Observations placeholder

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 -  Patient No. 4

A healthy 32-year-old right-handed man, who was a smoker and had no vascular risk factors, was admitted to the hospital after the appearance of weakness of the left side combined with auditory hallucinations.

He awoke one morning hearing himself speak that he feels bad. He called to his wife who immediately called an emergency care ambulance. During the transport to the hospital, he was very anxious, irritated and told the attendants for the entire transport time that he heard his wife and his children speaking to him about his condition.

The neurological examination revealed moderate left hemiparesis with hemihypoesthesia.

On the following days, the auditory hallucinations became more intense and were concentrated in two main topics:

(1) hearing himself speak about his condition without any real verbal speech and

(2) hearing his wife and older daughter discuss with him about non-medical issues. The messages were very specific and very well constructed.

He was only partially aware of the unreality of the hallucinations, plus very irritated, nervous and apprehensive. He has the feeling that the information came from an internal source, but also from an external one. CT scan showed involvement of the right insula and right superior temporal gyrus and part of the surrounding area 22.

Psychiatric examination did not reveal any abnormality, apart from the hallucinations. Neurocognitive tests (WAT – 94 percentile,MMSE– 30/30) were normal. Audiometric and evoked potentials, as well as repeat EEG examinations which showed a normal background with intermittent slowing on the right anterio-temporal area, were all normal. BEAR BTT was symmetrical at 0.25 msec. On brain CT scan, infarction of the right insula and right superior temporal gyrus and the surrounding Broadman area 22 was found (Fig. 3).

Two weeks after admission, the hallucination symptoms disappeared. The patient was transferred to a rehabilitation center where he stayed for the next five weeks. A combination therapy of resperidone carbamazepine was continued for the next three months. The patient continued to act normally, having only moderate motor impairment. Unfortunately, one year later he was admitted again to the hospital with a recurrent stroke of the contralateral temporal lobe expressed as a central bilateral deafness.