Case Diagnosis: Charles Bonnet Syndrome (CBS) in a patient with a spinal cord injury (SCI) and acquired visual impairment due to cataracts.
Case Description: A SCI patient with a history of bilateral cataracts presented with new-onset complex visual hallucinations. The hallucinations were vivid, stereotyped, and occurred in the context of significant visual loss from cataracts, with preserved insight and no evidence of psychiatric or cognitive disturbance. Comprehensive evaluation, including neuroimaging and laboratory studies, excluded alternative etiologies for the hallucinations.
Discussions: CBS is defined as visual hallucinations in individuals with visual pathway impairment and intact reality testing, in the absence of psychiatric illness. Cataracts are a well-established cause of CBS, as sensory deprivation and deafferentation of the visual cortex play key roles in its pathophysiology. SCI patients may be at increased risk of cataract formation due to corticosteroid exposure, and their limited environmental stimulation or polypharmacy may further exacerbate visual impairment. Recognizing CBS is crucial to avoid misdiagnosis and unnecessary psychiatric intervention. Management is primarily supportive, emphasizing patient education and reassurance about the benign nature of the condition. In our case, the patient’s hallucinations resolved following successful cataract surgery. Pharmacologic therapy, such as atypical antipsychotics, may be considered in refractory or distressing cases, though evidence remains limited.
Conclusions: This case highlights the importance of recognizing CBS in SCI patients with visual impairment due to cataracts. Early identification and appropriate management can reduce patient distress and prevent unnecessary psychiatric treatment. Furthermore, raising awareness of CBS among rehabilitation physicians is critical, as these patients may first present in rehab settings rather than ophthalmology or psychiatry clinics. Education of both patients and healthcare providers can improve diagnostic accuracy, facilitate timely ophthalmologic intervention, and foster reassurance for affected individuals.
