1333 - The Man who Hallucinated Cats: Managing Charles Bonnnet Syndrome in the Inpatient Rehabilitation Setting

Thursday, February 19, 2026

5:00 PM - 6:30 PM AST

Presenting Author(s)

LJ

Lea Jarrett, MD

PM&R Resident, PGY-3
Medical College of Wisconsin
Columbia, Wisconsin, United States

Co-Author(s)

DD

David Del Toro, MD

Attending Physician
Medical College of Wisconsin
Wauwatosa, Wisconsin, United States
MM

Mary Meyers, BS

Medical Student
Medical College of Wisconsin
Wauwatosa, Wisconsin, United States

Submitter(s)

LJ

Lea Jarrett, MD

Medical College of Wisconsin
Columbia, Wisconsin, United States

Case Diagnosis: Charles Bonnet syndrome (CBS), or phantom eye syndrome, involves visual hallucinations in people with acquired vision loss, caused by the brain generating images without external input.

Case Description: Mr. P</span>, a 65-year-old male, developed endophthalmitis and corneal ulcer after cataract surgery, ultimately requiring right eye enucleation. Pre-operatively, he experienced distressing visual and tactile hallucinations of spiders consistent with alcohol withdrawal, which resolved within two days of admission. Post-operatively, he developed new, non-distressing, constant visual hallucinations of wavy lines, colors, road maps, and cats. He had insight that these new visual hallucinations were not real and was started on oral olanzapine 5 mg daily. Upon transfer to inpatient rehabilitation (IPR), hallucinations had decreased in frequency, and by discharge a week later, they had mostly resolved.

Discussions: At IPR, CBS contributed to impaired mobility, balance, and activities of daily living (ADLs). Physical and occupational therapy documented difficulty ambulating due to colorful, patterned hallucinations on the floor, requiring minimal assistance. Functional gait assessment improved significantly during IPR, from 6/30 (fall risk) to 22/30 at discharge. Mobility/ADL Quality Indicator scores also improved for transfers and self-cares. With multidisciplinary support – physical and occupational therapy, rehabilitation psychology, and medication – the patient achieved improvement in mobility, independence, and reduced visual hallucinations.

Conclusions: The estimated prevalence of CBS varies from 0.4 to 4% and is likely underreported due to fear of being diagnosed with psychiatric disease. Although there have been case reports of CBS related to stroke in the IPR setting, to our knowledge, this is the first documented case following eye enucleation in IPR. While no definitive treatment exists, symptoms may improve with IPR therapy, psychoeducation, and medication. This case highlights the need for further research to establish optimal management strategies combining therapeutic and pharmacologic approaches.