LETTERS

Auditory Hallucinations as
the Only Presenting
Symptom of Right-Parietal
Spontaneous Hemorrhage:
FDG-PET Evidence of
Corpus Callosum
Hyperactivity

FIGURE 1.

To the Editor: Auditory hallucinations are very rare in stroke
patients. We report FDG-PET findings in a case of hemorrhagic
stroke presenting with auditory
hallucinations.
Case Report
A 67-year-old woman was admitted to the emergency room of our
hospital for acute onset of complex
auditory hallucinations; she
reported hearing loud music and
voices of known persons speaking
“filthy.” She had never suffered
any psychiatric disorders in the
past, and she was taking atenolol
for many years as the only treatment for chronic arterial hypertension.
Neurological examination did
not show any focal neurological
signs, and blood tests were normal.
Brain CT scan revealed a right-parietal hemorrhage involving both
superficial and deep territory of the
posterior branches of middle cerebral artery (Figure 1 [D]). EEG
showed absence of focal paroxystic
epyleptiform discharges. Brain MRI
and MR-angio confirmed the intraparenchimal hemorrhage, excluding the presence of aneurysm or
artero-venous malformations. FDGPET scan showed a significant
increase in glucose metabolism
(versus normal control database) in
the middle and posterior areas of

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corpus callosum as well as in the
precuneus and cuneus cortex
(Figure 1 [A, B, C]).
The auditory hallucinations gradually resolved in a few days without
any treatment. She was discharged
after 18 days from onset, and neurological examination showed visuospatial deficit as the consequence of
right-parietal damage.
Discussion
Auditory hallucinations are uncommon phenomena in patients with
acute stroke; in particular, they have
been reported in acute ischemic
lesions of the brainstem but very
rarely reported after cortical ischemic
strokes.1 To our knowledge, this is

the first case of auditory hallucinations as the only presenting symptom of a spontaneous hypertensive
parenchymal hemmorrhage.
In our case FDG-PET scan
showed high relative glucose metabolic rates in the middle and posterior areas of corpus callosum.
Hyperactivity of corpus callosum
has already been reported in
schizophrenic patients with auditory hallucinations.2,3 In particular,
abnormalities in the posterior part
of corpus callosum has been associated to schizophrenic positive
symptoms.4 We speculate that in
our patient the acute cortico-subcortical hemorrhage caused,
through rapid development of

J Neuropsychiatry Clin Neurosci 24:1, Winter 2012

LETTERS
peri-lesional edema and release of
excitatory mediators such as calcium ions and amino-acids, an
electrode-like effect,5 which
abnormally activated the posterior
part of corpus callosum, with
consequent development of auditory hallucinations. We believe
that a better understanding of
corpus callosum pathophysiology
could help in clarifying the mechanism of perceptive disturbances
of various origin.
Massimiliano Godani, M.D.
Andrea Ciarmiello, M.D.

Cesare Capellini, M.D.
Massimo Del Sette, M.D.
Neurology Unit
S. Andrea Hospital
LA Spezia, Italy
Correspondence: Massimiliano
Godani, M.D.;
massimiliano.
godani@asl5.liguria.it
References
1. Yair L, Mordechai L, Ronit G, et al:
Auditory hallucinations in acute stroke.
Behav Neurol 2005; 16:211–216
2. Buchsbaum MS, Buchsbaum BR, Hazlett

J Neuropsychiatry Clin Neurosci 24:1, Winter 2012

EA, et al: Relative glucose metabolic rate
higher in white matter in patients with
schizophrenia. Am J Psychiatry 2007;
164:1072–1081
3. Hubl D, Koenig T, Strik W, et al: Pathways that make voices. Arch Gen Psychiatry 2004; 61:658 – 668
4. Kubicki M, Styner M, Bouix S, et al:
Reduced interhemispheric connectivity in
schizophrenia: tractography base segmentation of the corpus callosum.
Schizophr Res 2008; 106(2–3):125–131
5. Weber B, Fouad K, Burger C, et al:
White-matter glucose metabolism during
intracortical electrostimulation: a quantitative fluorodeoxyglucose autoradiography study in the rat. Neuroimage 2002;
16:993–998

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