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Visual hallucinations common with giant cell arteritis-associated visual loss

מתוך medicontext.co.il

WESTPORT, CT (Reuters Health) – Patients with giant cell arteritis (GCA)-associated visual loss have a higher incidence of visual hallucinations than previously thought, according to a report in the September issue of The Journal of Rheumatology.

Dr. Gideon Nesher, of Shaare-Zedek Medical Center, Jerusalem, Israel, and colleagues prospectively studied 31 consecutive GCA patients after encountering a GCA patient with visual hallucinations who feared she would be considered insane.

"Since this patient was initially quite reluctant to disclose her experience…we assumed that visual hallucinations may be underdiagnosed in GCA," the researchers explain.

They asked the study participants whether they had experienced "recent visual phenomena." Those 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."

Six patients reported visual symptoms, including five with permanent visual loss and one with amaurosis fugax. Intermittent visual hallucinations preceded permanent visual loss over a period of 1 to 10 days in four of five patients.

The investigators note that the patients were aware of the unreal nature of the hallucinations. The visions disappeared within 2 weeks. In one patient, however, they recurred 6 months later in association with visual deterioration in the other eye.

"If reported when they first occur, these visual phenomena could serve as harbingers of imminent visual loss in patients with established GCA…or in patients in whom GCA was undiagnosed previously," Dr. Nesher and colleagues comment. "Physicians treating patients with GCA should be aware of the various premonitory symptoms of visual loss, since early diagnosis and treatment may save their vision."

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