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The carefully written letters by Dr Carney and Drs Rolak and Baram are appreciated. Concerning the letter by Dr Carney, vascular disease may well be the cause of this man's hemiparesis and symptoms, and was originally mentioned in the discussion. However, with an 80-year-old man with a severe fixed deficit, many physicians would not subject the man to an arteriogram and few would go further and attempt vertebral artery surgery. The value of vascular surgery for patients with cerebrovascular disease has always been speculative; with the combination of age and a severe deficit, I would think that further vascular evaluation would not be rewarding.Concerning the letter by Drs Rolak and Baram, the Charles Bonnet syndrome is indeed a possibility. With the patient of Dr Babcock's, however, the episodes of visual hallucinations were constant, brief, and stereotyped; they apparently did not vary from episode to episode. In my
Newmark ME. Visual Hallucinations: More Diagnoses-Reply. JAMA. 1987;257(15):2036. doi:10.1001/jama.1987.03390150051031