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Auditory hallucinations in acute stroke  Yair Lampla,∗, Mordechai Lorberboymb, Ronit Gilada, Mona Boazc and Menachem Sadeha
aDepartment of Neurology, Edith Wolfson Medical Center, Holon, Sackler Faculty of Medicine, Tel Aviv University,  Israel
bDepartment of Nuclear Medicine, Edith Wolfson Medical Center, Holon, Sackler Faculty of Medicine, Tel Aviv  University, Israel
cEpidemiology Unit and the Institute for Cardiovascular Research, Edith Wolfson Medical Center, Holon, Sackler  Faculty of Medicine, Tel Aviv University, Israel

CASE STUDY OF Patient No. 1

A 67-year-old right handed woman was admitted to the hospital due to sudden onset of headache, dizziness and auditory hallucinations which appeared two days prior to hospitalization. She kept complaining of hearing her sister and neighbour continuously speaking between them and was convinced that she, herself, was saying things, events that other members of the family denied the presence of any speech by the patient.

She had long-standing history of good health and no previous psychiatric event.

On admission, the patient was alert, well orientated as to time and place and had no speech or language difficulties. On the left side, mild hemiparesis and hemi-hypoesthesia was found. The deep tendon reflexes were brisker on the same side and accompanied by pyramidal signs.

In the next three weeks, the patient demonstrated continued vivid and clear auditory hallucinations. The hallucinations were complex, consisting of three types:

(1) family members and neighbours speaking to her – the content of the speech was about sharing information regarding family members, including past information about a pet dog, having no threatening or frightening components and was not emanating from an external source;

(2) the family members speaking with other persons, not about her, but projecting her ideas; and

(3) hearing herself speaking in her own voice. She defined the last two incidents as unpleasant and threatening.

The patient always declared that the spoken information came only from the right side.

Mental status tests were normal, including Waschler Adult test (WAT) (91 percentile) (27), Mini Mental State Examination (MMSE) (29/30) [12], digit span test, drawing a clock [24] and Trail Making Test [23].

Audiometric and repeat psychiatric examinations were normal. Electroencephalo-graphical examination revealed normal background with persistent appearance of waves in the right mid-temporal region without epileptic discharge. On the BEAR test, symmetrical BTT values <0.2 mg were found. On repeat CT scan and MRI, an acute lesion of the right temporal area was demonstrated. The infarction involved the right temporal auditory region (Broadman area 41, 42) (Fig. 1) and the post auditory area (interictal) (Broadman 22). SPECT HMPAO imaging demonstrated a hypoperfusion located in the middle and the posterior temporal lobe of the right side. The patient was treated with haloperidol with good effects. Four months later, the medication could be discontinued successfully.