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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. 2

A 56-year-old right handed woman with well controlled hypertension and diabetes mellitus, was reported as having an episode of syncope, sudden headache and auditory hallucination following the syncope. A family member noted the abnormal event, but the patient refused to leave the house for medical attention. The family members were confused by her complaints of “telling them all what she thought” without actually hearing any of her words. She told them also that she heard both her sisters speaking the whole time between them, leaving her out, without their being physically present in the room.

On neurological examination, no deficit was found. After admission, she continued to describe two types of hallucinations:

(1) hearing herself in her own voice speaking in a well constructed manner; and

(2) hearing her near relations discussing things above her head.

The hallucinations consisted of very frightening characters. She did not define her condition as anxious, but as bizarre and unpleasant.

The hallucinations occurred when she was not awake, and the voice was not of an external source.

On repeat psychiatric examination, no abnormality was found. Neurocognitive tests, including WAT (93 percentile), MMSE test (30/30), drawing a clock and trail making test, were all normal.  Audiometric and evoked potential tests were within normal limits.

During an episode of hallucination and interactive period, EEG examination showed no epileptic discharges with intermittent spikes in the mid and posterior right temporal region on a normal background. The BEAR examination showed a difference in the BTT of 0.3 msec between the right and left ear.

CT scan demonstrated two hypodense areas – an acute lesion of the right temporal post auditory region and a fixed lesion of the lateral periventricular region of the occipital lobe (Fig. 2). The patient was successfully treated with haloperidol combined with carbamazepine. The medications were discontinued one month after the onset of treatment.