I really love having students.  I particularly enjoy their list of differential diagnoses…..they often remember every zebra, but frequently omit the common and the obvious.  Often, the reel of diagnoses I’ve never seen in practice, or more commonly, never heard of.  When I look them up there is a reason….they are either orphan diagnoses or most commonly found in sub-sahara Africa or a remote region of Asia.  That teeny bit of research always makes me feel a little better — it’s ok that I didn’t know that bit of trivia, because it doesn’t cross my path.

However, I DID see a zebra the other day, Charles Bonnet Syndrome.  The epyonymous affliction was first described in 1760  as complex visual hallucinations in seeing-impaired patients who were otherwise healthy.  The hallmark of the disease is that the hallucinations are diminuitive and friendly – often described as ‘elf-like’ or nymphs, gnomes, angels or ‘Liliputians.’  For my patient, they were children, tiny, dancing all around us singing “Jesus Loves Me.”  She kept pointing them out to us during the interview.  It was like being in a room with the imaginary friends of a pre-schooler.

My patient, a spry 89 year old lady with advanced macular degeneration, appeared otherwise in perfect health.  She was articulate, oriented and in every other way, in her usual state of health.  Her bewildered and frightened son brought her to me within a day of the hallucinations appearance and begged me to make them stop.  The hallucinations were not frightening to her, but she was wandering around the house at night, following them around.

I agreed to a low dose of haldol at bedtime, 0.5 mg and will see her back on Friday.  I’ll keep you posted…..