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Medina-Rincón GJ, Martínez-Gil S, Tierradentro-García LO, Orrego-González EE, Botero-Meneses JS. Dmitri Shostakovich: a work of virtuosity or a profitable misfortune? ARQUIVOS DE NEURO-PSIQUIATRIA 2021; 79:933-935. [PMID: 34706023 DOI: 10.1590/0004-282x-anp-2020-0570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 04/07/2021] [Indexed: 11/22/2022]
Abstract
Dmitri Shostakovich was one of the greatest composers of 20th century, famous for his piano and violin compositions. One of the compositions, the 5th symphony, is arguably his greatest work, which brought him back to the grace of the Soviet authorities in a moment of a political crisis in Russia. Among the experts, there is a theory which supports that Shostakovich's talent was due to a traumatic brain injury involving a shrapnel. Moreover, he might have suffered from a neurodegenerative process throughout his life. In this paper, we intend to discuss these viewpoints.
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Affiliation(s)
- Germán José Medina-Rincón
- Universidad del Rosario, Escuela de Medicina y Ciencias de la Salud, Neuroscience Research Group, Bogotá D.C., Colombia.,Universidad del Rosario, Escuela de Medicina y Ciencias de la Salud, Centro de Neurociencia Neurovitae-Universidad del Rosario, Bogotá D.C., Colombia
| | - Sofía Martínez-Gil
- Universidad del Rosario, Escuela de Medicina y Ciencias de la Salud, Neuroscience Research Group, Bogotá D.C., Colombia.,Universidad del Rosario, Escuela de Medicina y Ciencias de la Salud, Centro de Neurociencia Neurovitae-Universidad del Rosario, Bogotá D.C., Colombia
| | - Luis Octavio Tierradentro-García
- Universidad del Rosario, Escuela de Medicina y Ciencias de la Salud, Neuroscience Research Group, Bogotá D.C., Colombia.,Universidad del Rosario, Escuela de Medicina y Ciencias de la Salud, Centro de Neurociencia Neurovitae-Universidad del Rosario, Bogotá D.C., Colombia.,Children's Hospital of Philadelphia, Department of Radiology, Philadelphia PA, United States of America
| | - Eduardo Esteban Orrego-González
- Universidad del Rosario, Escuela de Medicina y Ciencias de la Salud, Neuroscience Research Group, Bogotá D.C., Colombia.,Universidad del Rosario, Escuela de Medicina y Ciencias de la Salud, Centro de Neurociencia Neurovitae-Universidad del Rosario, Bogotá D.C., Colombia
| | - Juan Sebastián Botero-Meneses
- Universidad del Rosario, Escuela de Medicina y Ciencias de la Salud, Neuroscience Research Group, Bogotá D.C., Colombia.,Universidad del Rosario, Escuela de Medicina y Ciencias de la Salud, Centro de Neurociencia Neurovitae-Universidad del Rosario, Bogotá D.C., Colombia
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Abstract
have been reported in association with psychiatric diseases, brain stem strokes, deafness, degenerative diseases, intoxications, pharmacologic agents, and epilepsy. We present a patient who in the absence of these disorders developed musical hallucinations from an infarction of the right hemisphere that primarily injured his right frontal and anterior temporal lobes. This report discusses some of the possible mechanisms for this patient's presentation. Although the mechanism of his musical hallucinations remains unclear, recognition of this uncommon syndrome is important when structuring rehabilitation and management for patients with stroke who have this disorder.
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Affiliation(s)
- Natalie Buchwald
- Department of Neurology, University of Florida , Gainesville, Fl, USA
| | - Adam Kelly
- Department of Neurology, University of Rochester , Rochester, New York, USA
| | - Kenneth M Heilman
- Distinguished Professor Emeritus, Department of Neurology, University of Florida College of Medicine & Neurologist-Geriatric Research, Education, and Clinical Center Malcom Randall Veterans Affairs Medical Center , Gainesville, Florida, USA
| | - Alexis N Simpkins
- Vascular Neurology, Department of Neurology, University of Florida Gainesville, USA
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Cavaliere C, Longarzo M, Orsini M, Aiello M, Grossi D. Fronto-Temporal Circuits in Musical Hallucinations: A PET-MR Case Study. Front Hum Neurosci 2018; 12:385. [PMID: 30319380 PMCID: PMC6170624 DOI: 10.3389/fnhum.2018.00385] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2018] [Accepted: 09/05/2018] [Indexed: 11/13/2022] Open
Abstract
The aim of the study is to investigate morphofunctional circuits underlying musical hallucinations (MH) in a 72-years old female that underwent a simultaneous 18fluoredeoxyglucose positron emission tomography (PET) and advanced magnetic resonance (MR) exam. This represents a particular case of MH occurred in an healthy subject, not displaying neurological or psychopathological disorders, and studied simultaneously with a multimodal approach. For the resting-state fMRI analysis a seed to seed approach was chosen. For the task-based fMRI, 4 different auditory stimuli were presented. Imaging findings were compared with data obtained by ten healthy controls matched for age and sex. Neuropsychological evaluation and questionnaires investigating depression and anxiety were also administered. PET findings showed hypermetabolism of: superior temporal gyri, anterior cingulate, left orbital frontal, and medial temporal cortices. Structural MRI did not show macroscopical lesions except for gliotic spots along the uncinate fascicle pathways with an increased cortical thickness for the right orbitofrontal cortex (p = 0.003). DTI showed increased fractional anisotropy values in the left uncinate fascicle, when compared to controls (p = 0.04). Resting-state fMRI showed increased functional connectivity between the left inferior frontal gyrus and the left temporal fusiform cortex (p = 0.01). Task-based fMRI confirmed PET findings showing an increased activation of the superior temporal gyrus in all the auditory tasks except for the monotone stimulus, with a significant activation of the left orbital frontal cortex only during the song in foreign language, object of MH. Results on cognitive test did not show cognitive impairment, excepting for the performance on Frontal Assessment Battery where the patient fails in the cognitive domains of conceptualization, sensitive to interference, and inhibitory control. The subject did not show depressive or anxiety symptoms. Summarizing, multimodal imaging analyses in the MH case showed a microstructural alteration of the left uncinate fascicle paralleled by an increased metabolism and functional connectivity of cortical regions that receive left uncinate projections (orbital frontal cortex, and medial temporal cortex). This alteration of fronto-hyppocampal circuits could be responsible of retrieval of known songs even in the absence of real stimuli.
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Affiliation(s)
- Carlo Cavaliere
- NAPLab, IRCCS SDN Istituto di Ricerca Diagnostica e Nucleare, Naples, Italy
| | | | - Mario Orsini
- NAPLab, IRCCS SDN Istituto di Ricerca Diagnostica e Nucleare, Naples, Italy
| | - Marco Aiello
- NAPLab, IRCCS SDN Istituto di Ricerca Diagnostica e Nucleare, Naples, Italy
| | - Dario Grossi
- Department of Psychology, University of Campania Luigi Vanvitelli, Naples, Italy
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Coebergh JAF, Lauw RF, Bots R, Sommer IEC, Blom JD. Musical hallucinations: review of treatment effects. Front Psychol 2015; 6:814. [PMID: 26136708 PMCID: PMC4468361 DOI: 10.3389/fpsyg.2015.00814] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Accepted: 05/28/2015] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Despite an increased scientific interest in musical hallucinations over the past 25 years, treatment protocols are still lacking. This may well be due to the fact that musical hallucinations have multiple causes, and that published cases are relatively rare. OBJECTIVE To review the effects of published treatment methods for musical hallucinations. METHODS A literature search yielded 175 articles discussing a total number of 516 cases, of which 147 articles discussed treatment in 276 individuals. We analyzed the treatment results in relation to the etiological factor considered responsible for the mediation of the musical hallucinations, i.e., idiopathic/hypoacusis, psychiatric disorder, brain lesion, and other pathology, epilepsy or intoxication/pharmacology. RESULTS Musical hallucinations can disappear without intervention. When hallucinations are bearable, patients can be reassured without any other treatment. However, in other patients musical hallucinations are so disturbing that treatment is indicated. Distinct etiological groups appear to respond differently to treatment. In the hypoacusis group, treating the hearing impairment can yield significant improvement and coping strategies (e.g., more acoustic stimulation) are frequently helpful. Pharmacological treatment methods can also be successful, with antidepressants being possibly more helpful than antiepileptics (which are still better than antipsychotics). The limited use of acetylcholinesterase inhibitors has looked promising. Musical hallucinations occurring as part of a psychiatric disorder tend to respond well to psychopharmacological treatments targeting the underlying disorder. Musical hallucinations experienced in the context of brain injuries and epilepsy tend to respond well to antiepileptics, but their natural course is often benign, irrespective of any pharmacological treatment. When intoxication/pharmacology is the main etiological factor, it is important to stop or switch the causative substance or medication. CONCLUSION Treatments for musical hallucinations tend to yield favorable results when they target the main etiological factor of these phenomena. There is a need to establish the natural course of musical hallucinations, their response to non-pharmacological treatments, and their effects on the patient's quality of life. There is also a need to standardize the assessment of treatment responses, and document long-term follow up.
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Affiliation(s)
- Jan A. F. Coebergh
- Department of Neurology, Haga HospitalThe Hague, Netherlands
- Department of Neurology, Ashford/St. Peter's HospitalChertsey, UK
- Department of Neurology, St. George's HospitalLondon, UK
| | - R. F. Lauw
- Parnassia Psychiatric InstituteThe Hague, Netherlands
| | - R. Bots
- ‘S Heeren LooNoordwijk, Netherlands
| | - I. E. C. Sommer
- Department of Psychiatry, University Medical Center UtrechtUtrecht, Netherlands
- Brain Centre Rudolf MagnusUtrecht, Netherlands
| | - J. D. Blom
- Parnassia Psychiatric InstituteThe Hague, Netherlands
- Department of Psychiatry, University of GroningenGroningen, Netherlands
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Woo PY, Leung LNY, Cheng STM, Chan KY. Monoaural musical hallucinations caused by a thalamocortical auditory radiation infarct: a case report. J Med Case Rep 2014; 8:400. [PMID: 25468292 PMCID: PMC4289290 DOI: 10.1186/1752-1947-8-400] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2014] [Accepted: 10/13/2014] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Musical hallucinations are complex auditory perceptions in the absence of an external acoustic stimulus and are often consistent with previous listening experience. Their causation can be classified as associated with either psychiatric disorders, such as schizophrenia, or organic disorders, such as epilepsy or sensorineural deafness. Non-epileptic musical hallucinosis due to lesions of the central auditory pathway, especially of the thalamocortical auditory radiation, is rare. CASE PRESENTATION We describe the case of an 85-year old ethnic Chinese woman with a history of transient ischemic attacks and chronic bilateral hearing impairment, who experienced an acute onset of left unilateral musical hallucinations. Our patient did not experience any psychiatric symptoms and there was no other neurological deficit. Pure tone audiometry revealed bilateral hypacusis and magnetic resonance imaging revealed a right non-dominant hemisphere sublenticular lacunar infarct of the thalamocortical auditory radiation. Our patient was managed expectantly and after three months her symptoms subsided spontaneously. CONCLUSION We propose that all patients with monoaural musical hallucinations have brain imaging to rule out a central organic cause, especially within the non-dominant hemisphere, regardless of the presence of a hearing impairment.
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Affiliation(s)
- Peter Ym Woo
- Room 318, Nursing Quarters, Department of Neurosurgery, Kwong Wah Hospital, 25 Waterloo Road, Yaumatei, Hong Kong, SAR, China.
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Musical hallucination following whiplash injury: case report and literature review. The Journal of Laryngology & Otology 2012; 126:615-8. [PMID: 22643207 DOI: 10.1017/s0022215112000242] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
INTRODUCTION A musical hallucination is defined as a form of auditory hallucination characterised by the perception of music in the absence of external acoustic stimuli. It is infrequently cited in the literature, although population studies suggest a greater prevalence. The aetiology of this unusual disorder remains unclear. CASE REPORT A 70-year-old man with acquired hearing loss suffered a whiplash injury in a low-speed road traffic accident, and subsequently presented with bilateral 'tinnitus.' On closer questioning, he described hearing orchestral music. There was no evidence of psychosis, delirium or intoxication, and the patient was managed expectantly. CONCLUSION This patient represents the first published case of musical hallucination precipitated by whiplash injury. We explore the possible pathophysiological underpinnings of musical hallucination and highlight the need for a greater awareness of this disorder. A management strategy is suggested.
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Calabrò RS, Baglieri A, Ferlazzo E, Passari S, Marino S, Bramanti P. Neurofunctional assessment in a stroke patient with musical hallucinations. Neurocase 2012; 18:514-20. [PMID: 22224482 DOI: 10.1080/13554794.2011.633530] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
We reported a case of an elderly female patient affected by musical hallucinations (MHs) as the unique symptom of a right temporal ischemic stroke. A functional magnetic resonance imaging examination was performed in the patient and in five age- and sex-matched normal controls (NC) to detect the complex neural substrate subserving MHs in such a context. Although an activation pattern involving the primary auditory cortex and the temporal associative areas bilaterally was found in the patient and NC, a significant increased activation mostly located in right temporal cortex (in the ischemic area), was observed in the patient. Further functional neuroimaging studies should be performed to detect the complex neural pathways underlying MHs and to find out differences between these hallucinations and real music perception.
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Baurier VO, Tuca JO. Auditory hallucinosis in brainstem lesions and musical hallucination in deafness. Analogies and differences. Eur J Neurol 2011; 3:203-11. [DOI: 10.1111/j.1468-1331.1996.tb00424.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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9
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Abstract
We report a case of a 43-year-old woman with brainstem encephalitis in the third
trimester of pregnancy. She presented complex visual and auditory hallucinations
in the acute disease phase (hearing opera arias and seeing room furniture
upside-down). Hallucinations resolved with antiviral treatment.
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Affiliation(s)
- Melissa Castello Branco E Silva
- Behavioral and Cognitive Neurology Unit, Department of Neurology, University of São Paulo School of Medicine, São Paulo SP, Brazil
| | - Sonia Maria Dozzi Brucki
- Behavioral and Cognitive Neurology Unit, Department of Neurology, University of São Paulo School of Medicine, São Paulo SP, Brazil
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11
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Isolan GR, Bianchin MM, Bragatti JA, Torres C, Schwartsmann G. Musical hallucinations following insular glioma resection. Neurosurg Focus 2010; 28:E9. [DOI: 10.3171/2009.12.focusfocus09243] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Hallucinations can be auditory, visual, tactile, gustatory, or olfactory, and can be caused by psychiatric (such as schizophrenia and depression), neurological (such as cerebrovascular accidents, neoplasia, and infection), or endocrine and metabolic disorders. Musical hallucinations related to neurological disorders are rare. The authors present a case of a patient with a right insular glioma who developed transient musical hallucinations after microsurgical resection of the tumor.
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Affiliation(s)
| | | | | | | | - Gilberto Schwartsmann
- 3Oncology, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
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12
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Stewart L, von Kriegstein K, Warren JD, Griffiths TD. Music and the brain: disorders of musical listening. Brain 2006; 129:2533-53. [PMID: 16845129 DOI: 10.1093/brain/awl171] [Citation(s) in RCA: 213] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The study of the brain bases for normal musical listening has advanced greatly in the last 30 years. The evidence from basic and clinical neuroscience suggests that listening to music involves many cognitive components with distinct brain substrates. Using patient cases reported in the literature, we develop an approach for understanding disordered musical listening that is based on the systematic assessment of the perceptual and cognitive analysis of music and its emotional effect. This approach can be applied both to acquired and congenital deficits of musical listening, and to aberrant listening in patients with musical hallucinations. Both the bases for normal musical listening and the clinical assessment of disorders now have a solid grounding in systems neuroscience.
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Affiliation(s)
- Lauren Stewart
- Auditory Group, Newcastle University, Newcastle upon Tyne, London, UK
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13
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Thirthalli J, Kar N, Murali N. Unilateral auditory hallucinations in the absence of brain or ear pathology in a 27-year-old female. Schizophr Res 2005; 77:357-9. [PMID: 15913959 DOI: 10.1016/j.schres.2005.03.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2005] [Revised: 03/23/2005] [Accepted: 03/27/2005] [Indexed: 11/16/2022]
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Evers S, Ellger T. The clinical spectrum of musical hallucinations. J Neurol Sci 2004; 227:55-65. [PMID: 15546592 DOI: 10.1016/j.jns.2004.08.004] [Citation(s) in RCA: 99] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2004] [Revised: 06/23/2004] [Accepted: 08/10/2004] [Indexed: 11/17/2022]
Abstract
Musical hallucinations are a well known although rare phenomenon in neurological and psychiatric patients. Many case reports have been published to date. However, an accepted common theory on the classification and on the pathophysiology of musical hallucinations is still missing. We analysed all cases published to date, including two own cases, with respect to their demographic and clinical features and to the possible pathomechanisms underlying the hallucinations. In total, 132 cases could be analysed statistically and separated into five groups according to their aetiology (hypacusis; psychiatric disorder; focal brain lesion; epilepsy; intoxication). There was a female preponderance of 70% and a mean age of 61.5 years. Patients with focal brain lesions were significantly younger than the other groups, the hemisphere of the lesion did not play a major role. No systematic studies on treatment are available. However, anticonvulsant and antidepressive substances were reported to be effective most consistently. The pathophysiology of musical hallucinations is discussed considering the theories of deafferentiation including the concept of auditory Charles-Bonnet syndrome, of sensory auditory deprivation, of parasitic memory, and of spontaneous activity in a cognitive network module. In conclusion, musical hallucinations are a phenomenon with heterogeneous clinical and pathophysiological backgrounds.
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Affiliation(s)
- Stefan Evers
- Department of Neurology, University of Münster, Albert-Schweitzer-Str. 33, 48129 Münster, Germany.
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15
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Abstract
Musical hallucinosis is a rare and poorly understood clinical phenomenon. While an association appears to exist between this phenomenon and organic brain pathology, aging and sensory impairment the precise association remains unclear. The authors present two cases of musical hallucinosis, both in elderly patients with mild-moderate cognitive impairment and mild-moderate hearing loss, who subsequently developed auditory hallucinations and in one case command hallucinations. The literature in reference to musical hallucinosis will be reviewed and a theory relating to the development of musical hallucinations will be proposed.
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Affiliation(s)
- Corinne E Fischer
- St. Michael's Hospital, Lecturer, University of Toronto, University of Toronto, Ontario, Canada.
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16
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Braun CMJ, Dumont M, Duval J, Hamel-Hébert I, Godbout L. Brain modules of hallucination: an analysis of multiple patients with brain lesions. J Psychiatry Neurosci 2003; 28:432-49. [PMID: 14631455 PMCID: PMC257791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/01/2023] Open
Abstract
We systematically reviewed the localization of focal brain lesions that cause isolated hallucination in a single sensory modality. Case reports of post-lesion nonparoxysmal hallucination in 1 (and only 1) of 3 sensory modalities (i.e., visual, auditory, somatic) were reviewed, and the content of the qualitative descriptions was analyzed for each modality. The lesion is practically always located in the brain pathway of the sensory modality of the hallucination. There seem to exist localized sensory brain circuits that in healthy people diminish the intensity of internal sensory representation. After a lesion, hallucinosis seems to be caused also by compensatory overactivation of tissue in the nearby brain sensory pathway. This type of hallucination may indeed be termed a "release" form, whereby patients are aware of the hallucinatory nature of their experience, but not usually of "dream centres" as proposed by Lhermitte. Instead, we propose that it is dreaming that should be considered a special case of neural "release."
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Affiliation(s)
- Claude M J Braun
- Centre de Neurosciences Cognitives, Université du Québec à Montréal, Montréal, Que.
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Matsui T, Matsunaga H, Ohya K, Iwasaki Y, Koshimune K, Miyata A, Kiriike N. Clinical features in two cases with musical obsessions who successfully responded to clomipramine. Psychiatry Clin Neurosci 2003; 57:47-51. [PMID: 12519454 DOI: 10.1046/j.1440-1819.2003.01078.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Clinical features in two cases with musical obsessions are presented to discuss phenomenological and psychopharmacological differences from those in patients with musical hallucinations. The present patients commonly experienced music as an internally generated cognitive product accompanied by full insight into the senselessness of the symptoms. They also attempted to suppress the musical symptoms or to neutralize them with other thoughts. Thus, despite no covert or systematic compulsive behaviors, the musical symptoms of the present cases are consistent with the phenomenological nature of obsessive-compulsive disorder defined in DSM-IV. In addition, in contrast to previous case reports of musical hallucinations, the present patients failed to respond to neuroleptics, but showed significant response to an adequate trial of clomipramine. Thus, their symptoms appear to be phenomenologically and biologically distinct from musical hallucinations, especially those characteristic of schizophrenia.
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Affiliation(s)
- Tokuzo Matsui
- Department of Neuropsychiatry, Osaka City University Medical School, Osaka, Japan
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18
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Levy LM, Henkin RI. Physiologically initiated and inhibited phantosmia: cyclic unirhinal, episodic, recurrent phantosmia revealed by brain fMRI. J Comput Assist Tomogr 2000; 24:501-20. [PMID: 10966179 DOI: 10.1097/00004728-200007000-00001] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE Our goal was to use functional magnetic resonance imaging (fMRI) to demonstrate brain activation in patients with unirhinal, episodic, recurrent phantosmia who induced their phantosmia by coughing, sneezing, laughing or vigorous nasal inhalation and expiration, and inhibited it by sleep or performance of a Valsalva type maneuver. METHODS Three patients with unirhinal phantosmia without change in taste or smell acuity were studied by fast low angle shot (FLASH) MRI and by echo planar imaging (EPI). Brain activation was measured following memory of two tastants (salt, sweet), memory of two odorants (banana and peppermint), actual smell of three odors (amyl acetate, menthone, pyridine), memory of phantosmia (and phantageusia, where applicable), phantosmia initiated spontaneously or by vigorous nasal inhalation and exhalation, phantosmia after inhibition by Valsalva, and these stimuli before and after treatment with the neuroleptic thioridazine. Activation images were derived using correlation analysis and ratios of areas of brain activated to total brain areas were calculated. Total activated pixel cluster counts were also used to quantitative total and regional brain activation. RESULTS Sensory-specific brain activation was present in each section in each patient following memory of tastants and odorants, actual smell of each odor and memory, and initiation of and inhibition of phantosmia. Activation to odor memory after phantosmia initiation was very robust, whereas after phantosmia inhibition it was similar to that in normal subjects. Brain activation to unirhinal phantosmia was bihemispheric, independent of whether it was left or right sided or patient handedness. While phantosmia memory (in the absence of initiated phantosmia) produced extremely robust brain activation, after initiation and inhibition of phantosmia apparent brain activation decreased. These changes need to be related to shifting state of baseline brain activation and should be interpreted to reflect increased rather than decreased brain activation over that of phantosmia memory alone. Treatment with thioridazine inhibited brain activation to all stimuli including phantosmia and phantageusia memory, as it did previously in patients with birhinal phantosmia. CONCLUSIONS 1) Unirhinal phantosmia can be demonstrated by brain fMRI as can birhinal phantosmia; 2) unirhinal phantosmia can be initiated and inhibited by physiological maneuvers reflected by changes in fMRI brain activation; 3) fMRI brain activation of unirhinal phantosmia is bihemispheric and independent of peripheral side of phantosmia or patient handedness; 4) anterior frontal brain region plays a significant role in both phantosmia initiation and inhibition as, to some extent, do temporal brain regions; 5) activation of brain GABAergic systems appears to play a role in inhibition of unirhinal phantosmia; and 6) unirhinal phantosmia, similar to birhinal phantosmia, may reflect a type of maladaptive brain plasticity similar to that hypothesized to be responsible for phantom limb pain.
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Affiliation(s)
- L M Levy
- Department of Radiology, Georgetown University Medical Center, Washington, DC, USA
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19
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Abstract
Auditory verbal hallucinations (AVHs) are a cardinal feature of psychosis. Recent research is reviewed which has attempted to advance our knowledge of the mechanisms underlying this symptom. Phenomenological surveys have confirmed the importance of the content of such hallucinations and their meaning to the voice-hearer. Psychological and neuroimaging studies of inner speech and source monitoring have provided a neuropsychological framework for AVHs as well as some novel therapeutic strategies. There have also been successful attempts to 'capture' neural activity coincident with the experience of hallucinations using PET, SPECT and functional magnetic resonance imaging (MRI). This body of knowledge in combination with work on in-vivo receptor binding (dopamine and GABA) provides the beginnings of a cognitive and neurophysiological understanding of this complex and intriguing phenomenon.
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Affiliation(s)
- A S David
- Department of Psychological Medicine, Kings College School of Medicine and Dentistry and the Institute of Psychiatry, London, UK
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20
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Abstract
BACKGROUND Complex auditory hallucinations have rarely been reported in cases of brainstem stroke or tumor. METHOD Case study. RESULTS A patient with acute Listeria rhombencephalitis complained of formed musical auditory hallucinations on the side of recent sensorineural deafness. MRI revealed an abscess in the middle cerebellar peduncule with extensive surrounding edema. CONCLUSIONS Disruption of brainstem auditory pathways may cause complex auditory hallucinations. Potential pathogenetic mechanisms are discussed and a diagnostic approach is proposed.
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Affiliation(s)
- A G Douen
- Division of Neuroscience, Ottawa Civic Hospital, University of Ottawa, Ontario, Canada
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21
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Wodarz N, Becker T, Deckert J. Musical hallucinations associated with post-thyroidectomy hypoparathyroidism and symmetric basal ganglia calcifications. J Neurol Neurosurg Psychiatry 1995; 58:763-4. [PMID: 7608692 PMCID: PMC1073572 DOI: 10.1136/jnnp.58.6.763] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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Abstract
A 78-year-old hearing-impaired woman who presented to hospital with a stroke and a subsequent epileptic seizure later developed unilateral musical hallucinations in her better hearing (right) ear. She was found to have a left-sided temporal epileptic focus and the music ceased after a second anti-convulsant was introduced. Comments are made on unusual features of the hallucination and its probable causation.
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Affiliation(s)
- J Couper
- Footscray Psychiatric Hospital, Victoria
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