The Original Description of Anton Syndrome

To the Editor, We would like to commend Eby et al [1] regarding their recent case description in “The Rehabilitation of Anton Syndrome” and would like to share our perspective related to a review of Anton's original description. Many authors have used the eponym “Anton syndrome” to describe cortical blindness with visual anosognosia. Specifically, Eby et al [1] state that “Anton syndrome, also referred to as visual anosognosia, is a rare stroke syndrome that involves the bilateral occipital lobes seen most commonly as a result of cerebrovascular disease.” This description is consistent with many recent descriptions of this syndrome. However, it should be noted that Anton's original description differs from the contemporary characterization of Anton syndrome. Anton's original description highlighted the absence of insight into the neurologic deficit rather than the pathologic basis of the neurologic deficit. Anton also emphasized that the lack of insight had to be in the context of the absence of global cognitive impairment [2-5]. The lack of insight, as described by Anton, relates to deficits in vision and hearing as well as passive joint movement. As well, the pathologic conditions described in these 6 cases include strokes as well as a brain tumor and head injury. It should be noted that Anton was not the first physician to describe this lack of insight into a neurologic deficit. It had been previously described by Wernicke [6] and Westphal [7]. Our medical culture has de-emphasized the use of eponyms because of their associated clinical ambiguity. Often, eponyms evolve into characterizations that differ from their author's original descriptions. For this reason, it may be best to use descriptive terms instead of the eponym. We propose that if clinicians use the term Anton syndrome, it should include any lack of insight of a focal neurologic deficit in the absence of global cognitive impairment. This definition is more consistent with the original description. We suggest the term “visual anosognosia” as a more scientific description. Perhaps Anton syndrome is a case study for a continued dialogue regarding the use of eponyms in clinical practice.