My prompt: “Create a simulated patient case on Anton syndrome.”

ChatGPT said:

“Simulated Patient Case: Anton Syndrome”

Case Overview

A 67-year-old woman is brought to the ophthalmology clinic by her daughter due to recent changes in her behavior. The daughter reports that her mother has been "bumping into things at home" and has difficulty navigating her surroundings. However, the patient adamantly denies any vision problems. She insists that she can see perfectly fine, despite repeatedly knocking over objects and failing to recognize people in the room.

Her past medical history includes hypertension, type 2 diabetes mellitus, and a recent ischemic stroke affecting the posterior cerebral artery territory.

Step 1: Initial Patient Encounter

History Taking

• Chief Complaint: "I can see just fine! My daughter is just worrying too much."

• History of Present Illness:

  • Over the past two weeks, the patient has been unable to navigate her environment properly.

  • The daughter noticed that the patient is unable to describe objects accurately when asked.

  • The patient denies any visual disturbances, despite multiple falls and missteps.

• Past Medical History:

  • Hypertension (on amlodipine and losartan)

  • Type 2 Diabetes Mellitus (on metformin)

  • Ischemic stroke two months ago

• Social History:

  • Lives with her daughter, retired teacher, non-smoker, occasional alcohol use

• Review of Systems:

  • No reports of headache, eye pain, or flashes of light

  • No complaints of limb weakness or new neurological symptoms

Step 2: Physical Examination

General Examination:

• Alert, cooperative, but displays an inappropriate level of confidence in her visual abilities.

• No acute distress.

Neurological Examination:

• Cranial Nerves:

  • Visual acuity: Unable to read eye chart but insists she can see well.

  • Visual fields: Unable to respond accurately to confrontation testing.

  • Pupillary response: Normal and reactive bilaterally.

  • Fundoscopy: Normal optic discs, no signs of optic atrophy.

• Cognitive and Higher Functions:

  • Denial of blindness: The patient insists she can see despite clear evidence of visual impairment.

  • Confabulation: When asked about a picture in front of her, she describes incorrect details rather than admitting she cannot see it.

  • Disoriented to space, but no primary language deficits.

Step 3: Diagnostic Workup

• Brain MRI (with contrast):

  • Bilateral occipital lobe infarcts consistent with a previous ischemic stroke.

• Visual Evoked Potentials (VEP):

  • Absent cortical responses, confirming cortical blindness.

• Cognitive Testing (Mini-Mental State Exam - MMSE):

  • Mild deficits in attention but no major memory impairment.

Step 4: Diagnosis and Explanation to Patient/Family

• Diagnosis: Anton Syndrome (Cortical Blindness with Anosognosia)

• Pathophysiology:

  • Bilateral infarction of the occipital lobes disrupts visual processing, leading to complete cortical blindness.

  • The patient’s brain fails to recognize the blindness, resulting in confabulation and denial.

• Discussion with Family:

  • Explanation of the condition and reassurance that it is a known neurological syndrome following strokes.

  • Addressing safety concerns at home (e.g., fall risk).

  • Referral to neurology and neurorehabilitation for cognitive training and adaptive strategies.

Step 5: Management Plan

• Multidisciplinary Approach:

  • Neurology consultation for stroke follow-up and cognitive evaluation.

  • Occupational therapy for home modifications to prevent injury.

  • Low vision rehabilitation to teach adaptive strategies.

  • Psychiatry referral to address anosognosia if needed.

• Medical Management:

  • Stroke prevention: Antiplatelets (aspirin, clopidogrel), blood pressure control.

  • Diabetes management: Strict glycemic control to prevent further vascular events.

Step 6: Follow-up and Prognosis

• Patient Follow-up:

  • Close monitoring for stroke recurrence.

  • Gradual improvement in awareness may occur, but anosognosia is often persistent.

• Long-term Prognosis:

  • Visual recovery is unlikely, but adaptive strategies can improve the patient’s quality of life.

Key Learning Points

• Anton Syndrome is a rare condition of cortical blindness with anosognosia (denial of blindness).

• It occurs due to bilateral occipital lobe infarction, usually from a posterior cerebral artery stroke.

• Confabulation is common, as the brain tries to "fill in" the missing visual information.

• Management focuses on safety, cognitive rehabilitation, and stroke prevention.

Would you like to add interactive elements for training, such as multiple-choice questions or decision-making pathways?

My prompt: How do you suggest I present the case to my residents

ChatGPT said:

To effectively present Anton Syndrome to your ophthalmology residents, consider using an interactive, case-based approach with a progressive disclosure format. The key is to engage them actively, prompting them to think critically and apply their knowledge step by step.

Suggested Presentation Structure:

1. Start with a Clinical Vignette (Without Giving the Diagnosis)

🔹 Present the case as a realistic patient encounter, revealing details gradually.

🗣 Example: "A 67-year-old woman is brought to the clinic by her daughter. The daughter reports that the patient has been bumping into objects at home and misjudging distances. However, the patient insists she can see fine and believes her daughter is exaggerating the problem. How would you proceed?"

👉 Ask the residents:

• What differential diagnoses come to mind?

• What questions would you ask in the history?

➡️ Encourage discussion before revealing additional details.

2. Guide Them Through History-Taking & Exam Findings

As they propose questions, reveal information incrementally:

🔹 History of Present Illness

• Gradually reveal the key points (stroke history, denial of blindness, confabulation).

• Encourage them to recognize the red flags.

🔹 Neurological & Ophthalmologic Exam

• Visual acuity: The patient cannot read but claims to see well.

• Visual fields: No reliable responses.

• Pupils & Fundoscopy: Normal.

🗣 Ask:

• What do these findings suggest?

• Why does she insist she can see?

👉 Let them arrive at the concept of cortical blindness and anosognosia themselves.

3. Ask Them to Propose Investigations

🔹 Allow them to suggest:

• Brain MRI

• Visual Evoked Potentials (VEP)

• Cognitive screening

🎯 Then reveal the results (bilateral occipital infarcts, absent cortical responses).

🗣 Ask:

• What is your diagnosis now?

• What neurological mechanism explains this condition?

At this point, they should identify Anton Syndrome.

4. Discuss the Pathophysiology

👩‍🏫 Key Teaching Points:

• Cortical blindness due to bilateral occipital infarcts.

• Disconnection of visual processing from awareness causes anosognosia.

• The brain “fills in” missing vision, leading to confabulation.

• Lesion location: Posterior cerebral artery territory infarcts.

📌 Visual Aid Suggestion:
Show an annotated MRI scan of occipital infarcts.

5. Engage in Management Planning

💡 Ask:

• How would you explain this to the patient and family?

• What precautions should be taken for safety?

• What referrals would you make?

Encourage discussion on multidisciplinary care (neurology, rehab, psychiatry).

6. Conclude with Take-Home Messages

🔹 Summarize in three key points:

1. Anton Syndrome = Cortical Blindness + Anosognosia.

2. Due to bilateral occipital infarcts (PCA stroke).

3. Management focuses on safety, stroke prevention, and rehabilitation.

📌 Optional:

• Include a real-world case report to reinforce the lesson.

• Provide MCQs or case-based questions for self-assessment.

Alternative Formats for Engagement

✅ Simulated Patient Role-Play: Assign roles (patient, doctor, observer).
✅ AI-Powered Chatbot Case: Let them interact with a chatbot "patient."
✅ Problem-Based Group Work: Have teams analyze and discuss differentials.
✅ Flipped Classroom: Provide reading beforehand and focus on discussion.

Would you like me to create MCQs or a decision-making algorithm for further resident engagement?

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