Visual hallucinations in giant cell arteritis: association with visual loss

• Published in: Journal of rheumatology Vol. 28; no. 9; pp. 2046 - 2048
• Main Authors: NESHER, Gideon, NESHER, Ronit, ROZENMAN, Yaacov, SONNENBLICK, Moshe
• Format: Journal Article
• Language: English
• Published: Toronto, ON The Journal of Rheumatology 01-09-2001; Journal of Rheumatology Publishing
• Subjects: Age Distribution; Aged; Aged, 80 and over; Biological and medical sciences; Blindness - diagnosis; Blindness - epidemiology; Comorbidity; Female; Giant Cell Arteritis - diagnosis; Giant Cell Arteritis - epidemiology; Hallucinations - diagnosis; Hallucinations - epidemiology; Humans; Incidence; Male; Medical sciences; Middle Aged; Prognosis; Prospective Studies; Risk Factors; Sarcoidosis. Granulomatous diseases of unproved etiology. Connective tissue diseases. Elastic tissue diseases. Vasculitis; Severity of Illness Index; Sex Distribution; Human; Nervous system diseases; Optic nerve; Hallucination; Vision disorder; Clinical form; Cardiovascular disease; Neuropathy; Vascular disease; Symptomatology; Eye disease; Cranial nerve disease; Vasculitis; Association; Ischemia; Follow up study; Systemic disease; Blindness; Complication; Giant cell arteritis; Predictive factor; Elderly
• ISSN: 0315-162X; 1499-2752

OBJECTIVE: To evaluate the frequency and characteristics of visual hallucinations (VH) in patients with giant cell arteritis
(GCA) and to determine their relationship to other visual phenomena. METHODS: This prospective study included 31 consecutive
patients with GCA. All were asked whether they had experienced recent visual phenomena. Patients with visual symptoms underwent
a comprehensive ophthalmologic examination. When unusual visual phenomena were reported, patients were asked to describe their
nature, duration, and frequency of occurrence. RESULTS: Visual symptoms occurred in 6 patients: permanent visual loss in 5
and amaurosis fugax in one. In 4 of the 5 patients with permanent visual loss, it was preceded by intermittent VH over a period
of 1-10 days. Patients were aware of the unreal nature of the visions. Hallucinations disappeared within 2 weeks, but in one
patient, recurred 6 months later in association with further visual deterioration. CONCLUSION: The occurrence of visual hallucinations
in patients with GCA-associated visual loss is more common than previously appreciated. As hallucinations preceded permanent
loss of vision, this phenomenon may serve as a harbinger of imminent visual loss.