Anton-Babinski Syndrome Secondary to Posterior Reversible Encephalopathy Syndrome
Mohammad Khasawneh1, Nathaniel Stacy1, Alan Li1
1Washington University School of Medicine, Department of Neurology
Objective:
To present a rare case of Anton-Babinski syndrome (Anton syndrome) secondary to posterior reversible encephalopathy syndrome (PRES) and to demonstrate the importance of recognizing reversible causes of cortical blindness to improve patient outcomes and guide clinical management.
Background:
Anton syndrome is characterized by cortical blindness, visual anosognosia, and confabulation. This syndrome typically results from damage to the bilateral occipital lobes, most often due to cerebrovascular events. PRES, frequently triggered by hypertension, chemotherapy, or immunosuppressants, presents with posterior white matter edema and is associated with symptoms such as headache, seizures, and encephalopathy. Although PRES primarily affects the occipital lobes, complete cortical blindness is a rare manifestation, observed in only about 18% of cases.
Design/Methods:
Case Presentation: A 57-year-old woman with a history of pancreatic adenocarcinoma, well-controlled epilepsy, and migraines was admitted with acute worsening abdominal pain. Following the initiation of a dilaudid PCA pump for pain management, she developed progressive confusion, visual hallucinations, and abnormal behavior, including rummaging and finger-biting. Neurological examination revealed cortical blindness, with the patient insisting she could see despite failing multiple visual tests. EEG findings showed bi-occipital lateralized periodic discharges (LPDs) and captured focal seizures. Brain MRI confirmed PRES, revealing T2 hyperintensities in the bilateral parieto-occipital lobes.
Results:
The etiology of PRES was attributed to chronic chemotherapy toxicity (gemcitabine) and uncontrolled hypertension. Gemcitabine was discontinued, and the patient received anti-seizure and antihypertensive medications. Following treatment, her cortical blindness and confusion improved significantly, although visual hallucinations persisted at discharge but showed signs of reduction.
Conclusions:
This case illustrates a rare presentation of Anton syndrome secondary to PRES, emphasizing the need to consider reversible etiologies in cases of cortical blindness. Early recognition and management of PRES—through effective control of blood pressure and discontinuation of neurotoxic medications—can lead to good clinical outcomes, even in severe cases involving seizures and cortical blindness.
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