagnostic and therapeutic management of Charles Bonnet syndrome in an emergency department: a description of 10 cases

Guisado Vasco P, Trueba Vicente A, Barrancos Julián C, Cano Megias M

To describe the diagnosis and therapeutic management of Charles Bonnet syndrome in

the emergency department based on a retrospective descriptive study of all patients with

visual hallucinations who were diagnosed with Charles Bonnet syndrome in the

emergency department of Hospital Universitario Ramón y Cajal in 2010 and 2011. The

patients met all the diagnostic criteria for this syndrome: preserved insight, diminished

vision, and absence of an alternative diagnosis. Follow-up interviews were carried out by

telephone an average of 6 months after diagnosis. Of a total of 140 patients with visual

hallucinations, 14 were discharged with a diagnosis of Charles Bonnet syndrome but

only 10 met all the diagnostic criteria. The mean (SD) age was 80.4 (4.90) years, and

60% were women. Complex visual hallucinations (of persons in 70%) had developed

within 1 to 4 days of consultation in 90%. Visual acuity was less than 0.05 (hand

movements or lights) for 80%, and 3 had full loss of vision in one or both eyes.

Neurologic examination, laboratory tests, and a simple radiograph yielded no findings of

interest. Computed tomography images of the head (70%) yielded only nonspecific

findings. Hygienic measures and quetiapine (25 mg/d) were recommended for 4

patients. The syndrome resolved in less than 3 months in 60% of the patients. Charles

Bonnet syndrome is relatively common among elderly patients with visual hallucinations

and poor visual acuity, but the short-term prognosis is good. An understanding this

syndrome is of great importance in emergency medicine, in the interest of avoiding

unnecessary tests or treatments that may be harmful.

Barrancos Julián C, Cano Megias M, Guisado Vasco P, Trueba Vicente A