Complex Auditory Hallucinations Research Articles

Risperidone induced neutropenia in a 75-year-old man

IntroductionWe discuss the case of a 75-year-old man with no psychiatric history, presenting with complex auditory hallucinations, both commentary and imperative, delusions of persecution and prejudice, severe anxiety, modified behaviour, and altered sleep patterns.ObjectivesThe patient was started on oral risperidone, with favourable evolution of symptoms after reaching a daily dose of 3 mg/day. After three weeks of treatment, the laboratory results showed a low number of neutrophils. Interdisciplinary approach and examinations which included both clinical and paraclinical evaluation concluded that another cause of neutropenia was highly unlikely.MethodsThe patient was switched to olanzapine, with gradually increasing doses up to 10 mg/day. A significant improvement of the neutrophils’ level was noticed, with a return to normal parameters after a few days. Nevertheless, the clinical course was unfavourable, with reoccurrence of auditory hallucinations and delusions in two weeks’ time. Decision to rechallenge was made, with careful monitoring of the blood test results, particularly neutrophil levels. Risperidone was started at low doses of 0.5 mg/day and gradually increased up to 2 mg/day.ResultsSeven days after risperidone reinitiation laboratory tests showed normal absolute neutrophil count. However, another week later, neutrophils fell again out of the normal range.ConclusionsThe patient was discharged with haloperidol, with adequate control of symptoms and no adverse reactions.DisclosureNo significant relationships.

Schizophrenia with obsessive-compulsive suicidal images

IntroductionBackground A 19-year old patient with a history of traumatic childhood events presents herself for suicidal behavior driven by complex auditory hallucinations, self-mutilating behavior, and obsessive-compulsive suicidal images that depicted the patient lying dead on the floor with both wrists cut open. Prior to hospitalization, over the past 10 months, the patient exhibited symptoms of low mood, anhedonia, and an overall decline in school performance which led to a diagnosis of MDD with psychotic symptoms, but treatment with Duloxetine 60mg and Olanzapine 10mg proved to be inefficient.ObjectivesCase Presentation Upon admission the patient’s mimic and behavior did not support the described sadness, she presented a circumstantial discourse with frequent thought blockages and delusions. Associated the patient also described hypervigilance and avoidance behavior towards men, flashbacks, vivid nightmares, and obsessive-compulsive self-mutilating impulses and images.MethodsInitially, treatment was started with Olanzapine 20mg, which was augmented two months later with Sertraline 50mg and Bromazepam 3mg. This treatment led to an incomplete resolution of the obsessive symptoms, which led to the increase of Sertraline at 100mg, but at her 1-month check-up evaluation, she presented increased suicidal ideation and daily obsessive-compulsive images.ResultsThe patient was lastly diagnosed with schizophrenia, and due to the persistence of the suicidal ideations and delusions and the obsessive-compulsive symptoms, the treatment plan was revised.Conclusions Improvement of symptoms appeared under treatment with 300mg Clozapine and 50mg Fluvoxamine. In total the patient needed 98 days of hospitalization and lasting remission of symptoms appeared only under treatment with Clozapine and Fluvoxamine.DisclosureNo significant relationships.

What we know about Auditory Charles Bonnet Syndrome?

IntroductionCharles Bonnet syndrome (CBS) is defined like visual hallucinations found in individuals who are not necessarily mentally ill, who have visual impairment and no cognitive deficits. Although CBS make reference to visual hallucinations, in this case we are going to deal about Auditory Charles Bonnet Syndrome (aCBS), a very infrequent condition that consists in the presentation of musical hallucinations in patients with sensorineural hearing loss and which etiology is not clearly due to a psychiatric condition.ObjectivesReview the scientific literature available on aCBS to see how much we know about this syndrome.MethodsReview of available literature sources were obtained through electronic search in PubMed database.ResultsMusical hallucination is a complex form of auditory hallucinations. The most common of these are idiopathic and they present in elderly patients with deafness or impaired audition, which suggests a deterioration of cerebral function. The pathophysiologic mechanism is not understood. These patients tend to have intact reality tests. The time course is variable. In those cases in which it is possible, treating the hearing loss can lead to a significant improvement of the symptom. However, when every this strategies are insufficient, pharmacological treatments can be considered.Conclusions- aCBS is an uncommon condition characterized by the presence of complex auditory hallucinations that mainly affect elderly patients with hearing loss. - In most cases there is no previous psychiatric history. - The etiology and pathophysioplogic are not well defined. - There is no etiological treatment. We can use pharmacological and no pharmacological methods of treatment.DisclosureNo significant relationships.

Transient musical hallucinations in a young adult male associated with alcohol withdrawal

AimsWe present the case of a 25-year-old male who presented to A&E with isolated musical hallucinations, in the absence of audiological or neurological disease.BackgroundMusical hallucinations (MH) are a form of complex auditory hallucinations whereby an individual experiences an instrumental and/or vocal melody in the absence of auditory stimuli.ResultThe patient had a history of recreational drug use and a family history of psychosis. Hallucinations, which were preceded by discontinuation of alcohol and re-initiation of citalopram for depression, resolved spontaneously after three days.ConclusionAetiological factors are discussed alongside the existing literature. Whilst the underlying mechanisms underpinning musical hallucinations remains elusive, the case illustrates the potential role of alcohol withdrawal, serotonin toxicity, recreational drug use and genetic vulnerability.

Musical hallucinations in cerebrovascular disease.

Musical hallucinations (MH) are a subset of complex auditory hallucinations in which individuals perceive music in the absence of an external auditory stimulus. It is a rare phenomenon, first described by Ballinger in 1846, with diverse presentations from familiar childhood melodies to a simple pitch which evolved into the harmonies Robert Schumann incorporated in his sole Violin Concerto. This uncommon phenomenon has diverse etiologies, including psychiatric and neurological backgrounds, which guide its classification and methods of treatment. The pathophysiological basis of MH remains understood incompletely, potentially resulting from lesions anywhere along the auditory pathway, from the external auditory canal to the auditory cortex. The strong association between MH and hearing impairment has led researchers to hypothesize that MH represent a "release phenomenon," in which sensory deprivation, eliminating the afferent input to the auditory sensory network, instigates spontaneous activity within a system - comparable to the Charles Bonnet syndrome, in which visual impairment precipitates the development of visual hallucinations (so called auditory Charles Bonnet syndrome), and phantom limb syndrome, in which amputees experience sensations in a limb that is not no longer there. In this paper, we report on six cases of MH in patients with cerebrovascular disease, who presented to the neurology department at the Poznan University of Medical Sciences from 2015 to 2018. We discuss the findings of computed tomography and magnetic resonance imaging of six cases of MH in patients with cerebrovascular disease, and the treatment leading to its resolution. We briefly review the literature on MH in patients with cerebrovascular diseases, discussing their suggested pathophysiology, clinical presentations and response to medical treatment.

Functional imaging localization of complex organic hallucinations

ABSTRACTBackground: fMRI of mental phenomena is quite difficult to perform because lack of patient’s cooperation or because the symptoms are stable. In some exceptional cases, however, fMRI and DTI are capable to provide insights on the anatomy of organic hallucinations. Methods: In this report we describe a 14-year-old boy with a left fronto-dorsal tumor who experienced chronic complex brief, frequent and repetitive complex visual and auditory hallucinations. His clinical picture included multiple and severe social and mood problems. During a presurgical fMRI mapping the patient complained of having the visual and auditory hallucinations. A block-design FMRI paradigm was obtained from the event timecourse. Deterministic DTI of the brain was obtained seeding the lesion as ROI. The patient underwent surgery and electrocorticography of the lesional area. Results: The fMRI of the hallucinations showed activation in the left inferior frontal gyrus (IFG) and the peri-lesional area. The tractography of the tumor revealed structural aberrant connectivity to occipital and temporal areas in addition to the expected connectivity with the IFG via the aslant fasciculus and homotopic contralateral areas. Intraoperative EEG demonstrated epileptic discharges in the tumor and neighboring areas. After resection, the patient’s hallucinations stopped completely. He regained his normal social life and recover his normal mood. He remained asymptomatic for 90 days. Afterwards, hallucinations reappeared but with less intensity. Conclusions: To our knowledge, this is the first reported case of combined functional and structural connectivity imaging demonstrating brain regions participating in a network involved in the generation of complex auditory and visual hallucinations.

Epileptic auditory illusions as reliable findings in the determination of the lateralization and localization of epileptogenic zone

AimThe aim of this study was to investigate the types and prevalence of epileptic auditory auras (EAA) in a large population with epilepsy based on a clinical analysis, to analyze the relationship between auditory auras and the hemispheric lateralization/localization of the epileptogenic zone, and to determine whether there is a reliable EAA that could be used for the identification of the localization and lateralization of the epileptogenic zone. MethodsThe retrospective study included 1050 patients with a diagnosis of epilepsy, including 854 (81.33%) patients with focal epilepsy and 196 (18.67%) with generalized epilepsy. Medical records of 72 patients with auditory auras were singled out, and 63 of them were included in the study. The auditory auras were classified based on their clinical characteristics, and an analysis was performed to examine the relation of the type of auditory auras with the hemispheric lateralization/localization of the epileptogenic zone. Additionally, further analyses were performed to investigate whether there can be a reliable EAA that could be used for the identification of the localization and lateralization of the epileptogenic zone. ResultsOf the 1050 patients with a diagnosis of epilepsy, 63 cases of EAA were included in the study. The prevalence of EAA was 6% in the population with generalized epilepsy and 7.38% in the patients with focal epilepsy. Of the 63 patients, 58 (92.06%) were right-hand-dominant, and 5 (7.94%) were left-hand-dominant. The epileptogenic zone was mostly localized to the temporal lobe (n = 56; 88.89%). In all the 12 patients that had isolated auditory illusion or auditory illusion + elementary or complex auditory hallucinations, the epileptogenic zone was lateralized to the dominant hemisphere and even localized to the temporal lobe of the dominant hemisphere. SignificanceThe prevalence of EAA in the population with generalized epilepsy can be found higher than expected if a detailed evaluation of the population with generalized epilepsy can be performed, as in specific patient groups. Our results indicated that the epileptogenic zone was lateralized to the dominant hemisphere in all the patients with isolated auditory illusion or auditory illusion + elementary or complex auditory hallucinations, which suggests that auditory illusion can be a reliable tool in the determination of the lateralization and even localization of the epileptogenic zone.

Epilepsy with auditory features: Long-term outcome and predictors of terminal remission.

To assess the long-term outcome of epilepsy with auditory features (EAF) and to identify the clinical predictors for prognosis. The study involved consecutive EAF patients with a follow-up of ≥5 years. Terminal remission (TR) was defined as a period of ≥5 consecutive years of seizure freedom at the last follow-up. We used Kaplan-Meier estimate to calculate the cumulative time-dependent probability of conversion to TR. Log-rank test and multivariate Cox regression analyses were performed to study the association between time to TR and prognostic determinants. We included 123 EAF patients (male/female = 58/65) with a median follow-up of 11 years (1626.9 person-years). Most were sporadic cases (68.3%), whereas 31.7% reported a family history of epilepsy. At last assessment, 42 patients had achieved TR (34.1%). Of the remaining 81 cases with no TR (65.9%), 37% had been in remission for 1-4 years and 62.9% still had seizures within the past year. The cumulative rates of TR were 26.6%, 35.7%, and 51.6% at 10, 20, and 30 years from inclusion. On multivariate analysis, age at onset > 10 years (hazard ratio [HR] = 3.2, P = .028), auditory aura characterized by distortions only versus simple/complex hallucinations (HR = 2.9, P = .041), and unremarkable scalp electroencephalogram (EEG) versus EEG with focal epileptiform activity (HR = 3.5, P = .041) were associated with TR. Our data show a wide prognostic spectrum of EAF, ranging from mild forms with spontaneous remission, to severely refractory epilepsy addressed to surgery. The outcome, less favorable than expected from previous studies, appears to be primarily a function of 3 prognostic negative risk factors: age at onset < 10 years, auditory aura characterized by complex auditory hallucinations, and focal epileptiform abnormalities on scalp EEG. These predictors, easy to collect even at the first visit, may inform both clinicians and patients about the long-term prognosis and aid patient management.

Psychotic episode in a patient with antiphospholipid syndrome – case presentation

A 22-year-old pacient, without psychiatric antecedents, treated in the “Prof. Dr. Al. Obregia” Clinical Hospital, Clinical Psychiatry VIII Section, in December 2017, presented for psychomotor agitation, complex auditory hallucinations, solilocvia, mystical delusional ideation, social withdrawal, bizarre behaviour, and hypnic disorders. The symptoms started approximately one month before, and accentuated progressively. We will focus on the characteristics of the debute (psychotic episode) of a rare autoimmune disease, such as antiphospholipid syndrome, and also on the patient’s prognosis.

Differences in the symptom profile of methamphetamine-related psychosis and primary psychotic disorders

We examined the lifetime experience of hallucinations and delusions associated with transient methamphetamine-related psychosis (MAP), persistent MAP and primary psychosis among a cohort of dependent methamphetamine users. Participants were classified as having (a) no current psychotic symptoms, (n=110); (b) psychotic symptoms only when using methamphetamine (transient MAP, n=85); (c) psychotic symptoms both when using methamphetamine and when abstaining from methamphetamine (persistent MAP, n=37), or (d) meeting DSM-IV criteria for lifetime schizophrenia or mania (primary psychosis, n=52). Current psychotic symptoms were classified as a score of 4 or more on any of the Brief Psychiatric Rating Scale items of suspiciousness, hallucinations or unusual thought content in the past month. Lifetime psychotic diagnoses and symptoms were assessed using the Composite International Diagnostic Interview. Transient MAP was associated with persecutory delusions and tactile hallucinations (compared to the no symptom group). Persistent MAP was additionally associated with delusions of reference, thought interference and complex auditory, visual, olfactory and tactile hallucinations, while primary psychosis was also associated with delusions of thought projection, erotomania and passivity. The presence of non-persecutory delusions and hallucinations across various modalities is a marker for persistent MAP or primary psychosis in people who use methamphetamine.

Resistant psychosis in a patient with coexisting beta-thalassemia and latent toxoplasmosis

We present the case of a 44 year-old Caucasian male (V.B) with a known psychiatric history of paranoid schizophrenia, admitted to “Prof. Dr. Al. Obregia” Clinical Hospital of Psychiatry during the months of May-July 2015 (67 days of hospitalization) for: compound and complex auditory and visual hallucinations, paranoid delusions, hallucinatory behavior, psychotic anxiety and sleep disturbances, symptoms which had intensified in the several months preceding admission despite following adequate antipsychotic treatment. We present the difficulties we encountered in treating his resistant psychosis, the process of diagnosing his co-morbidities (beta-thalassemia and latent Toxoplasma gondii infection), a differential diagnosis of the intense positive symptoms the patient presented and the implications of toxoplasmosis in the evolution and treatment of a paranoid schizophrenic patient. Conclusion. The scope of this paper was to show the importance of performing a differential diagnosis and a thorough workup however certain we are of the patient's initial presentation. We also wanted to emphasize the need for studies that present more effective treatments of resistant psychosis with fewer adverse reactions. The etiology of schizophrenia presents a tremendous challenge for both researchers and physicians, the latent toxoplasmosis infection observed in high prevalence among schizophrenic patients representing only a small part of what remains to be discovered. Ultimately we must draw attention to the importance of a multidisciplinary approach to every case encountered.

Auditory verbal hallucinations of epileptic origin

Complex auditory hallucinations are often characterized by hearing voices and are then called auditory verbal hallucinations (AVHs). While AVHs have been extensively investigated in psychiatric patients suffering from schizophrenia, reports from neurological patients are rare and, in most cases, incomplete. Here, we characterize AVHs in 9 patients suffering from pharmacoresistant epilepsy by analyzing the phenomenology of AVHs and patients' neuropsychological and lesion profiles. From a cohort of 352 consecutively examined patients with epilepsy, 9 patients suffering AVHs were identified and studied by means of a semistructured interview, neuropsychological tests, and multimodal imaging, relying on a combination of functional and structural neuroimaging data and surface and intracranial EEG. We found that AVHs in patients with epilepsy were associated with prevalent language deficits and damage to posterior language areas and basal language areas in the left temporal cortex. Auditory verbal hallucinations, most of the times, consisted in hearing a single voice of the same gender and language as the patient and had specific spatial features, being, most of the times, perceived in the external space, contralateral to the lesion. We argue that the consistent location of AVHs in the contralesional external space, the prominence of associated language deficits, and the prevalence of lesions to the posterior temporal language areas characterize AVHs of neurological origin, distinguishing them from those of psychiatric origin.

Fluoxetine-Induced Atypical Serotonin Syndrome with Hallucinations Masquerading as a Parkinsonian Syndrome

Objective: To report a unique case of fluoxetine overdose leading to serotonin syndrome with auditory and complex visual hallucinations. This case also demonstrates serotonin syndrome may mimic a Parkinsonian syndrome, which is poorly described in the literature. Case Summary: A 65-year-old gentleman, undergoing evaluation for possible Parkinsonian syndrome with bradykinesia and rigidity presented to the emergency department with additional complaints of weakness, fatigue, flushing, and complex visual and auditory hallucinations. Chart review revealed he was unintentionally overdosed with fluoxetine to a total daily dose of 160 mg. Examination revealed tachycardia, diaphoresis, significant mydriasis, and visual hallucinations. Initial workup was unremarkable. Poison control recommended discontinuation of the fluoxetine and in follow up he reported resolution of all symptoms. Discussion: This case describes serotonin syndrome as the result of chronic fluoxetine overdose masquerading as a Parkinsonian syndrome. This patient also experienced auditory and visual hallucinations that resolved with cessation of fluoxetine, adverse effects which are relatively uncommon. The likelihood the patient’s symptoms were the result of fluoxetine intoxication is probable, as assessed by the Naranjo Adverse Drug Reaction (ADR) probability scale. Conclusions: Chronic fluoxetine overdose can lead to serotonin syndrome, as well as, several rare adverse effects including a Parkinsonian syndrome, complex visual, and auditory hallucinations. A high index of suspicion is necessary for diagnosis of serotonin syndrome, particularly in mild cases. Most cases can be prevented with careful medication reconciliation.

Schizophrenia Symptoms Relieved by CO-Induced Pallidal Lesion: A Case Report

Back to table of contents Previous article Next article LettersFull AccessSchizophrenia Symptoms Relieved by CO-Induced Pallidal Lesion: A Case ReportSalvatore Galati, M.D., Ph.D., and Claudio Städler, M.D.Salvatore GalatiSearch for more papers by this author, M.D., Ph.D., and Claudio StädlerSearch for more papers by this author, M.D.Published Online:1 Apr 2013https://doi.org/10.1176/appi.neuropsych.12060139AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail To the Editor: Although basal ganglia (BG) physiology is classically joined to motor function, increasing evidence has outlined its involvement also in cognitive and behavioral domains.1 Personality changes as well as clearly psychiatric traits can be recognized in BG syndromes like Parkinson’s disease, and BG alterations have been described in psychiatric disorders. In schizophrenia, changes in subcortical brain regions have been extensively observed.2 Herein, we describe a patient with schizophrenia who experienced a sustained remission after an occasional “selective” bilateral pallidal lesion induced by carbon monoxide (CO) intoxication.“Mrs. R” was a 50-year-old woman affected by a paranoid form of schizophrenia, with several hospitalizations for episodes of paranoia, complex auditory hallucinations, and delusional religious beliefs. During her life, she has been managed with several antipsychotic drugs, and the last therapy was based on haloperidol decanoate injections (200 mg every 4 weeks), with residual symptoms consisting of minor delusions and few episodes of auditory hallucinations.In December 2008, she was intoxicated with CO that caused an anoxic lesion of both pallidum structures, as shown in the MRI brain scan (Figure 1). During hospitalization, she was unexpectedly relating better, without paranoid or any delusion, and therefore no antipsychotic treatments were prescribed. Surprisingly, after the hospital discharge and in the following 2 years of visit appointments, she was completely stable, with full sustained psychiatric remission.FIGURE 1. Two Horizontal Sections of the MRI Scan Before and After CO IntoxicationRight: the two pallidal lesions.This unexpected clinical observation shines a further light on the intimate involvement of BG in schizophrenia. Although we cannot definitely demonstrate a causal relationship between the CO-mediated pallidal lesion and psychotic compensation, the temporal association is highly convincing. In one of the most fascinating patho-physiological theories, in schizophrenia, the pallidum is placed in overdrive by the hippocampus unbalancing the two distinct firing patterns of dopaminergic neurons of the ventral tegmental area.3 Particularly, the tonic component (responsible for the “background” dopamine) release is impaired, causing a lower threshold of the system sensitivity to short-term phasic increase of dopamine levels in response to behaviorally-relevant stimuli.3Thus, the present case could support this patho-physiological theory of schizophrenia, leading to a picture in the future of a neuro-surgical approach for this disorder as extensively proposed in other psychiatric conditions.4Neurocenter (EOC) of Southern Switzerland, SwitzerlandCorrespondence: Dr. Salvatore Galati, Neurocenter (EOC) of Southern Switzerland; e-mail: salvatore.[email protected]chReferences1 Afifi AK: The basal ganglia: a neural network with more than motor function. Semin Pediatr Neurol 2003; 10:3–10Crossref, Medline, Google Scholar2 Menon V, Anagnoson RT, Glover GH, et al.: Functional magnetic resonance imaging evidence for disrupted basal ganglia function in schizophrenia. Am J Psychiatry 2001; 158:646–649Crossref, Medline, Google Scholar3 Lisman JE, Coyle JT, Green RW, et al.: Circuit-based framework for understanding neurotransmitter and risk gene interactions in schizophrenia. Trends Neurosci 2008; 31:234–242Crossref, Medline, Google Scholar4 Schlaepfer TE, Bewernick B, Kayser S, et al.: Modulating affect, cognition, and behavior: prospects of deep brain stimulation for treatment-resistant psychiatric disorders. Front Integr Neurosci 2011; 5:29Crossref, Medline, Google Scholar FiguresReferencesCited byDetailsCited ByMutisme akinétique et lésion bipallidale après intoxication médicamenteuse à l’hydroxyzine. À propos d’un casL'Évolution Psychiatrique, Vol. 81, No. 1 Volume 25Issue 2 Spring 2013Pages E52-E53 Metrics PDF download History Published online 1 April 2013 Published in print 1 April 2013

The sound of silence

In January, 2011, a previously well 68-year-old woman, presented to our neurology outpatients department with a 6 week history of hearing a male voice singing and gradual bilateral hearing loss over the course of 1 year. The singing started suddenly with songs she knew from her childhood, and more recently she also reported hearing a choir. The singing was perceived as external, heard only in the left ear, and continued all day and night. She reported that the voices were irritating, particularly when trying to sleep. They stopped when she fell asleep and did not interfere with her daytime activities. She had insight that the voices were imaginary but said that she could not “switch them off ” and did not recall any specifi c triggers. There was no alteration of the symptoms with her mood or tiredness. There was no reported change in her mood, with no signs of depression or mania, nor thoughts or intentions of self harm. She did not report tinnitus, other sensory hallucinations, or any symptoms of epileptic seizures such as vacant attacks, odd tastes or smells, incontinence, tongue biting at night, or psychomotor automatisms. She had no history of thought insertion, withdrawal, broadcasting, or any other features of schizophrenia. She had a medical history of hypertension, and was on aspirin, atenolol, and olmesartan. Amitriptyline was prescribed for insomnia. She did not smoke, drink alcohol, or use recreational drugs. On examination she was anxious, but alert and oriented with no cognitive impairment. A full mini-mental state examination could not be done because her hearing loss made the repetition of a sentence impossible. However, she scored 27/27 points on the incomplete test. She was oriented in time, person, and place, with no evidence of alteration of consciousness. She had bilateral hearing loss. Neurological examination was unremarkable other than absent vibration sensation and ankle refl exes. Routine blood tests were normal. An electroencephalogram done whilst she was experiencing the singing, did not show epileptic activity or any other focal or generalised brain abnormalities. CT of the head was normal. MRI of the head (with T1, T2, and FLAIR sequences) showed only a few white matter hyper intensities of the T2 and FLAIR sequences, which can be associated with smallvessel disease secondary to hyper tension. Ear, nose, and throat examination and pure tone audiogram showed bilateral sensorineural hearing loss only. Psychiatric assessment ruled out the possibility of mental illness. Our patient was diagnosed with musical ear syndrome because there was no evidence of neurological or psychiatric disease. This is a syndrome comparable to Charles Bonnet Syndrome in which people with visual impairment have visual hallucinations. Our patient was reassured about the benign nature of her condition. Multiple anticonvulsants were tried with mixed results. In February, 2012, at last follow-up, she had marked improvement of her symptoms after starting Clonazepam. Charles Bonnet was a Swiss scientist who documented complex visual hallucinations in his blind but otherwise healthy grandfather in 1760. Later the blind Charles Bonnet also had similar hallu cinations. Diagnostic criteria have since been developed for the disorder fi rst described as Charles Bonnet Syndrome by a Swiss neurologist George de Morsier, in 1967. Clinical features are often stereotyped, complex visual hallucin ations in a partially sighted patient. The patient has insight that the hallucinations are not real, and there is no psychosis, neurological or cognitive impairment, intox ication, or metabolic abnormality. No other sensory hallu cinations should be present. Generally the hallucinations are self limiting. No clear evidence for treatment exists. The mechanism of Charles Bonnet Syndrome is poorly understood. Few reports about complex auditory hallucinations in people with hearing impairment exist; however, some have suggested that they are quite common. Whether the diagnostic criteria of Charles Bonnet Syndrome should be extended to include complex auditory hallucinations, or these considered separately as Musical Ear Syndrome, is debatable. Our patient’s case is a reminder that hallucinations are not always due to delirium or to psychological or neurodegenerative conditions. Other conditions, such as Charles Bonnet Syndrome or musical ear syndrome, should also be considered.

Auditory Hallucinations as the Only Presenting Symptom of Right-Parietal Spontaneous Hemorrhage: FDG-PET Evidence of Corpus Callosum Hyperactivity

Back to table of contents Previous article Next article LettersFull AccessAuditory Hallucinations as the Only Presenting Symptom of Right-Parietal Spontaneous Hemorrhage: FDG-PET Evidence of Corpus Callosum HyperactivityMassimiliano Godani, M.D., Andrea Ciarmiello, M.D., Cesare Capellini, M.D., and Massimo Del Sette, M.D.Massimiliano GodaniSearch for more papers by this author, M.D., Andrea CiarmielloSearch for more papers by this author, M.D., Cesare CapelliniSearch for more papers by this author, M.D., and Massimo Del SetteSearch for more papers by this author, M.D.Published Online:1 Jan 2012https://doi.org/10.1176/appi.neuropsych.11020054AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail To the Editor: Auditory hallucinations are very rare in stroke patients. We report FDG-PET findings in a case of hemorrhagic stroke presenting with auditory hallucinations.Case ReportA 67-year-old woman was admitted to the emergency room of our hospital for acute onset of complex auditory hallucinations; she reported hearing loud music and voices of known persons speaking “filthy.” She had never suffered any psychiatric disorders in the past, and she was taking atenolol for many years as the only treatment for chronic arterial hypertension.Neurological examination did not show any focal neurological signs, and blood tests were normal. Brain CT scan revealed a right-parietal hemorrhage involving both superficial and deep territory of the posterior branches of middle cerebral artery (Figure 1 [D]). EEG showed absence of focal paroxystic epyleptiform discharges. Brain MRI and MR-angio confirmed the intraparenchimal hemorrhage, excluding the presence of aneurysm or artero-venous malformations. FDG-PET scan showed a significant increase in glucose metabolism (versus normal control database) in the middle and posterior areas of corpus callosum as well as in the precuneus and cuneus cortex (Figure 1 [A, B, C]).The auditory hallucinations gradually resolved in a few days without any treatment. She was discharged after 18 days from onset, and neurological examination showed visuospatial deficit as the consequence of right-parietal damage.DiscussionAuditory hallucinations are uncommon phenomena in patients with acute stroke; in particular, they have been reported in acute ischemic lesions of the brainstem but very rarely reported after cortical ischemic strokes.1 To our knowledge, this is the first case of auditory hallucinations as the only presenting symptom of a spontaneous hypertensive parenchymal hemmorrhage.In our case FDG-PET scan showed high relative glucose metabolic rates in the middle and posterior areas of corpus callosum. Hyperactivity of corpus callosum has already been reported in schizophrenic patients with auditory hallucinations.2,3 In particular, abnormalities in the posterior part of corpus callosum has been associated to schizophrenic positive symptoms.4 We speculate that in our patient the acute cortico-subcortical hemorrhage caused, through rapid development of peri-lesional edema and release of excitatory mediators such as calcium ions and amino-acids, an electrode-like effect,5 which abnormally activated the posterior part of corpus callosum, with consequent development of auditory hallucinations. We believe that a better understanding of corpus callosum pathophysiology could help in clarifying the mechanism of perceptive disturbances of various origin.Neurology UnitS. Andrea HospitalLA Spezia, ItalyCorrespondence: Massimiliano Godani, M.D.; massimiliano.[email protected]liguria.it1. Yair L , Mordechai L , Ronit G, et al.: Auditory hallucinations in acute stroke. Behav Neurol 2005; 16:211–216Crossref, Medline, Google Scholar2. Buchsbaum MS , Buchsbaum BR , Hazlett EA, et al.: Relative glucose metabolic rate higher in white matter in patients with schizophrenia. Am J Psychiatry 2007; 164:1072–1081Crossref, Medline, Google Scholar3. Hubl D , Koenig T , Strik W, et al.: Pathways that make voices. Arch Gen Psychiatry 2004; 61:658–668Crossref, Medline, Google Scholar4. Kubicki M , Styner M , Bouix S, et al.: Reduced interhemispheric connectivity in schizophrenia: tractography base segmentation of the corpus callosum. Schizophr Res 2008; 106(2–3):125–131Crossref, Medline, Google Scholar5. Weber B , Fouad K , Burger C, et al.: White-matter glucose metabolism during intracortical electrostimulation: a quantitative fluorodeoxyglucose autoradiography study in the rat. Neuroimage 2002; 16:993–998Crossref, Medline, Google Scholar FiguresReferencesCited byDetailsCited byJournal of the Neurological Sciences, Vol. 398Frontiers in Psychiatry, Vol. 8PET and SPECT Findings in Patients with Hallucinations29 January 2014 Volume 24Issue 1 Winter 2012Pages E28-E29 Metrics PDF download History Published online 1 January 2012 Published in print 1 January 2012

Hallucinations and Reversed Cerebral Dominance in Mesial Temporal Sclerosis

The localizing value of experiential phenomena in temporal and occipital lobe epilepsy has become increasingly elucidated. We describe complex visual and auditory hallucinations in a right-handed adolescent and review the localization value of ictal visual and auditory auras in partial epilepsy. A 15-year-old right-handed girl with 2 previous secondarily generalized seizures manifested a new semiology of complex visual and auditory hallucinations, characterized by seeing a school bus full of children and then hearing a male voice tell her to "feed the children." Feeling compelled, she "fed" the children, and they reboarded the bus and the bus drove away. Video electroencephalogram monitoring demonstrated fluent language during her seizures. Magnetic resonance imaging was compatible with left mesial temporal sclerosis. Fluorodeoxyglucose positron emission tomography demonstrated left temporal hypometabolism. An ictal single-photon emission computed tomography study demonstrated left anterior temporal hyperperfusion; Wada testing revealed reversed cerebral dominance. The patient underwent left anterior temporal lobectomy without complication and remains seizure-free. Complex auditory and visual hallucinations can occur in occipitotemporal and anteromedial temporal epilepsy. Reversed cerebral dominance is more common in children than adults and should be considered in any dextral person with fluent ictal speech with a left-sided epileptogenic lesion.

De Novo Cerebral Arteriovenous Malformation: Pink Floyd's Song “Brick in the Wall” as a Warning Sign

Background: Arteriovenous malformations are shunts between an artery and the venous system that lie within a nidus without an intervening capillary bed. These lesions are thought to be congenital, but recent reports have challenged this assumption. Case Report: A 50-year-old man presented to the emergency department with a generalized tonic-clonic seizure. Before the onset of his seizure, he experienced a vivid auditory hallucination of his favorite song by the band Pink Floyd, “A Brick in the Wall.” He had been diagnosed with epilepsy 25 years previously. On presentation, his neurological examination was normal, but a computed tomography scan of the brain revealed a large arteriovenous malformation (AVM) occupying the left temporal lobe. Upon more detailed questioning, he recalled that a brain angiogram had been performed 25 years before and was reported to be normal. Neurosurgery was not performed in view of the size of the malformation. The patient is being followed-up as an outpatient. Conclusion: AVMs may arise de novo and then spontaneously become symptomatic. Cerebral de novo AVM should be considered in the differential diagnosis in patients with complex auditory musical hallucinations or any new neuropsychiatric symptoms.

Musical Hallucinations and Parkinson Disease

Musical hallucinations are complex auditory hallucinations. The term covers the clinical phenomenon of hearing tunes and melodies that are uncontrollable and not related to external stimuli. Musical hallucinations may be experienced in a variety of conditions including diseases of the ear and neurologic, psychiatric, infectious, and toxic states. When the underlying pathology resolves, musical hallucinations tend to disappear. We present an elderly man with musical hallucinations and without any conditions known to be related with its occurrence, except for Parkinson disease. Musical hallucinations in the elderly occur predominantly in women with a hearing impairment. Parkinson disease is usually accompanied by visual hallucinations. Auditory hallucinations are rare in Parkinson disease and most of them are accompanied by visual hallucinations. Isolated auditory hallucinations are rarer in Parkinson disease and mostly consist of human voices.

P02-284 The women who heard folk Portuguese music in the right ear: A case of unilateral musical hallucinosis

Introduction:Although probably undereported, musical hallucinosis is very rare and usually bilateral. It refers to auditory complex hallucinations, for which the patient has full insight, and includes melodies, tunes, rhythms and timbres.Clinical case:A 71-year-old women was seen for a history of hearing music in the right ear. She had mild hypertension and auricular fibrillation, being chronically medicated with aspirine, bisoprolol and hydroclorothiazide. Three months previously she started hearing some popular folk Portuguese songs in the right ear. She could identify the lyrics and sing the songs she heard. Weeks later fado and classical music were added to the repertoire, and later on she started hearing less well-formed sounds like “dlam... dlam” or “uhh... uhh”. There were no other auditory or visual hallucinations. She was seen by an otorhinolaryngologist, and made an audiogram showing bilateral, right-predominant, pre-coclear deafness with normal evoked brainstem auditory potentials. An MRI showed small deep subcortical lacunar lesions. EEG was normal. PET scan showed left temporal hypometabolism. On benzodiazepines she had discrete improvement.Conclusion:Musical hallucinosis has been found mainly in deaf patients, and a similar mechanism to that of Charles-Bonnet syndrome has been proposed. Sensory deprivation of primary auditory cortex would “release” the secondary auditory cortex, to produce complex auditory hallucinations with full insight. In our patient we were able to demonstrate the integrity of the brainstem pathway, supporting a direct link between diminished right ear sound transmission and left temporal lobe diminished activation as ascertained by the pet scan.