Atypical Charles Bonnet syndrome with visual and auditory musical hallucinations. Case report and literature review

   Charles Bonnet syndrome (CBS) is defined as complex visual hallucinations (VH) in people with visual impairments who are awake, fully or partially aware of the unreality of the hallucinatory images they see, and who do not have cognitive or psychotic disorders. Auditory hallucinations (AH) associated with severe acquired hearing loss are called the “auditory analogue” of СBS. In rare cases, AH in patients with hearing loss are represented by musical fragments and are referred to as “musical ear syndrome”.The combination of classical СBS and its auditory analogue is considered a variant of atypical CBS (ACBS). This combination is rarely described, although in reality its prevalence may be
quite high.

   The aim of this study was to describe a clinical case of ACBS, manifested by a combination of CBS and its auditory counterpart, in an 82-year-old cognitively intact woman without psychotic disorders.

   The clinical features of this variant of AСBS are discussed taking into account the descriptions of 15 more patients published over the past 25 years. Current views on the pathogenesis of VH and AH in visually and hearing-impaired patients, as well as issues of their differential diagnosis and treatment, are outlined.

   Conclusion. Atypical Charles Bonnet syndrome, characterized by a combination of visual and auditory hallucinations in people with visual and hearing impairment, may be much more common than is believed, as many patients avoid reporting hallucinations, and doctors don’t always ask about them. Its timely diagnosis, based on a thorough examination of complaints and medical history, as well as the exclusion of other causes of perceptual disorders, helps to avoid ineff ective treatment and improve quality of life.

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