Cerebral Venous Sinus Thrombosis Presenting With Auditory Hallucinations and Illusions

Abstract

Cerebral venous sinus thrombosis may present with seizures or neuropsychiatric symptoms, but does not typically present with hallucinations. We present a case of venous thrombosis of the right sigmoid and transverse sinuses that presented with auditory hallucinations and illusions. We describe a 45-year-old woman with a history of myasthenia gravis, stable on oral prednisone and monthly intravenous immunoglobulin infusions, who started on a progesterone/estrogen combination contraceptive pill for menorrhagia 3 weeks before admission and presented with symptoms of headache, fever, and auditory hallucinations and illusions. The patient's cerebrospinal fluid showed lymphocytic pleocytosis. Two electroencephalograms showed significant right temporal lobe slowing. Magnetic resonance venogram of the brain showed venous sinus thrombosis of the right sigmoid and transverse sinuses. Magnetic resonance imaging showed a cortical venous infarct in the right middle temporal gyrus. The patient's auditory hallucinations and illusions resolved spontaneously weeks after presentation. This case suggests that auditory hallucinations and illusions should be added to the already broad spectrum of presenting features of cerebral venous sinus thrombosis. The nondominant right middle temporal gyrus may play a role in such auditory hallucinations.