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April 17, 1987

Visual Hallucinations: More Diagnoses

Author Affiliations

Baylor College of Medicine Houston
University of Texas Houston

Baylor College of Medicine Houston
University of Texas Houston

JAMA. 1987;257(15):2036. doi:10.1001/jama.1987.03390150051030

To the Editor.—  We must disagree with the answer given in response to Dr Babcock's inquiry to the QUESTIONS AND ANSWERS section about an 80-year-old man with visual hallucinations,1 or at least suggest another alternative that should be strongly considered.We believe Dr Babcock's patient probably has the Charles Bonnet syndrome.2,3 This is a constellation of formed visual hallucinations with visual loss, usually seen in elderly people, characterized by several diagnostic features that seem applicable to the patient under discussion: (1) The hallucinations are exclusively visual and are well formed, such as people and places. (2) They occur with insight and a clear consciousness—the patient is sane and aware he is hallucinating. The hallucinations are fairly devoid of emotional content and not sinister or threatening. (3) They are superimposed on or occur in combination with normal perceptions. The patient can still perceive events around him. (4) They are