An 82-year-old female presents with a complaint of visual hallucinations. She has a past medical history of age-related macular degeneration, hypeension and hypercholesterolemia. On questioning, the patient repos seeing wild animals in her side room. She states that this has been happening for a year since she lost her sight but says she knows they are not real. MMSE = 28/30. What is the most likely diagnosis?

**Core Concept**
The patient's presentation of visual hallucinations, despite being aware that they are not real, suggests a disorder of perception rather than a primary psychiatric condition. This is often seen in conditions that affect the visual pathway or in neurological disorders that alter perception.

**Why the Correct Answer is Right**
The patient's symptoms are likely due to Charles Bonnet syndrome (CBS), a condition characterized by complex visual hallucinations in the context of severe visual impairment. This syndrome is thought to occur due to the brain's attempt to compensate for the lack of visual input, leading to the generation of complex visual patterns or hallucinations. The patient's awareness that the hallucinations are not real and the fact that they have been experiencing these symptoms for a year since losing her sight support this diagnosis. The patient's MMSE score of 28/30 suggests that she is cognitively intact, making a primary psychiatric condition less likely.

**Why Each Wrong Option is Incorrect**
**Option A:** Dementia with Lewy bodies is a possibility in this patient given her age and history of hypertension and hypercholesterolemia, but the key feature in DLB is fluctuating cognitive impairment, which is not mentioned in this case.

**Option B:** Parkinson's disease is not typically associated with visual hallucinations as a primary symptom, and the patient's MMSE score suggests that she is cognitively intact.

**Option C:** Temporal lobe epilepsy can cause complex visual hallucinations, but the patient's history of age-related macular degeneration and the fact that her hallucinations began after she lost her sight make this diagnosis less likely.

**Clinical Pearl / High-Yield Fact**
Charles Bonnet syndrome is a common condition in patients with severe visual impairment, and it is essential to recognize it to avoid misdiagnosis and unnecessary treatment.

**Correct Answer:** C.

✓ Correct Answer: D. Charles-Bonnet Syndrome