ABSTRACT NUMBER: ESOC2026A222 A RARE CASE OF ANTON SYNDROME IN AN ELDERLY WOMAN WITH BILATERAL PCA INFARCTION

Abstract Background and aims Anton syndrome is a rare neuro-behavioural condition characterised by cortical blindness, visual anosognosia, and confabulation, most often due to bilateral occipital lobe damage. Affected patients deny visual loss despite complete blindness, creating diagnostic and safety challenges. We report a case of Anton syndrome following bilateral posterior cerebral artery (PCA) infarction, highlighting the need for clinical vigilance and neuroimaging in diagnosis. Methods Case report Results A 72-year-old woman with hypertension, type 2 diabetes mellitus, Parkinsonism, and previous left posterior cerebral artery (PCA) infarction presented with progressive visual disturbance, confusion, and worsening mobility over several days following a minor fall. Initial assessment attributed symptoms to functional decline related to prior stroke. Stroke review revealed marked bilateral visual loss, limited to hand movements, with absent menace reflex. The patient denied visual impairment and produced confabulatory descriptions of her surroundings, including the examiner’s “mosaic-patterned tie.” No other focal neurological deficits were present. The NIH Stroke Scale score was 4, reflecting visual deficit and confusion. MRI demonstrated bilateral subacute PCA infarctions. The clinical triad of cortical blindness, denial of blindness, and confabulation confirmed a diagnosis of Anton syndrome. She was treated with antiplatelet therapy and cardiovascular risk-factor optimization and transferred to inpatient rehabilitation. Cardiac monitoring and embolic source evaluation were unremarkable. On follow-up, she remained cortically blind with persistent anosognosia, requiring supervised mobility and continuous safety support. Conclusions Anton syndrome should be considered in patients with bilateral occipital infarction who deny visual loss. Early recognition with MRI avoids psychiatric misdiagnosis, facilitates safety planning, and enables tailored neurorehabilitation. Conflict of interest Shwe Paing: nothing to disclose