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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. 3

A 72-year-old left handed woman, suffering from hypertension, and hyperlipidemia, was examined by a psychiatrist after sudden onset of auditory hallucinations.

According to her husband, she was in good health when she went to sleep, and during the night awoke, complaining of headache and saying that she heard her mother speaking in the other room. She was aware of the fact that her mother had died several years ago and that this phenomenon was illogical; and therefore, became very frightened and confused.

One day later, the patient complained of hearing herself telling what she has to do and discussing problems about which she had no insight. She has a suspicion that the voice did not come from an external source, but was not sure.

The commands consisted of short phrases of 2–3 words and were constructed well grammatically.

In the emergency room, no abnormalities were found on the neurological examination. The psychiatric examination revealed no pathology, apart from the auditory hallucination and severe anxiety state.

Audiometric and evoked potential tests were normal.  On EEG examination, slowing of the background in the tetra wave rate (more on the right side), but without epileptic discharge, was found during and after the hallucination period. BEAR examination was symmetrical with BTT less than 0.2 msec. On repeat brain CT scan, acute ischemic infarct of the middle upper region of the right temporal lobe was found.

She started a combined haloperidol and carbamazepine therapy which had very good efficacy. After one week, the auditory hallucinations disappeared, and the anti-psychotic treatment was discontinued. A trial of discontinuing the anti-convulsive medication two months later was successful.