Anton's Syndrome Research Articles

Resident & Fellow Rounds.

This issue starts off with a Clinical Reasoning case that reviews the differential diagnosis of acute headache in an adult. The Pearls & Oy-sters is a pediatric case discussing a genetic syndrome with paroxysms that may be difficult to distinguish from seizures. There are also 2 Teaching NeuroImages that describe a rare cause of ophthalmoparesis and visual anosognosia.

Ceguera de Anton-Babinski, a propósito de un caso

Clinical caseA 22 year-old woman complained about blurred vision after an episode of recovered cardiorespiratory arrest. She had bilateral low visual acuity («count fingers») and no ophthalmological or visual pathways changes. She also had an apparent lack of awareness of the deficit. The Magnetic Resonance Imaging (MRI) showed ischaemic changes in both occipital lobes. As a result, she was diagnosed with Anton-Babinski syndrome. DiscussionThis is a rare disease that should be suspected in strange or poorly congruent visual loss. It is usually due to an ischaemic injury in this region of brain, manifesting itself with low vision not perceived by the patient (visual confabulation). It can simulate a non-organic visual loss or psychiatric disease.

Bilateral cortical blindness with Anton–Babinski syndrome in an elderly Nigerian woman: Challenges for tertiary prevention

Anton–Babinski syndrome (Anton's syndrome) is well described in the scientific literature even though it is a rare neurological condition. Most publications have highlighted the anatomy, neurophysiology, and pathology of visual anosognosia, which is the hallmark of the syndrome. We are not aware of any published report of cortical blindness with Anton's syndrome from Africa. We report a catastrophic complication of severe hypertension in an elderly Nigerian woman who was on follow-up for stroke, chronic heart failure, diabetes mellitus, and glaucoma. She developed bilateral cortical blindness with Anton's syndrome as a complication of severe hypertension, following 3 weeks of missed medications. This report highlights some challenges of tertiary prevention in this elderly woman without health insurance, who before becoming blind, had been largely dependent on family members' goodwill for her medical care.

Resolution of Anton–Babinski syndrome after systemic thrombolysis and mechanical thrombectomy with a stentriever

Anton–Babinski syndrome is a rare neuropsychiatric syndrome characterized by bilateral cortical blindness and anosognosia with visual confabulation. We present the case of a patient presenting with occlusion of both posterior cerebral arteries (PCA), with Anton–Babinski syndrome, completely solved after combined systemic thrombolysis and mechanical thrombectomy with a stent-retriever.

Anton syndrome as a result of MS exacerbation.

I read with interest the case report by Kim et al.1 detailing Anton syndrome (AS) in a patient with multiple sclerosis. Apart from visual anosognosia, confabulation is an important symptom of AS. It is …

Poster 384: Anton-Babinski Syndrome Diagnosed During Inpatient Rehabilitation

Poster 384: Anton-Babinski Syndrome Diagnosed During Inpatient Rehabilitation

CORTICAL BLINDNESS AND ANTON SYNDROME IN POSTERIOR CORTICAL ATROPHY

The dementia disorder - Posterio Cortical Atrophy (PCA) is clinically characterized by progressive impairment in visuoperception and visuospatial function. The imaging studies (brain MRI and FDG-PET/CT) show outstanding cortical atrophy or hypometabolism of visual association cortices of occipital, temporal and parietal lobes. Though the underlying pathology includes Alzheimer's disease, corticobasal degeneration and Lewy-body dementia, Alzheimer's pathology has been reported in majority of PCA patients in medical literature. Among all visual symptoms of PCA, cortical blindness and Anton syndrome mostly devastate patients. In this report, the PCA patients with cortical blindness and Anton syndrome are studies in a dementia specialty clinic. The medical charts of patients, who had met the diagnostic criteria of PCA from July 2015 to December 2016, were reviewed. For this study, the patients with documented cortical blindness and Anton syndrome were recruited. The data of clinical evaluation, MMSE scores, brain MRI studies, neurological reports, FDG-PET/CT, Amyloid-PET/CT and neuropsychiatric profiles were analyzed. There were four PCA patients with cortical blindness and Anton syndrome (one woman; three men). The average age was 58. Compared with the PCA patients without cortical blindness and Anton syndrome, these four subjects displayed either worse cortical atrophy of brain MRI studies or severe hypometablism of the FDG-PET/CT study. However, the positive result of Amyloid PET/CT was the same in these four subjects as those patients without cortical atrophy and Anton syndrome. These four subjects presented frequent neuropsychiatric symptoms daily, including agitation and visual hallucinations. The progression of PCA often results in cortical blindness and Anton syndrome. The implication of this development is extensive neuron loss and breakdown of higher cortical visual system. Early intervention of the Alzheimer pathology could be the future hope to halt the progression of PCA.

Cortical blindness (Anton-Babinski Syndrome), an Unusual Manifestation of Central Nervous System Tuberculosis

Anton syndrome, or cortical blindness, consists of an objective blindness in the presence of an intact anterior visual pathway, with the patient expressing a denial of blindness; it is a peculiar form of visual anosognosia. Those patients with this syndrome often show an inappropriate affect and confabulate to conceal their visual loss. The common pathologic process in Anton syndrome is an ischemic event of the occipital circulation, and the most frequent causes are cerebral infarctions in aged patients with vascular risk factors, while hypertensive encephalopathy, eclampsia, hypoperfusion, trauma, tumors, and bacterial meningitis are common in children. Herein we report two patients with Anton-Babinski syndrome related to tuberculous meningitis, cared for at a single center. A search in the literature did not render any similar cases previously reported. The patients had no previous history of vascular risk factors, and the presentation of tuberculous meningitis was atypical: in the context of a rapidly evolving headache, one of the patients had visual changes and mental confusion; the other patient presented with stupor caused by acute hydrocephalus. Ischemic events were documented by imaging studies, and cerebrospinal fluid was inflammatory with positive polymerase chain reaction (PCR) for Mycobacteriumtuberculosis and high adenosine deaminase levels. Antituberculous drugs wereadministered and both patients stabilized; one patient showed no significant visual recovery, while the other was able to walk unassisted but had severe and incapacitating neuropsychiatric sequels at 3 years of follow-up.

Introspection, Anton's Syndrome, and Human Echolocation

AbstractPhilosophers have recently argued that since there are people who are blind, but don't know it, and people who echolocate, but don't know it, conscious introspection is highly unreliable. I contend that a second look at Anton's syndrome, human echolocation, and ‘facial vision’ suggests otherwise. These examples do not support skepticism about the reliability of introspection.

Posterior Reversible Encephalopathy Syndrome in pre-eclampsia presenting as Anton syndrome

Introduction: Posterior reversible encephalopathy syndrome (PRES) is a transient clinical neuroradiological entity caused by reversible ischemia most commonly of the posterior cerebral vasculature. Diagnosis ofPRES might be obscured when the patient presents with visual anasognosia (Anton syndrome) as the initial manifestation. Case report: An 18 year old lady presented with vomiting, severe headache and oedema at 32 weeks gestation. She had severe-preeclampsia evidenced by blood pressure of 160/110mmHg, hyperreflexia and albuminuria. She further had visual anasognosia (cortical blindness) and a post-partum convulsion prompting the consideration of PRES, which was later confirmed by Magnetic Resonance imaging. She underwent immediate delivery by caesarean section followed by rapid reduction of blood pressure resulting in complete recovery within 48 hours. Conclusion: Prompt recognition of Posterior Reversible Encephalopathy Syndrome (PRES), which has a strong association with pre-eclampsia, is extremely important to prevent the associated morbidity and mortality. Eventhough, the vigilant management of PRES during ante-partum period might be complicated, this case consolidates the fact that early diagnosis of PRES leads to a favourable outcome. DOI: http://dx.doi.org/10.4038/slja.v23i1.7636

No. 54 A Rare Reversible Case of Anton Syndrome and the Role of Amantadine in Management: A Case Report

No. 54 A Rare Reversible Case of Anton Syndrome and the Role of Amantadine in Management: A Case Report

Haliucinacijų etiologijos aspektai

Hallucinations are misperceptions of things or events with one or more senses when an internal or external trigger doesn’t exist. They can be divided into visual, audioverbal, olfactorical, tactile and gustatory. Hallucinations develop due to 3 main pathophysiologicalmechanisms: psychophysiological, psychobiochemical (neurohormone dependent) and psychodynamic. Etiology of these perceptions consists of many things and is not always binned to psychiatric illnesses. These are some of the etiological factors which will be mentioned further bellow: psychosis, delirium, dementia, Charles Bonnet syndrome, Anton syndrome, seizures, migraine, Lhermitte syndrome, sleep disorders and “Alice in Wonderland” syndrome. Audioverbal hallucinations are thought to be a misperceptionof one’s own thoughts which are understood as the speech of someone else. This happens because of distorted function of frontotemporal efferents. These parts of brain are known for their sensorial region activation in the brain and also for the identification and perception of triggers that arise in a person. Furthermore, and increased activity of Wernicke’s region, right putamen, thalamus, and nucleus caudatus was also noticed. During the events of audioverbalhallucinations increased activity of Broca’s region and dorsal cortex of gyrus cinguli were noticed. Subcortical structures might also be the reason or the regulating part of the brain responsiblefor the manifestation of hallucinations which originate in the cortex. Visual hallucinations appear after triggering the primary or associational visual cortex, deafferetion mechanism, when there is some sort of damage to the periferial or central parts of nervous system responsible for visual perceptions. In addition, sleep and wakefulness cycles might be unbalanced and there can be some cognitive disorders.

Recurrent bilateral occipital infarct with cortical blindness and anton syndrome.

Bilateral cortical blindness and Anton syndrome, are most commonly caused by ischaemic stroke. In this condition, patients have loss of vision but deny their blindness despite objective evidence of visual loss. We report a case of a patient with multiple cardiovascular risk factors who developed recurrent bilateral occipital lobe infarct with Anton syndrome. A suspicion of this condition should be raised when the patient has denial of blindness in the presence of clinical and radiological evidence of occipital lobe injury. Management of this condition should focus on the underlying cause, in which our patient requires secondary stroke prevention and rehabilitation.

Anton's Syndrome due to Bilateral Ischemic Occipital Lobe Strokes.

We present a case of a patient with Anton's syndrome (i.e., visual anosognosia with confabulations), who developed bilateral occipital lobe infarct. Bilateral occipital brain damage results in blindness, and patients start to confabulate to fill in the missing sensory input. In addition, the patient occasionally becomes agitated and talks to himself, which indicates that, besides Anton's syndrome, he might have had Charles Bonnet syndrome, characterized by both visual loss and hallucinations. Anton syndrome, is not so frequent condition and is most commonly caused by ischemic stroke. In this particular case, the patient had successive bilateral occipital ischemia as a result of massive stenoses of head and neck arteries.

Rehabilitation of a Patient with Balint's Syndrome Who Initially Presented with Cortical Blindness and Visual Anosognosia: A Case Report

PM&RVolume 5, Issue 9S p. S269-S270 Neurological Rehabilitation Rehabilitation of a Patient with Balint's Syndrome Who Initially Presented with Cortical Blindness and Visual Anosognosia: A Case Report Emilia Ravski DO, Emilia Ravski DO NYU, New York, NY, United StatesSearch for more papers by this authorSergio R. Lombardo DO, Sergio R. Lombardo DO NYU, New York, NY, United StatesSearch for more papers by this authorKevin Bernard MD, Kevin Bernard MD NYU, New York, NY, United StatesSearch for more papers by this authorHeidi N. Fusco MD, Heidi N. Fusco MD NYU, New York, NY, United StatesSearch for more papers by this author Emilia Ravski DO, Emilia Ravski DO NYU, New York, NY, United StatesSearch for more papers by this authorSergio R. Lombardo DO, Sergio R. Lombardo DO NYU, New York, NY, United StatesSearch for more papers by this authorKevin Bernard MD, Kevin Bernard MD NYU, New York, NY, United StatesSearch for more papers by this authorHeidi N. Fusco MD, Heidi N. Fusco MD NYU, New York, NY, United StatesSearch for more papers by this author First published: 17 September 2013 https://doi.org/10.1016/j.pmrj.2013.08.462Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume5, Issue9SSeptember 2013Pages S269-S270 RelatedInformation

The Dide–Botcazo syndrome: Forgotten and misunderstood

Bilateral infarcts of the posterior cerebral arteries are associated with a range of visual and memory deficits. In 1902, Dide and Botcazo presented a clinico-pathological case study linking visual field defects, topographical disorientation, retro-anterograde amnesia and alexia with bilateral medial occipito-temporal lesions. Based on the findings they suggested the occipital lobe and inferior longitudinal fasciculus played an important role in memory. The combination of deficits was subsequently referred to on occasion as Dide–Botcazo syndrome but the term was largely forgotten until revived in the 1980s. More recently, some authors have included visual anosognosia – Anton's syndrome – in the syndrome, a feature that was not in the original case report. Here we present a historical review of Dide–Botcazo syndrome, illustrated with a recent case with almost identical clinical features to that described by Dide and Botcazo. Although Dide and Botcazo's theory of occipital amnesia has been superseded by developments in our understanding of the neurobiology of memory, it seems fitting to remember in some way their description of a clinical association of visual and memory deficits. We suggest Dide–Botcazo syndrome be used to describe a variant of vascular dementia, where visual field deficits are associated with memory impairment and, depending on the location of the vascular lesions, visual perceptual dysfunction, topographic, imagery or dreaming deficits.

The “Altitudinal Anton’s Syndrome”: Coexistence of Anosognosia, Blindsight and Left Inattention

The “Altitudinal Anton’s Syndrome”: Coexistence of Anosognosia, Blindsight and Left Inattention

The "Altitudinal Anton's syndrome": coexistence of anosognosia, blindsight and left inattention.

We describe a 69-year-old patient with superior altitudinal hemianopia who contentiously denied having any visual impairment after stroke in the lower banks of both calcarine fissures. Although the patient did not produce intentional responses to visual stimuli in the blind fields, he showed reduced reaction times to stimuli presented in the inferior visual fields when they were primed by identical stimuli in the superior blind fields. Furthermore he showed left extinction to the double stimulation and delayed reaction times for left unprimed stimuli in the inferior fields. Based on these findings we discuss the possibility that blindsight and right hemisphere damage might be both necessary conditions for denying bilateral blindness.

Neurological symptoms following exposure to ozone

The proven efficacy and safety of medical ozone therapy remains controversial [1–6]. In rats, ozone inhalation was shown to promote neuronal activation in stress-responsive regions of the central nervous system (CNS) [7], electrical activity alterations and changes in brain major neurotransmitter systems [8, 9]. We here describe two patients who developed cortical blindness and seizures shortly after intraarticular ozone infiltrations. There is only a prior report of top of the basilar stroke and Anton syndrome following ozone therapy [10]. A 75-year-old man complained of dizziness, slurred speech, tingling in the left extremities and visual loss, which developed 10 min after receiving a paravertebral ozone therapy session and autohemotherapy for spondylarthrosis. On admission he was fully aware with left neglect, cortical blindness, left central facial paralysis, and numbness and mild weakness of the left extremities. A brain magnetic resonance imaging (MRI) scan showed subcortical/juxtacortical white matter chronic ischemic lesions in the right cerebral hemisphere without evidence of acute lesions (Fig. 1a). Stenosis of the distal branch of the left cerebral posterior artery and a severe stenosis of the right carotid artery on MR angiograms were found. An EEG showed an alpha rhythm (8 Hz) predominantly in the left posterior region and a slow attenuated delta rhythm in the right hemisphere. A Tc-ECD brain SPECT showed bilateral hypoperfusion areas particularly in the left occipitotemporal region (Fig. 2). Twenty-four hours later, the patient presented visual hallucinations, various episodes of forced oculocephalic deviation to the left, clonus on left extremities and a tonic–clonic seizure. He was successfully treated with valproic acid and levetiracetam. A brain MRI performed 7 days later showed one small juxtacortical subacute ischemic lesion in the right occipital lobe (Fig. 1b). A 60-year-old woman presented with posterior cortical blindness and history of a tonic–clonic seizure, which developed shortly after intraarticular infiltration of ozone and procaine for the treatment of a left shoulder joint disease. On admission she was disoriented with repetitive speech, anterograde memory impairment and cortical blindness. The brain MRI showed a right acute ischemic cerebellar lesion (Fig. 1c). The EEG showed slowed brain D. V. Rolan (&) J. L. B. Cunat J. V. Hervas D. Escudero Neuroscience Department, Hospital Universitari Germans Trias i Pujol, Universitat Autonoma de Barcelona, Carretera de Canyet s/n, 080916 Badalona, Barcelona, Spain e-mail: doloviro@hotmail.com

Anton's Syndrome Presenting as Vertigo

Anton's syndrome is a rare cause of vertigo. Its diagnosis may be hindered by confabulatory claims of normal vision by the patient. Any cause of cortical blindness may result in Anton's syndrome, the commonest being a posterior circulation stroke. Here, we highlight a case of Anton's syndrome that was a result of a left vertebral artery thrombosis, presenting initially with vertigo. The patient had a background of previously undiagnosed bilateral posterior communicating artery and right vertebral artery hypoplasia.