DOCSLIB.ORG

Dom Been Reported and the Diagnosis Could Showed the Existence of Specific Intrathecal Between 3% and 10%.2 Be Established Only at Postmortem Examina- Synthesis

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Dom Been Reported and the Diagnosis Could Showed the Existence of Specific Intrathecal Between 3% and 10%.2 Be Established Only at Postmortem Examina- Synthesis Letters to the Editor 869 The MR of the brainstem showed a small A CURT of the herpes group. A strong signal was V DIETZ on ethidium ischaemic lesion in the left dorsolateral Swiss Paraplegic Centre, obtained bromide stained gel. medulla without any further pathology. University Hospital, Balgrist, Characterisation of HSV-2 DNA was Until confirmation of the total occlusion CH-8008 Zurich, achieved by restriction analysis of the of the left vertebral artery the patient was Switzerland amplified product. a-Interferon in CSF was treated with cumarine to prevent arterial Correspondence to: V Dietz, Paraplegic Centre, normal. The patient had no history of embolism. The clinical symptoms progres- Balgrist, Forchstrasse 340, CH-8008 Zurich, recurrent herpes genitalis. There was no sively disappeared over the next 30 days Switzerland. serological evidence for borreliosis, HIV-1 and the patient left hospital with only a 1 Hart RG. Vertebral artery dissection. or HIV-2, HTLV-I, Q-fever, listeriosis, slight ataxic gait and mild dysaesthesia Neurology 1988;38:987-9. cytomegalovirus, measles, varicella zoster, within the left C6 segment. 2 Fakhry SM, Jaques PF, Proctor HJ. Cervical or Epstein-Barr virus infection. CD4 counts vessel injury after blunt trauma. Jf Vasc Surg 1988;8:501-8. were normal and no cause for immuno- Discussion 3 Parent AD, Harkey HL, Touchstone DA, depression could be identified. The patient presented with an anterior dis- Smith EE, Smith RR. Lateral cervical spine Parenteral acyclovir (30 mg/kg daily) was placement and fracture of the left facet joint dislocation and vertebral artery injury. given for 10 days and the patient's neuro- Neurosurgery 1992;31:501-9. between level C5 and C6 and radicular pain 4 Louw JA, Mafoyane NA, Small B, Neser CP. logical state remained unchanged. Six days in the left C6 distribution, and subsequently Occlusion of the vertebral artery in cervical after admission, sparse vesicular lesions developed a left vertebral artery dissection spine dislocations. J Bone Joint Surg 1990; appeared on the patient's buttocks, internal with left brainstem ischaemia. It is 72B:679-81. suspect- 5 Jabre A. Subintimal dissection of the vertebral aspects of the thighs, and lower part of the ed that the dissection occurred during the artery in subluxation of the cervical spine. abdomen. Ten days later, numbness in both 19 day delay with subsequent occlusion Neurosurgery 1991;29:912-5. hands appeared. Examination showed bilat- including the posterior infracerebellar eral arm and shoulder weakness and the artery. By contrast with our case, most disappearance of upper limb reflexes. The reports during the past decade concerning patient then became confused and drowsy, posterior circulation ischaemia connected Herpes simplex virus type 2 ascending developed hyponatraemia and hyperazo- with vertebral artery occlusion occurred myeloradiculitis: 1IU findings and taemia and died on day 21 after admission. spontaneously or were loosely related to rapid diagnosis by the polymerase Necropsy examination was not performed. minor trauma during sport or neck manipu- chain method Subsequently, CSF cultures were reported lation during chiropraxy. These typically as positive for HSV-2. Analysis of serial occurred in young or middle aged adults, Although neurotropic viruses are often sus- serum samples showed a sevenfold rise in equally between the sexes.' Although trau- pected of causing spinal cord injuries, con- anti-HSV antibodies between admission matic fractures of the cervical spine occur firmation by early diagnosis is difficult. and death. IgM antibodies were detected in often, injuries of the vertebral arteries with Ascending myelitis related to herpes sim- one early serum sample. Analysis of the or without clinical symptoms are rarely evi- plex virus type 2 (HSV-2) infection has sel- CSF and serum anti-HSV antibodies ratio dent. The incidence is postulated to be dom been reported and the diagnosis could showed the existence of specific intrathecal between 3% and 10%.2 be established only at postmortem examina- synthesis. In a retrospective study Parent and tion. 1-5 We report the case of an elderly Various clinical syndromes have been coworkers reviewed some 640 patients sus- woman with a subacute ascending myelo- linked to HSV-2 involvement in the nervous taining fractures of the cervical spine. Of radiculitis. MRI showed spinal cord and system. HSV-2 encephalitis typically occurs these, 96 had facet involvement and in only sacral root involvement and the polymerase in the newborn, but accounts for less than five was injury of the vertebral artery diag- chain reaction allowed the rapid identifica- 5% of herpetic encephalitis in children and nosed by initial major neurological deficits tion of HSV-2 DNA in the CSF. adults. Acute, self limited meningitis is such as cerebellar infarction, cortical blind- A 76 year old woman was referred found in young adults with primary genital ness, or pontine infarction, which have been because of urinary retention and parapare- HSV infection. Sacral radiculitis with per- documented by postmortem examination in sis. Three weeks previously, she had noted ineal dysaesthesias, autonomic dysfunction, two cases.3 All these patients had cervical the progressive onset of anorexia, fever and sometimes mild lower limb weakness fractures located at C5-C6 and in one case (38°C), weight loss (4 kg), and low back may also be associated with herpes genitalis in combination with a fracture at C6-C7. pain. Evaluation performed in another hos- in young adults. In most cases, neurological Radiographs showed anterior dislocation at pital showed negative bacterial cultures symptoms occur two to seven days after the C5-C6 in four cases and at C6-C7 in one from blood and urine and CT of the thorax, genital eruption and patients recover within case. Bilateral facet fractures were evident abdomen, and lumbosacral spine was nor- three weeks. in four cases. mal. Three days before admission she com- By contrast, HSV-2 involvement in the Only one prospective study exists that plained of right sciatalgia and rapidly spinal cord is rare and severe. Two cases of considers the combination of facet joint dis- developed lower extremity weakness and HSV-2 extensive myeloradiculitis have been location of the cervical spine, the incidence sphincter disturbances. reported in patients with AIDS simultane- of vertebral artery injury, and the neurologi- Neurological examination showed a flac- ously infected with cytomegalovirus,' 2 and cal deficit.4 From 12 consecutively exam- cid paraplegia, a TI0 sensory level, and a two others in diabetic patients.34 HSV-2 ined patients with facet joint dislocation distended bladder. Deep tendon reflexes necrotising myelopathy has also been found (C5/C6 in seven, C6/C7 in three, and were absent in the lower limbs and plantar in association with malignancy.5 In all cases C4/C5 in two) nine showed an occlusion of responses were both extensor. In the upper the outcome was fatal within four to seven at least one vertebral artery. Of these nine extremities strength was normal but reflexes weeks, and the diagnosis could only be patients only two with bilateral facet joint were brisk and a bilateral Hoffman sign was made at necropsy, when HSV-2 was recov- dislocations had a transient neurological noted. Mental state and cranial nerves were ered from the spinal cord. There has been a deficit. Further indications of a traumatic or normal. single report of HSV-2 myelitis with a spontaneous dissection of the vertebral Non-enhanced TI weighted images of favourable outcome in which the virus was artery are neck pain and symptoms of a C6 the spine were normal. T2 weighted isolated from the CSF.6 root compression.5 sequences showed a linear hyperintense sig- In our patient, MRI clearly showed Thus a combination of neurological and nal at the T10 level and within the conus myeloradiculitis, on T2 weighted and radiological findings could lead to an early medullaris. TI weighted images with con- gadolinium enhanced TI weighted sagittal diagnosis and may indicate development of trast injection showed an enhancement of sequences. Although well correlated with a dissection of the vertebral artery. We sug- both the posterior meninges and the roots the clinical features, however, MRI findings gest that patients with the clinical symptoms of the cauda equina. lacked specificity. and type of injury described here are prone Her CSF contained 73 leucocytes/mm3 The direct diagnosis of nervous system to development of a dissection or occlusion (97% lymphocytes), 132 mg/dl protein and infection by HSV is difficult as isolation of of the vertebral artery. Early diagnostic pro- 68 mg/dl glucose. Electrophoresis of CSF the virus from CSF is most often unsuccess- cedures by non-invasive diagnostic tech- protein showed 26% y-globulins with an ful and serological confirmation is too late. niques such as MR angiography and oligoclonal distribution and a raised Recently, the polymerase chain reaction has ultrasound techniques coupled with treat- IgG/albumin ratio (0 56; normal <0 25). A proved to be a powerful tool in the rapid ment at the onset of a possible dissection polymerase chain reaction was performed diagnosis of meningoencephalitis due to may help to prevent the formation of a on CSF with a pair of primers that allowed herpes viruses. In this case, it allowed us to microembolism or arterial occlusion. the simultaneous detection of four viruses identify HSV-2 in the CSF immediately 870 Letters to the Editor after admission, a week before the appear- ism. An MRI showed a unilateral infarction nosis due to unilateral lesion. Although the ance of the cutaneous eruption. involving the left cerebral peduncle. precise anatomical basis for peduncular hal- The pathogenesis of HSV-2 myelitis in A previously healthy 70 year old right lucinosis remains unclear, it seems that the this case remains ill defined. Although IgM handed woman presented with visual hallu- substantia nigra pars reticulata (SNpr) is antibodies were detected in the first serum cinations.
Load more

Recommended publications
  • Visual Hallucinations As Disorders of Attention
    G Model PRONEU-1324; No. of Pages 8 Progress in Neurobiology xxx (2014) xxx–xxx Contents lists available at ScienceDirect Progress in Neurobiology jo urnal homepage: www.elsevier.com/locate/pneurobio Tricks of the mind: Visual hallucinations as disorders of attention a, a,b b a James M. Shine *, Claire O’Callaghan , Glenda M. Halliday , Simon J.G. Lewis a Parkinson’s Disease Research Clinic, Brain and Mind Research Institute, The University of Sydney, NSW, Australia b Neuroscience Research Australia and the University of New South Wales, Sydney, NSW, Australia A R T I C L E I N F O A B S T R A C T Article history: Visual hallucinations are common across a number of disorders but to date, a unifying pathophysiology Received 9 September 2013 underlying these phenomena has not been described. In this manuscript, we combine insights from Received in revised form 29 January 2014 neuropathological, neuropsychological and neuroimaging studies to propose a testable common neural Accepted 30 January 2014 mechanism for visual hallucinations. We propose that ‘simple’ visual hallucinations arise from Available online xxx disturbances within regions responsible for the primary processing of visual information, however with no further modulation of perceptual content by attention. In contrast, ‘complex’ visual hallucinations Keywords: reflect dysfunction within and between the Attentional Control Networks, leading to the inappropriate Hallucinations interpretation of ambiguous percepts. The incorrect information perceived by hallucinators is often Common neural mechanism differentially interpreted depending on the time-course and the neuroarchitecture underlying the Attentional Control Networks Dorsal Attention Network interpretation. Disorders with ‘complex’ hallucinations without retained insight are proposed to be Default Mode Network associated with a reduction in the activity within the Dorsal Attention Network.
    [Show full text]
  • Peduncular Hallucinosis: an Unusual Sequel to Surgical Intervention in the Suprasellar Region
    B ritish Journal of Neurosurgery 1999;13(5):500± 503 SHORT REPORT Peduncular hallucinosis: an unusual sequel to surgical intervention in the suprasellar region R. KUMAR, S. BEHARI, J. WAHI, D. BANERJI & K. SHARMA Departments of Neurosurgery and Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India Abstract Peduncular hallucinations are formed visual images often associated with sleep disturbance, and are caused by lesions in the midbrain, pons and diencephalon. In the present study, we report two patients who developed peduncular hallucinations following surgery in the suprasellar region. In one of these, the peduncular hallucinations were a sequele to endoscopic third ventriculostomy, while in the other, they were due to diencephalon and mid-brain compression by a postoperative clot following excision of a hypothalamic astrocytoma. Key words: Peduncular hallucinosis, visual hallucinations, suprasellar astrocytoma. Introduction fu ndoscopy showed bilateral secondar y optic atrophy. She also had bilateral abducent paresis Peduncular hallucinations are formed, coloured, visual and gait ataxia. images.1 They have been reported in vascular and Computed tomography (CT) revealed aqueductal infective lesions2± 4 of the thalamus,5 the pars reticu- stenosis, and dilated lateral and third ventricles with lata of the substantia nigra,1 midbrain,6 pons7 and periventricular lucency.Therefore, an endoscopic third basal diencephalon,8 as well as by extrinsic compres- ventriculostomy was perform ed to relieve the sion of the midbrain.9 We report the occurrence of hydrocephalus. The rigid endoscope was negotiated peduncular hallucinosis in two patients after endo- via a right frontal burr hole, through the lateral scopic third ventriculostomy in one, and to dien- ventricles and the foramen of Monro.
    [Show full text]
  • REVIEW ARTICLE Complex Visual Hallucinations Clinical and Neurobiological Insights
    Brain (1998), 121, 1819–1840 REVIEW ARTICLE Complex visual hallucinations Clinical and neurobiological insights M. Manford1 and F. Andermann2 1Department of Clinical Neurology, Addenbrooke’s Correspondence to: Dr M. Manford, Department of Hospital, Cambridge, UK and 2Montreal Neurological Clinical Neurology, Addenbrooke’s Hospital, Hills Road, Institute, Montreal, Canada Cambridge CB2 2QQ, UK. E-mail: [email protected] Summary Complex visual hallucinations may affect some normal hallucinations are probably due to a direct irritative individuals on going to sleep and are also seen in process acting on cortical centres integrating complex pathological states, often in association with a sleep visual information. (ii) Visual pathway lesions cause disturbance. The content of these hallucinations is defective visual input and may result in hallucinations striking and relatively stereotyped, often involving from defective visual processing or an abnormal cortical animals and human figures in bright colours and release phenomenon. (iii) Brainstem lesions appear to dramatic settings. Conditions causing these affect ascending cholinergic and serotonergic pathways, hallucinations include narcolepsy–cataplexy syndrome, and may also be implicated in Parkinson’s disease. peduncular hallucinosis, treated idiopathic Parkinson’s These brainstem abnormalities are often associated with disease, Lewy body dementia without treatment, disturbances of sleep. We discuss how these lesions, migraine coma, Charles Bonnet syndrome (visual outside the primary visual system, may cause defective hallucinations of the blind), schizophrenia, hallucinogen- modulation of thalamocortical relationships leading to induced states and epilepsy. We describe cases of a release phenomenon. We suggest that perturbation of hallucinosis due to several of these causes and expand a distributed matrix may explain the production of on previous hypotheses to suggest three mechanisms similar, complex mental phenomena by relatively blunt underlying complex visual hallucinations.
    [Show full text]
  • Visual Hallucinations in Parkinson's Disease
    J Neurol Neurosurg Psychiatry 2001;70:727–733 727 J Neurol Neurosurg Psychiatry: first published as 10.1136/jnnp.70.6.727 on 1 June 2001. Downloaded from Visual hallucinations in Parkinson’s disease: a review and phenomenological survey J Barnes, A S David Abstract According to the DSM IV criteria,1 a hallucina- Objectives—Between 8% and 40% of pa- tion is “a sensory perception without external tients with Parkinson’s disease undergo- stimulation of the relevant sensory organ” dis- ing long term treatment will have visual tinguishing it from an illusion, in which an hallucinations during the course of their external stimulus is perceived but then misin- illness. There were two main objectives: terpreted. Although separate, the phenomena firstly, to review the literature on Parkin- often overlap, with illusions leading to halluci- son’s disease and summarise those factors nations and vice versa. One of the commonest most often associated with hallucinations; neurological conditions associated with visual secondly, to carry out a clinical compari- hallucinations is Parkinson’s disease. Although son of ambulant patients with Parkinson’s there are reports of visual hallucinations in disease with and without visual hallucina- Parkinson’s disease before the dopamine era,2 tions, and provide a detailed phenomeno- the phenomena have only been noted as a fre- logical analysis of the hallucinations. quent complication of the disorder since Methods—A systematic literature search levodopa treatment was introduced.3 using standard electronic databases of One categorisation of visual hallucinations is published surveys and case-control stud- “simple” versus “complex”. Simple hallucina- ies was undertaken.
    [Show full text]
  • Altered Functional Connectivity in Lesional Peduncular Hallucinosis with REM Sleep Behavior Disorder
    cortex 74 (2016) 96e106 Available online at www.sciencedirect.com ScienceDirect Journal homepage: www.elsevier.com/locate/cortex Clinical neuroanatomy Altered functional connectivity in lesional peduncular hallucinosis with REM sleep behavior disorder * Maiya R. Geddes a,b, , Yanmei Tie c, John D.E. Gabrieli a, Scott M. McGinnis b, Alexandra J. Golby c and Susan Whitfield-Gabrieli a a Department of Brain and Cognitive Sciences and McGovern Institute for Brain Research, Massachusetts Institute of Technology, Cambridge, MA, USA b Brigham and Women's Hospital, Division of Cognitive and Behavioral Neurology, Harvard Medical School, Boston, MA, USA c Brigham and Women's Hospital, Department of Neurosurgery, Harvard Medical School, Boston, MA, USA article info abstract Article history: Brainstem lesions causing peduncular hallucinosis (PH) produce vivid visual hallucinations Received 24 May 2015 occasionally accompanied by sleep disorders. Overlapping brainstem regions modulate Reviewed 16 July 2015 visual pathways and REM sleep functions via gating of thalamocortical networks. A 66- Revised 14 August 2015 year-old man with paroxysmal atrial fibrillation developed abrupteonset complex visual Accepted 23 October 2015 hallucinations with preserved insight and violent dream enactment behavior. Brain MRI Action editor Marco Catani showed restricted diffusion in the left rostrodorsal pons suggestive of an acute ischemic Published online 5 November 2015 stroke. REM sleep behavior disorder (RBD) was diagnosed on polysomnography. We investigated the integrity of ponto-geniculate-occipital circuits with seed-based resting- Keywords: state functional connectivity MRI (rs-fcMRI) in this patient compared to 46 controls. Rs- Resting state fMRI fcMRI revealed significantly reduced functional connectivity between the lesion and Lesion lateral geniculate nuclei (LGN), and between LGN and visual association cortex compared Lateral geniculate nucleus to controls.
    [Show full text]
  • A Potential Case of Peduncular Hallucinosis Treated Successfully with Olanzapine David Spiegel 1, Jessica Barber 1, Margarita Somova 1
    Case Reports A Potential Case of Peduncular Hallucinosis Treated Successfully with Olanzapine David Spiegel 1, Jessica Barber 1, Margarita Somova 1 Abstract Visual hallucinations have a differential diagnosis, both psychiatric and nonpsychiatric in nature. Described first by Lhermitte, peduncular hallucinosis is an uncommon etiology of visual hallucinations (VH). Typically, the offending lesion is vascular in origin and occurs at the level of the midbrain, thalamus, or rostral brainstem. Interestingly, the origin of the VH in our patient’s case could have been either/both from an ischemic insult at the midbrain or compres- sion of the brainstem due to aneurism. While evidence for treatment is scarce, we present a posited case of peduncular hallucinosis treated successfully with olanzapine. Key Words: Psychoses/Visual Hallucinations, Neurology, Magnetic Resonance Imaging, Olanzapine Introduction Visual hallucinations (VH) have a broad differential theory is that the brainstem plays an integral role in sup- diagnosis including peduncular hallucinosis (PH) (1). PH, pressing visual hallucinations, and the spontaneous activity first described by Lhermitte, included symptoms of VH with of the visual system increases if this is disrupted, leading to nocturnal insomnia and daytime somnolence (2). The hal- hallucinations (3, 4). lucinations are usually well-formed, with vivid colors and The following case illustrates a possible case of PH detailed images (1). Lilliputian hallucinations, in which the successfully ameliorated with olanzapine (OLZ). figures or objects are shrunken but still fully detailed, are a common aspect of PH. Patients usually, but not always, Case Report retain insight (1). Our patient was a 77-year-old female who presented Although there are several theories speculating on the to the Emergency Room with sudden onset intermittent cause of PH, there is presently no one accepted etiology.
    [Show full text]
  • Peduncular Hallucinosis Due to Multiple Sclerosis: a Case Report Multipl Skleroza Bağlı Pedinküler Halüsinoz: Olgu Sunumu
    DO I:10.4274/Tnd.05658 Case Report / Olgu Sunumu Peduncular Hallucinosis due to Multiple Sclerosis: A Case Report Multipl Skleroza Bağlı Pedinküler Halüsinoz: Olgu Sunumu Özden Kamışlı, Yüksel Kaplan, Suat Kamışlı, Cemal Özcan İnönü University Faculty of Medicine, Turgut Özal Medical Center, Department of Neurology, Malatya, Turkey Sum mary Peduncular hallucinosis is a snydrome characterized by vivid, colored visual hallucinations due to brain stem and thalamic involvement. The etiology of peduncular hallucinosis mostly involves lesions of vascular nature and infections. The cases of peduncular hallusinosis due to multiple sclerosis is very rare in the literature. In this report we presented a peduncular hallucinosis case who is a 46 year old woman with multiple sclerosis diagnosis. (Turkish Journal of Neurology 2013; 19:143-144) Key Words: Peduncular hallucinosis, multiple sclerosis, brain stem Özet Pedinküler halüsinoz, beyin sapı ve talamus gibi yapıların etkilenmesiyle ortaya çıkan kısa süreli renkli, canlı görsel halusinasyonlarla karakterize bir sendromdur. Etiyolojide daha çok vasküler hadiseler ve enfeksiyonlar yer almaktadır. Literatürde multipl skleroza bağlı pedinküler hallusinozis olgusu oldukça az sayıdadır. Biz bu yazıda multipl skleroz tanısı olan, 46 yaşındaki bir hastada gelişen pedinküler halusinozisi sunduk. (Türk Nöroloji Dergisi 2013; 19:143-144) Anah tar Ke li me ler: Pedinküler halusinozis, multipl skleroz, beyin sapı Introduction and reported having daily hallucinations of long, yellow hair on her fingers, insects on her hair or people wearing bags on their First described by Lhermitte, peduncular hallucinosis (PH) is head for 4-5 minutes almost every day for the past year. Her MS a syndrome characterized by brief, colorful visual hallucinations complaints started 20 years ago with difficulty in walking and (1, 2).
    [Show full text]
  • New-Onset Psychosis Associated with a Lesion Localized in the Rostral Tectum: Insights Into Pathway-Specific Connectivity Disrupted in Psychosis
    Downloaded from https://academic.oup.com/schizophreniabulletin/advance-article-abstract/doi/10.1093/schbul/sbaa018/5760704 by Access provided HEAL-Link (National Technical University of Athens) user on 22 June 2020 applyparastyle "fig//caption/p[1]" parastyle "FigCapt" applyparastyle "fig" parastyle "Figure" Schizophrenia Bulletin doi:10.1093/schbul/sbaa018 New-Onset Psychosis Associated With a Lesion Localized in the Rostral Tectum: Insights Into Pathway-Specific Connectivity Disrupted in Psychosis Eleftheria Koropouli*,1,2, Nikos Melanitis3, Vasileios I. Dimitriou1, Asimina Grigoriou1, Efstratios Karavasilis4, Konstantina S. Nikita3, Elias Tzavellas1, and Thomas Paparrigopoulos1 1First Department of Psychiatry, Aiginition Hospital, National and Kapodistrian University of Athens School of Medicine, Athens, Greece; 2Present address: First Department of Neurology, Aiginition Hospital, National and Kapodistrian University of Athens School of Medicine, Athens, Greece; 3School of Electrical and Computer Engineering, National Technical University of Athens, Athens, Greece; 4Second Department of Radiology, Attikon Hospital, National and Kapodistrian University of Athens School of Medicine, Athens, Greece *To whom correspondence should be addressed; First Department of Neurology, Aiginition Hospital, National and Kapodistrian University of Athens, Vasilissis Sofias Avenue 72–74, Athens, Attica 11528, Greece, e-mail: [email protected]. Objective: To investigate pathway-specific connectivity dis- primary and higher-order brain areas serving distinct rupted in psychosis. Methods: We carried out a case study of functions.1,2 This dysregulation has been substantiated a middle-aged patient who presented with new-onset psychosis on the basis of resting-state activity of broadly distrib- associated with a space-occupying lesion localized in the right uted functional networks in schizophrenic individuals.2 superior colliculus/periaqueductal gray.
    [Show full text]
  • Peduncular Hallucinosis: a Case Report
    The Ochsner Journal 14:450–452, 2014 Ó Academic Division of Ochsner Clinic Foundation Peduncular Hallucinosis: A Case Report Lauren Penney, MBBS,1 David Galarneau, MD1,2 1The University of Queensland School of Medicine, Ochsner Clinical School, New Orleans, LA 2Department of Psychiatry, Ochsner Clinic Foundation, New Orleans, LA hallucinosis secondary to infarction in the basal ABSTRACT ganglia only. To the best of our knowledge, few Background: Peduncular hallucinosis is a rare form of visual cases involving only the basal ganglia have been hallucination often described as vivid, colorful visions of people reported. and animals. The exact pathophysiology is unknown; however, most cases have been described in relation to lesions in the CASE REPORT thalamus or midbrain. A 59-year-old female presented to the hospital Case Report: We present the case of a 59-year-old female with with a 3-week history of right-sided headache and a 1- peduncular hallucinosis associated with infarction in the right week history of irritability, confusion, and visual basal ganglia with the background of malignant hypertension. hallucinations with a background of malignant hyper- The patient’s visual hallucinations decreased without pharma- tension and hyperlipidemia. One week prior to ceutical treatment by the time of discharge and on further hospital admission, she had presented to an outpa- follow-up had resolved completely. tientclinicbecauseoftheheadachesandwas Conclusion: We believe ours is one of few reported cases of diagnosed with malignant hypertension and sinusitis. peduncular hallucinosis in a patient with an infarct isolated to Magnetic resonance imaging revealed an infarct in the basal ganglia (striatum and globus pallidus).
    [Show full text]
  • Network Localization of Neurological Symptoms from Focal Brain Lesions
    Brain Advance Access published August 10, 2015 doi:10.1093/brain/awv228 BRAIN 2015: Page 1 of 15 | 1 Network localization of neurological symptoms from focal brain lesions Aaron D. Boes,1,2 Sashank Prasad,3 Hesheng Liu,4 Qi Liu,4,5 Alvaro Pascual-Leone,1 Verne S. Caviness Jr2 and Michael D. Fox1,4,6 A traditional and widely used approach for linking neurological symptoms to specific brain regions involves identifying overlap in lesion location across patients with similar symptoms, termed lesion mapping. This approach is powerful and broadly applicable, but has limitations when symptoms do not localize to a single region or stem from dysfunction in regions connected to the lesion site rather than the site itself. A newer approach sensitive to such network effects involves functional neuroimaging of patients, but this requires specialized brain scans beyond routine clinical data, making it less versatile and difficult to apply when symptoms are rare or transient. In this article we show that the traditional approach to lesion mapping can be expanded to incorporate network effects into symptom localization without the need for specialized neuroimaging of patients. Our approach involves three steps: Downloaded from (i) transferring the three-dimensional volume of a brain lesion onto a reference brain; (ii) assessing the intrinsic functional con- nectivity of the lesion volume with the rest of the brain using normative connectome data; and (iii) overlapping lesion-associated networks to identify regions common to a clinical syndrome. We first tested our approach in peduncular hallucinosis, a syndrome by guest on August 17, 2015 of visual hallucinations following subcortical lesions long hypothesized to be due to network effects on extrastriate visual cortex.
    [Show full text]
  • Jacques Jean Lhermitte and the Syndrome of Peduncular Hallucinosis
    NEUROSURGICAL FOCUS Neurosurg Focus 47 (3):E9, 2019 Jacques Jean Lhermitte and the syndrome of peduncular hallucinosis Jennifer A. Kosty, MD,1 Juan Mejia-Munne, MD,2 Rimal Dossani, MD,1 Amey Savardekar, MD,1 and Bharat Guthikonda, MD1 1Department of Neurosurgery, Louisiana State University Health Sciences Center–Shreveport, Louisiana; and 2Department of Neurosurgery, University of Cincinnati Medical Center, Cincinnati, Ohio Jacques Jean Lhermitte (1877–1959) was among the most accomplished neurologists of the 20th century. In addition to working as a clinician and instructor, he authored more than 800 papers and 16 books on neurology, neuropathology, psychiatry, and mystical phenomena. In addition to the well-known “Lhermitte’s sign,” an electrical shock–like sensation caused by spinal cord irritation in demyelinating disease, Lhermitte was a pioneer in the study of the relationship be- tween the physical substance of the brain and the experience of the mind. A fascinating example of this is the syndrome of peduncular hallucinosis, characterized by vivid visual hallucinations occurring in fully lucid patients. This syndrome, which was initially described as the result of a midbrain insult, also may occur with injury to the thalamus or pons. It has been reported as a presenting symptom of various tumors and as a complication of neurosurgical procedures. Here, the authors review the life of Lhermitte and provide a historical review of the syndrome of peduncular hallucinosis. https://thejns.org/doi/abs/10.3171/2019.6.FOCUS19342 KEYWORDS Jacques Jean Lhermitte; peduncular hallucinosis; complex visual hallucinations; peduncular hallucination ACQUES Jean Lhermitte (Fig. 1) was among the most Augustin Lhermitte, was a French realist painter, and his accomplished neurologists in modern history, yet he brother, Charles Augustin, was a photographer.15 Vincent is often overlooked in the neurosurgical literature.
    [Show full text]
  • Distinguishing Neuroimaging Features in Patients Presenting with Visual Hallucinations
    Published January 7, 2016 as 10.3174/ajnr.A4636 REVIEW ARTICLE Distinguishing Neuroimaging Features in Patients Presenting with Visual Hallucinations X T.T. Winton-Brown, X A. Ting, X R. Mocellin, X D. Velakoulis, and X F. Gaillard ABSTRACT SUMMARY: Visual hallucinations are relatively uncommon presentations in medical and psychiatric clinics, where they are generally regarded as a marker of possible underlying “organic” brain disease. Thus, patients with visual hallucinations are often referred for imaging of the brain. This article presents a pragmatic approach for the radiologist reviewing such imaging. Because conditions that can present with visual hallucinations are legion, a familiarity with the features of the hallucinations themselves, which can serve as clues to the underlying cause, can be helpful in interpreting such cases. We consider the nature of visual hallucinations and the mechanisms underlying their formation. We then provide a framework to guide the search for their cause, first in terms of focal lesions along the visual pathway and then global conditions affecting Ͼ1 region. ABBREVIATIONS: CJD ϭ Creutzfeldt-Jakob disease; VH ϭ visual hallucination he presentation of visual hallucinations (VHs) to general rather than on a clear understanding of the pathophysiology of Tmedical and psychiatric clinics often triggers a search for un- VHs. We briefly consider the nature of hallucinations and clues derlying “organic” brain disease and a referral for imaging of the in the clinical context on the request form. We then consider brain, first with CT and then MR imaging. If the findings are mechanisms underlying the formation of VHs to guide the interpreted as normal, patients who in actuality have underlying search for their cause.
    [Show full text]