Anton's syndrome due to cerebrovascular disease: a case report

Mohana Maddula,Stuart Lutton,Breffni Keegan

doi:10.4076/1752-1947-3-9028

Abstract

IntroductionAnton's syndrome describes the condition in which patients deny their blindness despite objective evidence of visual loss, and moreover confabulate to support their stance. It is a rare extension of cortical blindness in which, in addition to the injury to the occipital cortex, other cortical centres are also affected, with patients typically behaving as if they were sighted.Case presentationWe present a case report of an 83-year-old white woman with cortical blindness as a result of bilateral occipital lobe infarcts. Despite her obvious blindness, illustrated by her walking into objects, the patient expressed denial of visual loss and demonstrated confabulation in her accounts of her surroundings, consistent with a diagnosis of Anton's syndrome.ConclusionsA suspicion of cortical blindness and Anton's syndrome should be considered in patients with atypical visual loss and evidence of occipital lobe injury. Cerebrovascular disease is the most common cause of Anton's syndrome, as in our patient. However, any condition that may result in cortical blindness can potentially lead to Anton's syndrome. Recovery of visual function will depend on the underlying aetiology, with cases due to occipital lobe infarction after cerebrovascular events being less likely to result in complete recovery. Management in these circumstances should accordingly focus on secondary prevention and rehabilitation.

Highlights

Introduction: Anton’s syndrome describes the condition in which patients deny their blindness despite objective evidence of visual loss, and confabulate to support their stance. It is a rare extension of cortical blindness in which, in addition to the injury to the occipital cortex, other cortical centres are affected, with patients typically behaving as if they were sighted
Case presentation: We present a case report of an 83-year-old white woman with cortical blindness as a result of bilateral occipital lobe infarcts
Despite her obvious blindness, illustrated by her walking into objects, the patient expressed denial of visual loss and demonstrated confabulation in her accounts of her surroundings, consistent with a diagnosis of Anton’s syndrome

Summary

Introduction

That is, denial of loss of vision, associated with confabulation in the setting of obvious visual loss and cortical blindness is known as Anton’s syndrome. A computed tomography scan of the patient’s brain (Figure 1) demonstrated evidence of acute infarction in the right occipital and left occipito-parietal lobes, on a background of generalised periventricular ischaemia, consistent with a diagnosis of cortical blindness Her receptive dysphasia resolved early in the course of her hospitalisation, but during her rehabilitiation she continued to deny any loss of vision and showed signs of confabulation. Towards the end of her admission, she asked a nurse to “light up some candles” because she felt the room was dark, suggesting a degree of light perception that was not present on admission She required assistance in mobilising safely in view of her visual impairment, and required help for most activities of daily living. There had perhaps been a slight improvement, the likelihood of a marked recovery in visual acuity remained low

Discussion

Riddoch G

Zeki S

10. Gazzaniga MS