Anton-Babinski syndrome as a rare complication of chronic bilateral subdural hematomas

Abstract

Clinical presentation: We report the case of a 68-year-old patient that presented at our department 6 weeks after a mild traumatic brain injury with confusion and drowsiness. Emergency head CT scan revealed chronic bilateral subdural hematomas with no midline shift. His neurological status quickly deteriorated after admission (GCS of 9 points) and he was operated immediately. Although surgery was uneventful and his neurological status markedly improved, in the first postoperative day he developed blindness with visual anosognosia and visual confabulations, suggestive for Anton-Babinski syndrome. Emergency head MRI performed on the same day was normal but a repeat head MRI in the seventh postoperative day revealed bilateral occipital ischemia, thus explaining his symptoms. The patient became aware of his deficit two weeks after surgery, but was surprisingly ambivalent regarding it. Conclusion: Cortical blindness (sometimes presenting in the context of Anton-Babinski syndrome) is a rare complication of chronic bilateral subdural hematomas, a rather common neurosurgical pathology. Although it can be overlooked on the initial neurological examination, it should be taken into account, prompting emergency surgical treatment in order to prevent permanent visual deficits.

Keywords

• chronic bilateral subdural hematoma
• visual anosognosia
• visual confabulations