Abstract
IntroductionMusical hallucinations are complex auditory perceptions in the absence of an external acoustic stimulus and are often consistent with previous listening experience. Their causation can be classified as associated with either psychiatric disorders, such as schizophrenia, or organic disorders, such as epilepsy or sensorineural deafness. Non-epileptic musical hallucinosis due to lesions of the central auditory pathway, especially of the thalamocortical auditory radiation, is rare.Case presentationWe describe the case of an 85-year old ethnic Chinese woman with a history of transient ischemic attacks and chronic bilateral hearing impairment, who experienced an acute onset of left unilateral musical hallucinations. Our patient did not experience any psychiatric symptoms and there was no other neurological deficit. Pure tone audiometry revealed bilateral hypacusis and magnetic resonance imaging revealed a right non-dominant hemisphere sublenticular lacunar infarct of the thalamocortical auditory radiation. Our patient was managed expectantly and after three months her symptoms subsided spontaneously.ConclusionWe propose that all patients with monoaural musical hallucinations have brain imaging to rule out a central organic cause, especially within the non-dominant hemisphere, regardless of the presence of a hearing impairment.
Highlights
Musical hallucinations are complex auditory perceptions in the absence of an external acoustic stimulus and are often consistent with previous listening experience
We propose that all patients with monoaural musical hallucinations have brain imaging to rule out a central organic cause, especially within the non-dominant hemisphere, regardless of the presence of a hearing impairment
It was suggested that musical hallucinosis occurs exclusively with acquired hearing loss, especially in older women, and this hypothesis is supported by the observation that hypacusis was the only detectable etiological factor in half of patients observed [4,13]
Summary
Our experiences in this case support the proposition that organic musical hallucinogenesis is a result of both peripheral and central deafferentation. To the best of our knowledge, this is the first report of a lacunar infarct of the auditory thalamocortical radiation triggering such symptoms. We recommend that all patients with monoaural musical hallucinations have brain imaging to rule out a central organic cause, regardless of the presence of a hearing impairment. Consent Written informed consent was obtained from the patient for publication of this case report and any accompanying images. Authors’ contributions PYMW conceived and designed the study in addition to drafting the manuscript. LNYL participated in conceiving the study, acquisition of data and drafting of the manuscript. All authors read and approved the final manuscript. Eur Arch Psychiatry Clin Neurosci 2002, 252(6):299302. Doi:10.1186/1752-1947-8-400 Cite this article as: Woo et al.: Monoaural musical hallucinations caused by a thalamocortical auditory radiation infarct: a case report. Journal of Medical Case Reports 2014 8:400
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