Visual hallucinations in giant cell arteritis: association with visual loss.
G Nesher1, R Nesher, Y Rozenman
1Department of Ophthalmology, Shaare-Zedek Medical Center, Hebrew University Medical School, Jerusalem, Israel.
The Journal of Rheumatology
|September 12, 2001
Summary
Visual hallucinations (VH) are more common in giant cell arteritis (GCA) patients than previously thought. These hallucinations can precede permanent vision loss, signaling an urgent need for intervention.
Area of Science:
- Ophthalmology
- Rheumatology
- Neurology
Background:
- Giant cell arteritis (GCA) is a vasculitis that can affect cranial arteries.
- Visual disturbances are a known complication of GCA, but the specific role of visual hallucinations (VH) is not well-defined.
Purpose of the Study:
- To investigate the occurrence and features of VH in patients diagnosed with GCA.
- To explore the relationship between VH and other visual phenomena in GCA patients.
Main Methods:
- Prospective study involving 31 consecutive GCA patients.
- Systematic inquiry about recent visual phenomena.
- Comprehensive ophthalmologic examinations for patients with visual symptoms.
- Detailed characterization of reported hallucinations (nature, duration, frequency).
Main Results:
- Six out of 31 GCA patients experienced visual symptoms.
- Permanent visual loss occurred in 5 patients; amaurosis fugax in one.
- Intermittent VH preceded permanent visual loss in 4 of 5 patients over 1-10 days.
- Hallucinations were recognized as unreal and typically resolved within two weeks, though recurrence was noted.
Conclusions:
- Visual hallucinations are a more frequent occurrence in GCA-associated visual loss than previously recognized.
- VH may act as an early warning sign, or harbinger, of impending permanent vision loss in GCA patients.
- Prompt recognition and management of VH in GCA patients are crucial to prevent irreversible visual impairment.
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