Anton–Babinski syndrome

Overview

Anton–Babinski Syndrome is a rare neurological condition characterized by cortical blindness (complete loss of vision due to damage in the occipital lobes of the brain) accompanied by anosognosia—a denial or unawareness of the blindness. Despite being functionally blind, patients behave as if they can see and may confabulate (make up visual descriptions) when questioned.

This syndrome is a form of visual anosognosia and is often associated with bilateral occipital lobe damage, usually from a stroke. It was first described by neurologists Gabriel Anton and Joseph Babinski in the early 20th century.

Causes

Anton–Babinski Syndrome typically results from damage to both occipital lobes—the regions of the brain responsible for processing visual information. Common causes include:

• Bilateral occipital lobe infarction: Most often due to posterior cerebral artery strokes

• Head trauma: Severe injury involving the posterior brain

• Hypoxic-ischemic encephalopathy: Brain injury due to oxygen deprivation

• Encephalitis or infections: Such as herpes simplex virus affecting the occipital cortex

• Brain tumors or large mass lesions compressing both visual cortices

Symptoms

The hallmark of Anton–Babinski Syndrome is the combination of cortical blindness and denial of visual loss. Key symptoms include:

• Total or near-total blindness: Due to bilateral occipital lobe damage

• Anosognosia: Patient insists they can see despite being blind

• Confabulation: Fabrication of visual experiences when asked what they see

• Normal pupillary light reflex: The eyes respond to light, confirming the blindness is cortical, not ocular

• Occasionally accompanied by disorientation, memory issues, or other cognitive deficits depending on the extent of brain damage

Diagnosis

Diagnosis is based on clinical evaluation and neuroimaging. The following steps are involved:

• Neurological examination: Reveals blindness without awareness of the deficit, and intact pupillary responses

• Neuropsychological assessment: Confirms confabulation and anosognosia

• Brain imaging (CT or MRI): Shows bilateral occipital lobe lesions, often due to stroke or trauma

• Visual evoked potentials (VEP): May confirm disrupted visual pathway despite intact eye structure

Differentiating Anton–Babinski Syndrome from psychiatric conditions or malingering is essential and relies on objective imaging and neurological findings.

Treatment

There is no specific treatment for Anton–Babinski Syndrome itself. Management focuses on the underlying cause of the brain injury and supportive care:

Acute Management:

• Stroke care: If due to infarction, standard stroke protocols apply

• Infection or inflammation: Treated with antivirals, antibiotics, or steroids depending on etiology

Supportive and Long-Term Care:

• Vision rehabilitation: Orientation and mobility training for cortical blindness

• Occupational therapy: Adaptation to daily living with vision loss

• Cognitive and behavioral therapy: To address confabulation and improve insight

• Family education: Essential for safety and communication support

Prognosis

The prognosis of Anton–Babinski Syndrome depends on the extent and cause of brain damage. Key points include:

• In most cases, vision loss is permanent due to irreversible cortical injury

• Insight may improve over time, but anosognosia often persists

• Associated cognitive and neurological impairments may further affect recovery and independence

Supportive care, therapy, and safety adaptations can help improve quality of life, though full recovery is rare.