Complex musical hallucinosis in a patient with left temporal hemorrhage: Clinical MRI study

P. Cerrato, D. Imperiale, C. Baima, M. Grasso, M. Giraudo, E. Verdun, B. Bergamasco

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A 35-year-old, right-handed man experienced complex acoustic perceptions after he had attended a symphonic concert (an orchestral transcription of Wagner's Sigfried). Acoustic perceptions were described as a symphonic piece performed by a large orchestra with numerous timpani and other percussion instruments. It was somewhat familiar but not a well-known piece and it had some similarities to what was heard during the concert. The theme was played in a minor tonality with frequent employment of drums, timpani, and other percussion instruments interspersed with string instruments playing in unison. A chorus accompanied the theme played by the string instruments. The music resembled a piece by late German romantic authors: the patient cited Mahler, Bruckner and the late works of Wagner. The music was initially low in intensity but progressively increased and was perceived in the middle of the head with no ear lateralization as if he were hearing "with headphones". The patient was reactive and aware of the unreal nature of the perceptions and felt the music rather disquieting and even frightful. Conflicting emotions occurred: on the one hand, he felt it as "the most disquieting and terrifying music" he had ever heard in his life and strongly desired to remove it out of his mind; on the other and, he was deeply fascinated and "would like to compose such an emotional and exciting piece". During the episode the patient was able to speak, watch and understand television programs and go about his normal activities. The episode lasted about 60 min. Hearing sensation was normal at clinical and instrumental evaluation. Brain MRI showed a hemorrhagic lesion involving the left putamen and external capsula hyperintense in the centre and hypointense in the periphery on T2-weighted images. The lesion was located next to the acoustic radiations. Cerebral angiography, audiogram, and BAEP were normal, while EEG showed no epileptiform graphicelements. There was no evidence of drug abuse or alcohol intoxication. The physiopathology of musical hallucinosis (MH) in our case might be related to the involvement of the acoustic radiations: an impairment of the descending fibers from the auditory cortex to lower structures of the acoustic coclear pathway modulating acoustic perceptions may cause a "disinhibitory" effect on the auditory cortex. Our case indicates that MH may occur even in the absence of sensory-neural deafness and may be influenced by the level of musical training, which probably influences the cortical representation of musical perception. The similarities with the symphonic music that he had previously heard suggests a role of the acoustic memory circuits in the genesis of MH while the professional experience and the emotional context might have influenced the features of MH, affecting the unconscious processing of internal sensations.

Original languageEnglish
JournalNeurological Sciences
Issue number4 SUPPL.
Publication statusPublished - 2000

ASJC Scopus subject areas

  • Neuroscience(all)
  • Clinical Neurology

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