Do You See What I See Denise A
- Slides: 26
Do You See What I See? Denise A. John VEI 10/20/2006
Case n HPI: 35 y/o ♀ c/o’s of “seeing shapes, colors & partially-formed images. ” n ROS: (+) Mild headache/weight loss/poor energy/constipation Questions? ? ?
Differential Diagnosis n Classic Migraine n Psychosis n Psychiatric illness n Schizophrenia n Affective disorders n Conversion disorders n Metabolic/toxic n Electrolyte imbalance n Uremic n Liver dz n Infection n Alcohol/drug effects Neurodegenerative disorder n Diffuse Lewy Body n Parkinson’s n Alzheimer’s Sleep-related hallucinations n “ Hypnopompic “ n n n Peduncular hallucinations n Seizures n Release hallucinations
Fortification Spectrum
Case n FHX: n Glaucoma n Heart & liver dz; HTN; cancer; stroke n SHX: ø Tobacco/IVDA/ETOH n NKDA n MEDS: ASA; prednisone; pepcid; metoclopramide; anzemet; synthroid; colace; lexapro; zyprexa; morphine; lortab
Case n PMHX: n Migraines n Pituitary GH-producing adenoma n Pituitary apoplexy n Subarachnoid hemorrhage n S/p trans-sphenoidal hypophysectomy x 2; CSF leak x 2 s/p repair n Panhypopituitarism n SIADH n Depression n Polycystic ovarian syndrome n Psoriatic arthritis
Case n Alert & oriented x 3 n Normal affect 5 n Pupils 5 n n NLP n VA NLP n n NR to light Partial reaction to near n External/PLE exam unremarkable n DFE: n Mild disc pallor OU n Macula/vessels/peripher y unremarkable OU CVF: Unable OU Motility: Full OU 11 n IOP 12
Patient
Patient
Visual Hallucinations
Visual Hallucinations Visual perceptions not associated with external visual stimuli
Visual Hallucinations n Simple (non-formed): n Dots n Colors n Flashing lights n Geometric patterns
Visual Hallucinations n Complex (formed): n Objects n Animals n People n Scenery
Visual Illusions n Distortion or modification of a real visual image
Visual Hallucinations n Most are NOT due to psychiatric dz n Related to ocular, optic nerve or brain pathology n Treatment involves managing underlying disorder n Insight into the reality of the hallucinations varies with the associated etiology n May interfere with daily functioning & cause significant anxiety
Visual Hallucinations: Etiologies
Phosphenes n “Seeing light” n Insight preserved n Visual hallucinations: n “Scintillating blue spots on a black background n Rubbing closed eyes n “Seeing stars” n Sneeze, head trauma, low blood pressure n “Flashes of light” (photopsias) n Dim lightening or total darkness n Light twinkles to bright flashes n Irritation of photoreceptors n Vitreous traction n Retinal detachment/ inflammation n Optic neuritis n Esp. with EOM/sound
Psychosis n Visual Hallucinations: n Complex n Duration: Variable n +/- Other hallucinations n n Esp. auditory +/- Insight preservation
Release Hallucinations Complete or partial visual acuity/field loss from any cause n n n Commonly seen in AMD Charles Bonnet Syndrome (CBS) n Described in 1769 n Swiss naturalist & philosopher n ~ 14% prevalence in U. S. eye clinics n with age n Ø Gender predilection
Release Hallucinations n Theory of CBS: n Sensory deprivation n Visual cortex “release phenomenon” n Input from other cortical areas (esp. memory) “fill-in” the sensory deficit n Risk factors: n Bilateral visual loss n age n Solitude n Cognition
Release Hallucinations n Visual hallucinations: 65%: Weekly/monthly; 27%: Daily n People: 80%; animals: 38%; plants/trees: 25%; buildings/other scenery: 15% n Color: 63% n Movement: 47% n Duration: n 53%: 1 -60 mins; 13% < 5 secs n Eyes open: 67% n n Teurisse et al. Visual hallucinations in psychologically normal patients: CBS. Lancet, 1996
Release Hallucinations n Insight preserved n Setting: n Fatigue n Stress n Early mornings/late evening n Poor lightening n Often spontaneously resolve n Worsening/improvement of visual loss
Release Hallucinations n Management: n Reassurance of sanity n Keep eyes closed n Look away from visions n Improve lightening n social interactions n Antipsychotic/antiepileptic medications
Back to our patient… Assessment: Visual - deprivation hallucinations (Charles Bonnet Syndrome) n n Plan: n Psychiatry consulted n Olanzapine 5 mg QHS
References n n n n BCSC. Neuro-Ophthalmology. AAO. 2004 -05 Kanski. Clinical Ophthalmology, 5 th Ed. Butterworth Heinemann. 2003 Teurisse et al. Visual hallucinations in psychologically normal patients: CBS. Lancet, 1996 Manford et al. Complex visual hallucinations. Brain. 1998 Visual hallucinations caused by vision impairment. Geriatrics. 2002. 57 (6): 45 -6 Charles Bonnet syndrome. Psychology of medicine. 1982; 12: 251 -61 Charles Bonner syndrome: A review. Journal of Mental Disorders. 1997; 185 (3): 195 -200 Pelak et al. Visual Hallucinations. Current Science. 2006
- It's not what you look at that matters, it's what you see.
- Major prophets
- Good morning nice to see you
- Tardes buenas tardes
- Vrije observatie
- Denise yaghmourian gallery phoenix
- Denise lord
- Denise wagoner car accident
- Denise schout
- Denise gabuzda
- Dr denise wood
- Denise farrelly
- Thirsty sign language
- Weeds denise
- Denise hayward
- Denise fritz
- The weary blues themes
- Denise kerrigan
- Denise camp
- Denise caldwell nsf
- Ulf borg
- Dra denise hematologista
- Denise johnson case
- Sound energy pictures
- Denise coffey death
- Business ed with denise leigh
- Denise keaton