Anton syndrome

At the Anton syndrome Cortical blindness occurs, but is not noticed by the patient. The brain continues to produce images that those affected accept as images of their surroundings and thus do not see their blindness. Patients often do not consent to treatment because of their lack of insight.

What is Anton Syndrome?

Anton syndrome is characterized by cortical blindness and thus represents a neurological syndrome. In the context of the syndrome, blindness is not caused by damage to the eyes, but is related to a lesion of the cerebral cortex. In Anton syndrome, the visual pathways are damaged in both halves of the brain, so that visual stimuli no longer reach the brain and cannot be processed there either.

Those affected also suffer from anosognosia and do not recognize the diagnosis of their own blindness. In Anton syndrome, anosognosia is also caused by damage to certain areas of the brain. The syndrome is named after the Austrian neurologist Gabriel Anton, who first described the disease in the 19th century. At that time he describes the case of a lady who does not recognize her blindness and who actually seeks medical advice because of a word-finding problem.

causes

Anton syndrome is usually the result of a stroke. The visual cortex of both hemispheres of the brain is typically affected by the causative cerebral infarction. The visual cortex is supplied with arterial blood by the brainstem artery. Both posterior cerebral arteries arise from this artery. A circulatory disorder in these arteries affects the visual cortex and, according to current research, probably triggers a connection error in the processing of the visual information.

This means that in Anton's syndrome the eyes actually see, but the conscious mind no longer receives any insight into the visual stimuli. For example, the visual cortex no longer transmits visual information to the language brain center. Anosognosia results when the center for the verbalization of visual information simply invents things based on the missing information. In addition to the stroke, a lesion of the anterior visual tract, bleeding, or epilepsy can also be the cause of Anton syndrome.

Symptoms, ailments & signs

Anton syndrome is characterized by a usually complete blindness of cortical cause. The lack of insight for the lack of vision is the most characteristic symptom of the syndrome. Those affected do not tell themselves to be able to see, but actually have no doubts about it. Their own brain fools them by providing them with images that are consistently made up.

Most of the time, patients with Anton syndrome run into door frames, walls or even in front of cars because of these fake, but for them absolutely real, images. They stumble, stagger and stumble. They no longer recognize objects and people. They give numerous explanations for this to themselves and to others. So they see their own clumsiness when they stumble and stumble. Failure to recognize objects and people is usually attributed to poor lighting or a lack of attention. They do not deliberately deceive other people and also themselves about their blindness, but are actually not aware of the blindness.

Diagnosis & course

The doctor makes the diagnosis of Anton syndrome based on the medical history, brain imaging, and eye tests. Especially in the anamnesis, the patients say no to the question whether their eyesight has decreased recently. During the eye tests, they describe objects, numbers and letters vividly, but completely incorrectly. Finally, the imaging reveals the lesions of the visual cortex.

Whether a stroke or damage to the anterior visual tract has triggered Anton's syndrome can either be recognized by imaging or by various examinations of the cerebral arteries. Since the patients with Anton syndrome do not show any insight, the prognosis for this clinical picture is rather poor. If left untreated, the syndrome can deteriorate neurologically.

The rejection of diagnostic methods sometimes even prevents the diagnosis from being confirmed. Rehabilitation measures can be used to cure damage caused by epilepsy if the patient agrees to the treatment.

Complications

With Anton syndrome there are severe psychological and physical complications. On the one hand, it can be a case of blindness in the patient, which, however, is not seen because the brain continues to produce images of the environment. The Anton syndrome significantly restricts everyday life and quality of life.

The treatment also turns out to be serious, as the person concerned does not see directly that he has Anton syndrome. By imagining that they can continue to see, the patient poses a danger to himself and to other people. It often happens that those affected run into objects or even in front of vehicles.

This can lead to accidents which, in the worst case, can be fatal. Therefore, the person affected with Anton syndrome is in any case dependent on the help of other people as long as no treatment has started. The syndrome itself can easily be identified with an eye test. The treatment usually involves discussions with the psychologist.

It can, however, take a long time for the patient to admit Anton syndrome. Various measures can then be taken to increase the patient's orientation and mobility. Life expectancy is reduced in the sense that the patient is exposed to an increased risk of being involved in accidents.

When should you go to the doctor?

The Anton syndrome should be clarified as quickly as possible by a doctor. The most effective therapeutic measure, neuroplasticity, only shows an effect in the first twelve weeks after going blind. Thereafter, far less effective physical and occupational therapy measures have to be taken. Since those affected usually do not realize their blindness themselves, the diagnosis is usually too late and the treatment options are accordingly limited. Therefore, in the best case scenario, preventive action is taken.

It is advisable to consult a doctor as soon as the first circulatory disorders or other health problems that could result in a stroke and, as a result, Anton syndrome occur. Patients with epilepsy or a lesion of the anterior visual pathways should inform themselves in good time about possible secondary diseases.

If Anton syndrome then occurs, the disease can be accepted more easily. Anyone who suspects that another person has the rare syndrome should accompany them to a doctor and clarify the causes. Other contact persons are the ophthalmologist as well as neurologists and angiologists.

Doctors & therapists in your area

Treatment & Therapy

Treating Anton syndrome is a challenge because patients are completely unclear about their own disease. Therapeutic steps are usually vehemently rejected and considered pointless. The necessary therapy is symptomatic and interdisciplinary. Neurology plays just as important a role in the therapy path as psychiatry, internists and physiotherapists. Above all, the underlying disease that caused it must be identified and treated consistently.

In psychotherapeutic and psychopharmacological therapy, the patients are convinced of the disease through the consistent memory of their blindness, which, however, is often associated with the potential for conflict. In physical and occupational therapy, deficits relevant to everyday life are remedied as far as possible. Compensation strategies are learned and can serve to compensate for deficits.

Neuroplasticity is a rather newer therapeutic option for cortical blindness, which can reactivate visual perception by stimulating adjacent cortical neurons. However, since the method shows success only twelve weeks after going blind and patients with Anton syndrome usually do not even see a doctor in this short time because of their lack of insight, the method for Anton syndrome is often out of the question.

Outlook & forecast

A prognosis for Anton syndrome is largely dependent on the patient's insight into the disease and their cooperation in the treatment process. In almost all cases, the sick do not have insight. It is therefore difficult or impossible to carry out a treatment. Without medical care, symptoms persist. There is no deterioration, but also no improvement in the state of health.

Treatment can relieve symptoms.Proven neuroplastic techniques provide relief within weeks and months. In addition, intensive psychotherapy is used to work on the patient's cognitive patterns, incorrect beliefs and behavioral changes. This approach is extremely difficult and often takes several months or years to complete.

However, due to the lack of insight into the disease, the few patients who have agreed to treatment discontinue therapy early. In addition, due to the lack of insight, it is associated with a high potential for conflict between the patient and the treating doctors and therapists. The adversities make the prospect difficult and there is only in extremely rare cases a clear progress in the healing process or a complete healing. On the other hand, if the disease is accepted or if the doctors treating it are trusted, the prognosis is good.

prevention

Anton syndrome can be prevented to a certain extent using the same steps as the stroke, which usually triggers the syndrome.

Aftercare

Anton syndrome is a chronic disease that cannot be treated causally. Follow-up care focuses primarily on regular screenings and a constant adaptation of the treatment to the current state of health of the person concerned. In addition, measures must be taken to avoid deterioration in health.

This includes, on the one hand, therapeutic exercises and, on the other hand, comprehensive medication, which must also be checked and adjusted regularly. The patient must be examined by a doctor once a week. In the later stages of the disease, hospitalization is required. Eye tests and neurological examinations, which depend on the severity of Anton's syndrome, are part of the follow-up care.

If accompanying symptoms occur, additional doctors must be called in. Psychological counseling may also be necessary. Not only those affected, but also relatives and friends often need the support of a specialist. As the neurological syndrome progresses slowly, follow-up care is always accompanied by active treatment of the symptoms. After all, the patient is permanently under medical treatment and must accordingly take steps to process and reduce the associated stress.

You can do that yourself

As a rule, those affected by Anton syndrome cannot contribute directly to the treatment of the underlying underlying disease. However, they can learn to cope with everyday life despite their illness, which, however, first requires that they accept it. The realization that there is indeed a visual impairment that needs treatment is the first step towards self-help and a major challenge for patients and their relatives.

As long as patients are unapologetic, it is important that the near social field confronts them with their suffering in a sensitive but consistent manner. Those affected can, for example, be made aware of inconsistencies between visual and haptic perception. The patient can be asked to describe what another person is holding in their hand. The patient can then check for himself whether his visual perception agrees with what he feels. The use of ice cubes is particularly effective. Here the person affected immediately recognizes that he is seeing something different from what he is feeling.

The social environment must also guarantee accident prophylaxis. Furniture should not be rearranged, sharp-edged objects and tripping hazards such as carpets and rugs should be removed and access to stairwells should always be kept locked. Under no circumstances may the person concerned take part in road traffic independently. Unless the person is aware of their blindness, they should not leave the house alone.

In addition, efforts should be made to initiate psychotherapeutic or psychopharmacological therapy. As soon as the patient realizes that he is blind, attempts can be made to compensate for everyday deficits with physiotherapeutic measures.