PSYCHIATRIC ISSUES 2014 

Minerva Psichiatrica 2014 March;55(1):17-23

Copyright © 2014 EDIZIONI MINERVA MEDICA

language: English

Charles Bonnet syndrome and dementia after traumatic brain injury

Tobe E. H.

Department of Psychiatry, Cooper Medical School of Rowan University, Camden, NJ, USA

Traumatic brain injury (TBI) is a serious public health problem that may cause permanent disability and death. Charles Bonnet syndrome, uncommon after TBI, is a syndrome manifested by visual hallucinations. We evaluated a patient who developed Charles Bonnet syndrome after TBI in a motor vehicle accident. After the acute hospitalization (43 d), he had visual hallucinations of people or animals in trees, and fish, dogs, and scorpions in his backyard. Neuropsychologic testing showed left-sided brain impairment and major impairment of visual working memory, abstract processing, motor coordination, spatial perception, and reasoning. At 23 months after the injury, neurologic examination showed bradyphrenia, confusion, difficulty following directions, emotional withdrawal, and fear. Positron emission tomography scan showed large, diffuse, symmetrical areas with decreased uptake of 18F-fluorodeoxyglucose in bilateral temporal lobes, parietal lobes, and left frontal lobe; the dorsal portions of bilateral caudate nucleus were poorly visualized. In summary, this patient developed Charles Bonnet syndrome and probable Lewy Body Dementia and Alzheimer disease within two years after TBI, most likely as a result of synergy between family history of synucleinopathy, older age, and TBI.