Charles bonnet syndrome due to cerebral venous thrombosis

Resumo

Introduction
Charles Bonnet Syndrome (CBS) is characterized by visual hallucinations, preserved awareness of unreal visions and absence of psychotic symptoms. There are limited cases reported on CBS after ischemic stroke and just one describing CBS due to cerebral venous thrombosis (CVT). Our aim is to describe the clinical course of the first case of CBS after CVT without optic nerve atrophy or vision loss in a patient admitted with intense headache and acute onset of visual hallucinations. The patient has signed the consent form and were only used the medical records for the case.
Case Report
A fifty-nine years old healthy man was admitted with complaints of recurrent episodes of headache in the last month and subsequent visual hallucinations, specifically prosopometamorphopsia - he reported seeing distorted images of faces and objects -. It was not associated with any sensory or motor complaints. General medical and neurological examination on admission was intact. He had no meningismus. Blood work revealed an alteration in C-reactive protein and cerebrospinal revealed lymphocytic pleocytosis. Brain computed tomography scan showed an ill-defined hypodense cortical lesion in the right temporal and occipital region. Magnetic resonance imaging scan confirmed the presence of a cerebral venous thrombosis in the right sigmoid and transverse sinuses. He was treated with heparin followed by warfarin, but the visual hallucinations remained. It was opted to start corticosteroid. The patient had excellent recovery a few weeks after admission and was regularly followed up. Later, he was found to be positive for the mutation in the prothrombin gene.
Conclusions
Cerebral venous thrombosis can be presented with different neurological symptoms but does not typically present with hallucinations. For this reason, illusions should be added to the already broad spectrum of presenting features of CVT. This diagnosis may be, still, considered in patients presenting with new auditory hallucinations and illusions, particularly in the context of accompanying headache and conventional risk factors for venous thrombosis.