1/679. Musical hallucinations and palinacousis. So far, little attention has been paid to the similarities between musical hallucinations and palinacousis. Since the authors found a 75-year-old woman suffering from both symptoms, the similarities were investigated. As a result, musical hallucinations have all the four components of palinacousis structurally, although there are some differences in content. Thus, there exist substantial similarities. Moreover, both symptoms are often associated with seizure activity and there have been several case reports where anticonvulsants were successfully used to treat both symptoms. These findings indicate the possibility that there may exist a common pathway generating musical hallucinations and palinacousis. ( info) |
2/679. The coincidence of schizophrenia and Parkinsonism: some neurochemical implications. The hypothesis has recently been advanced that increased activity of central dopaminergic mechanisms underlies the symptomatology of the schizophrenias. The evidence that dopaminergic transmission in the corpus striatum is impaired in Parkinson's disease suggests that observations on the relationship between Parkinson's disease and schizophrenia may illuminate the patholophysiology of the latter disease. Four cases are reported in which an illness with schizophrenic features developed in the setting of longstanding Parkinson's disease; attention is drawn to earlier reports of schizophrenic illnesses occurring as postencephalitic sequelae in the presence of a parkinsonian syndrome. These observations appear to conflict with the view that increased dopamine release in the striatum is necessary for the expression of schizophrenic psychopathology, but do not exclude the possibility that increased transmission may occur at other dopaminergic sites in the brain, for example the nucleus accumbens, tuberculum olfactorium or cerebral cortex. Similarly the dopamine receptor blockade hypothesis of the therapeutic effects of neuroleptic drugs cannot be maintained with respect to an action in the striatum in view of the differences between the actions of thioridazine and chlorpromazine in this structure, but may be tenable for actions at extra-straital sites. ( info) |
3/679. Transient peduncular hallucinations secondary to brain stem compression by a cerebellar pilocytic astrocytoma. Almost all peduncular hallucinations have been described in patients with intrinsic lesions of the midbrain. An, as yet, unreported case of peduncular hallucinosis caused by posterior compression of the midbrain by a cerebellar pilocytic astrocytoma is described. The hallucinations and associated symptoms only ceased after removal of the tumour. ( info) |
4/679. A unique case of vibroacoustic disease: a tribute to an extraordinary patient. This paper describes the case of a patient, Mr. A, who died in 1987. The information provided by Mr. A in life, and his insistence on making a will demanding an autopsy on his death, has given us invaluable data on Vibroacoustic disease (VAD). Mr. A was an intellectually curious man who researched the medical literature related to his condition, and compared it to his own experience. He would describe all his sensations during his many epileptic seizures. Solely because of the results of Mr. A's autopsy, new avenues of research were initiated. These have led to new concepts and exciting new perspectives on noise-induced extraaural pathology. VAD is today a well-established and easily diagnosed entity. This paper is a tribute to Mr. A, in whose honor we have an on-going commitment to establish VAD as an occupational disease, reimbursable by Worker's Compensation. ( info) |
5/679. Unidirectional olfactory hallucination associated with ipsilateral unruptured intracranial aneurysm. PURPOSE: We describe a patient with complex partial seizure with unidirectional olfactory aura associated with ipsilateral unruptured aneurysm. methods AND RESULTS: The patient felt a sweet pleasant smell coming from behind her right side every time before the attack. Cranial magnetic resonance imaging (MRI) and three-dimensional computed tomography (CT) angiography revealed a large aneurysm at the bifurcation of the right middle cerebral artery and compression of the right orbitofrontal cortex. Small spikes were recorded from the right orbitofrontal and superior temporal gyri and from the uncus by the cortical electrodes during clipping of the aneurysm. CONCLUSIONS: The orbitofrontal cortex may have a function related to the ipsilateral directional olfactory sensation. ( info) |
| Besides the well-known adverse effects of clozapine, such as granulocytopenia, tiredness and hypersalivation, acute pancreatitis is known to be a very rare complication of the drug. In the literature a total of five case reports have been published so far. We report a case of asymptomatic pancreatitis subsequent to clozapine treatment at therapeutic doses in a 38-year-old male patient with chronic paranoid-hallucinatory schizophrenia. The patient was rehospitalized after an acute exacerbation of the psychosis subsequent to an attempt to change medication on an outpatient basis. Treatment with clozapine was initiated again. During phases of progressively increasing the clozapine dose, serum levels of amylase and lipase were increased; after maintaining daily doses of clozapine of 300 mg and/or 600 mg the pancreatic enzymes normalized quickly within a few days. The patient did not report any pancreas-related complaints, nor did specific diagnostic studies produce any indicative result, only a minor thickening of the head and body of the pancreas in the ultrasound. It is assumed that the phenomenon of subclinical, asymptomatic pancreatitis during increasing dosage of clozapine occurs more often than previously supposed. The monitoring of serum amylase levels during slow increase in clozapine is recommended; if leukocytosis or eosinophilia is present, the possibility of even a subclinical and asymptomatic pancreatitis should be considered. ( info) |
7/679. A puzzling case of seizures and visual hallucinations during clomipramine treatment with a high dose but causing a low serum concentration. We present a puzzling case of a 25-year-old depressive man suffering from seizures and visual hallucinations during clomipramine treatment with a high dose but causing a low serum concentration. We examined alleles of cytochrome P450 (CYP) isozymes. It was revealed that he was not an ultrarapid metabolizer for CYP2D6, and that the genotypes were homozygous for CYP2D6J and heterozygous for CYP2C19m1. Throughout the treatment period, his compliance was good. Since he was a smoker, it seems likely that his low clomipramine level was due to smoking-induced CYP1A2 activity. These findings suggest that smoking-induced CYP1A2 activity overcomes the possibly inhibiting effects of homozygosity for CYP2D6J and heterozygosity for CYP2C19m1, and that high-dose clomipramine is not always a direct cause of seizures. ( info) |
| BACKGROUND: Prior studies suggest that auditory hallucinations of "voices" arise from activation of speech perception areas of the cerebral cortex. Low frequency transcranial magnetic stimulation (TMS) can reduce cortical activation. methods: We have studied three schizophrenic patients reporting persistent auditory hallucinations to determine if low frequency TMS could curtail these experiences. One hertz stimulation of left temporoparietal cortex was compared with sham stimulation using a double-blind, cross-over design. RESULTS: All three patients demonstrated greater improvement in hallucination severity following active stimulation compared to sham stimulation. Two of the three patients reported near total cessation of hallucinations for > or = 2 weeks. CONCLUSIONS: TMS may advance our understanding of the mechanism and treatment of auditory hallucinations. ( info) |
9/679. hypercalcemia in an euthyroid patient with secondary hypoadrenalism and diabetes insipidus due to hypothalamic tumor. A 20-year-old Japanese man with a hypothalamic tumor (most likely germ-cell tumor) which caused secondary hypoadrenalism, hypogonadism and diabetes insipidus developed hypercalcemia and acute renal failure. The serum levels of intact PTH (iPTH), PTH-related protein (PTH-rP), 1,25-dihydroxy vitamin d (1,25- (OH)2 D), ACTH, cortisol, gonadotropins and testosterone were decreased, but his serum levels of triiodothyronine (T3) and thyroxine (T4) were within the normal range at admission, with depressed TSH and slightly increased thyroglobulin. The hypercalcemia was refractory to extensive hydration and calcitonin, but was ameliorated by pamidronate. After irradiation of the hypothalamic tumor, panhypopituitarism gradually developed. The patient has been normocalcemic for the last 2 years and is doing well under replacement therapy with glucocorticoid, L-thyroxine, methyltestosterone and 1-desamino D arginine vasopressin (dDAVP). As to the mechanism of euthyroidism at admission, transient destructive thyroiditis associated with hypopituitarism or delayed development of hypothyroidism following the hypoadrenalism was suggested. This is the first reported case of hypercalcemia in secondary hypoadrenalism due to hypothalamic tumor. hypercalcemia was most likely induced by increased bone resorption, which was probably elicited by the combined effects of deficient glucocorticoid and sufficient thyroid hormones in addition to hypovolemia and reduced renal calcium excretion. Furthermore, severe dehydration due to diabetes insipidus and disturbance of thirst sensation caused by the hypothalamic tumor aggravated the hypercalcemia, leading to acute renal failure. ( info) |
10/679. Dialogical engagement with voices: a single case study. This paper raises the possibility that a dialogical, or discursive, model of human experience may be useful in helping someone who experiences verbal hallucinations. The model regards verbal hallucinations as a variety of inner speech with dialogical properties. The explication of these properties in the context of a personal narrative allowed the individual to engage in dialogue with the voices, through the medium of a new, supportive and positive voice. This process made it possible to introduce moral responses to distressing and potentially dangerous imperative verbal hallucinations, through the mediation of the new voice. Her dialogical engagement with this voice enabled her to deal effectively with troublesome voices, and was a powerful source of self-esteem. We briefly present the theoretical perspective underlying this approach, and compare and contrast the approach with cognitive-behavioural techniques. ( info) |