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LETTER TO EDITOR
Year : 2020  |  Volume : 8  |  Issue : 2  |  Page : 82

A unique form of blindness


Department of Neurology, Dr RML Hospital, Delhi, India

Date of Submission20-Nov-2019
Date of Decision03-Feb-2020
Date of Acceptance10-Feb-2020
Date of Web Publication2-Jul-2020

Correspondence Address:
Abhishek Juneja
A-15, Old Quarters, Ramesh Nagar, New Delhi - 110 015
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jcor.jcor_97_19

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How to cite this article:
Juneja A, Anand KS. A unique form of blindness. J Clin Ophthalmol Res 2020;8:82

How to cite this URL:
Juneja A, Anand KS. A unique form of blindness. J Clin Ophthalmol Res [serial online] 2020 [cited 2020 Aug 7];8:82. Available from: http://www.jcor.in/text.asp?2020/8/2/82/288853



Dear Editor,

Anton syndrome is a form of visual anosognosia, where patients deny their blindness despite obvious visual impairment. It is mostly due to underlying cerebrovascular disease. We came across a 56-year-old male patient who had diabetes mellitus and hypertension for the past 15 years. The patient had sudden onset pulsating headache in the occipital region while watching television at home. It was moderate in intensity and the patient lied down after taking a painkiller. Soon patient got up and while attempting to walk, he fell after colliding with the furniture around. He got up and again walked towards the washroom. He again bumped into the wall and fell. The attendants noticed his gross visual impairment and brought him to the casualty. Surprisingly to the attendants, the patient denied having any visual problem and complained of mild headache in the occipital region. The patient could move all his limbs without any focal motor deficit on neurological examination. There was no gross sensory impairment. His inability to see the things around was evident during examination. The patient insisted that he could see the examiner's fingers in a direction where there was none. He even confabulated that he could see his family members sitting around him. He denied his blindness despite repeatedly pointing it out by the attendants and examiner. Pupillary reflexes were normal and fundoscopy was suggestive of mild nonproliferative diabetic retinopathy. His brain magnetic resonance imaging revealed acute bilateral occipital ischemic infarcts [Figure 1].
Figure 1: Magnetic resonance imaging brain showing diffusion restriction suggesting acute ischemic infarcts in the bilateral occipital lobe

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The clinical symptoms and signs, along with neuroimaging, were consistent with a diagnosis of cortical blindness with visual anosognosia. During the hospital stay, he maintained that he could see normally. Aggressive rehabilitation was initiated with the help of family members. The patient was discharged in stable condition and followed later in the outpatient department on a regular basis. There has been no significant improvement in the visual impairment but the patient accepts the support of his family members in carrying out activities of daily living.

Bilateral occipital stroke is a common cause of visual anosognosia also known as Anton's syndrome.[1] Cortical blindness due to bilateral damage of the occipital lobes is most likely secondary to hypoxia, vasospasm, and cardiac embolism.[2] Confabulation is one of the important criteria of Anton's syndrome. Anton suggested that damaged visual areas are effectively disconnected from functioning areas, such as speech and language areas. In the absence of input, functioning speech areas often confabulate a response.[3] In our patient, clinical history, examination, and neuroimaging were suggestive of Anton syndrome. Early and aggressive rehabilitation measures should be undertaken to prevent accidental injuries and further clinical deterioration.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Aldrich MS, Alessi AG, Beck RW, Gilman S. Cortical blindness: Etiology, diagnosis, and prognosis. Ann Neurol 1987;21:149-58.  Back to cited text no. 1
    
2.
Kondziella D, Frahm-Falkenberg S. Anton's syndrome and eugenics. J Clin Neurol 2011;7:96-8.  Back to cited text no. 2
    
3.
Maddula M, Lutton S, Keegan B. Anton's syndrome due to cerebrovascular disease: A case report. J Med Case Rep 2009;3:9028.  Back to cited text no. 3
    


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