Abstract
Introduction: Peduncular hallucinosis (PA) refers to self-discriminating hallucinations, these are caused by lesions in the midbrain and pons.
Presentation of the case: 27-year-old right handed female patient with visual and auditory hallucinations self-discriminated by the patient, with no prior history of importance and with lesions in cerebral and cervical Magnetic Resonance in the superior cerebellar peduncle, pontine tegmentum, and in the cervical spine with pattern 2 oligo clonal bands, which met Mc Donald’s criteria for multiple sclerosis.
Discussion: Peduncular hallucinosis refers to the presence of visual hallucinations criticized by the patient, consequence of lesions in the inhibitory pathways with deafferentation and disinhibition of the midbrain-thalamic and retinogeniculus-calcarine pathways. Described as a manifestation of multiple neurological pathologies such as trauma, vascular, tumor and few cases of demyelinating among others.
Conclusion: Peduncular hallucinosis is an atypical form of presentation of ponto-mesencephalic lesions described in several pathologies, it must be taken into account when locating the neurological lesion, few cases have been reported as symptom of the demyelinating disease.
References
Rizzo M, Barton JJS. Central disorders of visual function. En: Miller NR, Newman NJ, Biousse V, Kerrison JB, editores. Walsh y Hoyt's Clinical Neuro-ophthalmology. 6.a ed. Filadelfi: Lippincott, Williams and Wilkins; 2005. p. 575-645.
Weil RS, Lees AJ. Visual hallucinations. Pract Neurol. 2021:practneurol-2021-003016.
Fraser CL, Lueck CJ. Illusions, hallucinations, and visual snow. Handb Clin Neurol. 2021;178:311-35. https://doi.org/10.1016/B978-0-12-821377-3.00014-3
Kosty JA, Mejia-Munne J, Dossani R, Savardekar A, Guthikonda B. Jacques Jean Lhermitte and the syndrome of peduncular hallucinosis. Neurosurg Focus. 2019;47(3). https://doi.org/10.3171/2019.6.FOCUS19342
Lhermitte J. Syndrome de la calotte du pedoncule cerebral. les troubles psycho-sensoriels dans les lesions du mesocephale. Rev Neurol. 1922;38:1359-65.
Van Bogaert L. Syndrome inferieur du noyau rouge, troubles psycho-sensoriels dorigine me'soence'- phalique. Rev Neurol. 1924 ;40:423-61.
Van Bogaert L. Lhallucinose pedonculaire. Rev Neurol. 1927;47:417-23. https://doi.org/10.7767/zrgra.1927.47.1.417
Manford M, Andermann F. Complex visual hallucinations. Clinical and neurobiological insights. Brain. 1998;121(10):1819-40. https://doi.org/10.1093/brain/121.10.1819
Schielke E, Reuter U, Hoffmann O, Weber JR. Musical hallucinations with dorsal pontine lesions. Neurology. 2000;55:454-55. https://doi.org/10.1212/WNL.55.3.454
Evans LR, Drummond KJ. Peduncular hallucinosis after debulking of a third ventricular pilocytic astrocytoma: Case report and review of the literature. J Clin Neurosci. 2021;83:96-8. https://doi.org/10.1016/j.jocn.2020.11.021
Lauterbach EC, Spears TE. Longterm psychiatric and neurologic treatment after a traumatic midbrain lesion. Neurocase. 1997;3:103 https://doi.org/10.1080/13554799708404042
Maiuri F, Iaconetta G, Sardo L, Buonamassa S. Peduncular hallucinations associated with large posterior fossa meningiomas Clin Neurol Neurosurg. 2002;104. https://doi.org/10.1016/S0303-8467(01)00184-6
Nicolai A, Lazzarino LG. Peduncular hallucinosis as the first manifestation of multiple sclerosis. Eur Neurol. 1995;35(4):241-2. https://doi.org/10.1159/000117139
Fénelon G. From dreams to hallucinations: Jean Lhermitte's contribution to the study of peduncular hallucinosis and the dissociation of states. J Neuropsychiatry Clin Neurosci. 2022;34(1):16-29. https://doi.org/10.1176/appi.neuropsych.20120314
Drouin Para E, Péréon Y. Peduncular hallucinosis according to Jean Lhermitte. Rev Neurol (Paris). 2019;175:377-9. https://doi.org/10.1016/j.neurol.2018.11.005
Galetta KM, Prasad S. Historical trends in the diagnosis of peduncular hallucinosis. J Neuroophthalmol. 2018;38(4):438-41. https://doi.org/10.1097/WNO.0000000000000599
Geller TJ, Bellur SN. Peduncular hallucinosis: magnetic resonance imaging confirmation of mesencephalrc infarction during life. Ann Neurol. 1987;21(6):602-4. https://doi.org/10.1002/ana.410210614
Winton-Brown TT, Ting A, Mocellin R, Velakoulis D, Gaillard F. Distinguishing neuroimaging features in patients presenting with visual hallucinations. AJNR Am J Neuroradiol. 2016;37:774-81. https://doi.org/10.3174/ajnr.A4636
Penney L, Galarneau D. Peduncular hallucinosis: a case report. A probable case of peduncular hallucinosis secondary to a cerebral peduncular lesion successfully treated with an atypical antipsychotic. Innov Clin Neurosci. 2013;10(5-6):28-31.
Spiegel DR, Harsch C, Pattison A. A case of peduncular hallucinosis due to right pontine and cerebral peduncle cerebrovascular accident treated successfully with risperidone: insights into an uncommon cause of visual hallucinations. Prim Care Companion CNS Disord. 2020;22(5):19l02584. https://doi.org/10.4088/PCC.19l02584
Benke T. Peduncular hallucinosis: A syndrome of impaired reality monitoring. J Neurol. 2006;253(12):1561-71. https://doi.org/10.1007/s00415-0060-0254-4
Kölmel, HS. Peduncular hallucinations. J Neurol. 1991;238:457-9. https://doi.org/10.1007/BF00314654
Prasad S, Dinkin M. Higher cortical visual disorders. Contin Lifelong Learn Neurol. 2019;25(5):1329-61. https://doi.org/10.1212/CON.0000000000000774
Vetrugno R, Vella A, Mascalchi M, Alessandria M, D'Angelo R, Gallassi R, et al. Peduncular hallucinosis: A polysomnographic and spect study of a patient and efficacy of serotonergic therapy. Sleep Med. 2009;10(10):1158-60. https://doi.org/10.1016/j.sleep.2009.05.005
Fraser CL, Lueck CJ. Illusions, hallucinations, and visual snow. Handb Clin Neurol. 2021;178:311-35. https://doi.org/10.1016/B978-0-12-821377-3.00014-3
Dunn DW, Weisberg LA, Nadell J. Peduncular hallucinations caused by brainstem compression. Neurology. 1983;33:1360-1. https://doi.org/10.1212/WNL.33.10.1360
Boes AD, Prasad S, Liu H, Liu Q, Pascual-Leone A, Caviness VS, et al. Network localization of neurological symptoms from focal brain lesions. Brain. 2015;138(10):3061-75. https://doi.org/10.1093/brain/awv228
LaPorta J, Stanton R, Koss A. The man behind the bed: a case of peduncular hallucinosis treated with quetiapine and melatonin. Neurocase. 2021;27:205-8. https://doi.org/10.1080/13554794.2021.1915338
Biswas SN, Biswas S, Chakraborty PP. Peduncular hallucinosis as first presentation of juvenile pilocytic astrocytoma. Indian Journal of Pediatrics. 2016;83:736-7. https://doi.org/10.1007/s12098-015-1935-8
Couse M, Wojtanowicz T, Comeau S, Bota R. Peduncular hallucinosis associated with a pontine cavernoma. Ment Illn. 2018;10 https://doi.org/10.4081/mi.2018.7586
O'neill SB, Pentland' B, Sellar R. Peduncular hallucinations following subarachnoid haemorrhage. Br J Neurosurg. 2005 19(4):359-60. https://doi.org/10.1080/02688690500305407
Kulhari A, Manjila S, Singh G, Kumar K, Tarr RW, Bambakidis N. Auditory hallucinosis as a presenting feature of interpeduncular lipoma with proximal P1 segment fenestration: report of a rare case and review of literature on peduncular hallucinosis. J Vasc Interv Neurol. 2016;9(1):7-11.
Geddes MR, Tie Y, Gabrieli JD, McGinnis SM, Golby AJ, Whitfield-Gabrieli S. Altered functional connectivity in lesional peduncular hallucinosis with REM sleep behavior disorder. Cortex. 2016;74:96-106. https://doi.org/10.1016/j.cortex.2015.10.015
Shahab M, Ahmed R, Kaur N, Masoud H. Peduncular hallucinosis after a thalamic stroke. BMJ Case Rep. 2021;14(5):e241652. https://doi.org/10.1136/bcr-2021-241652
Degueure A, Fontenot A, Husan A, Khan MW. An unusual presentation of vivid hallucinations. Cureus. 2022;14(5):1-6. https://doi.org/10.7759/cureus.25441
Berry R, Panegyres PK. Peduncular hallucinosis and autonomic dysfunction in anti-aquaporin-4 antibody syndrome. Cogn Behav Neurol. 2017;30(3):116-24. https://doi.org/10.1097/WNN.0000000000000132
Walterfang M, Goh A, Mocellin R, Evans A, Velakoulis D. Peduncular hallucinosis secondary to central pontine myelinolysis. Psychiatry Clin Neurosci. 2012;66(7):618-21. https://doi.org/10.1111/j.1440-1819.2012.02399.x
Gómez-Choco M, García S, León L. Peduncular hallucinosis in a patient with subclavian steal syndrome: Usefulness of Doppler ultrasonography. J Clin Ultrasound. 2014;42(1):63-6. https://doi.org/10.1002/jcu.22042
Tobita M, Fanchiang SP, Saldivar A, Taylor S, Jordan B. Complex hallucinations in hospitalized rehabilitation patients with COVID-19. Arch Rehabil Res Clin Transl. 2022:100234. https://doi.org/10.1016/j.arrct.2022.100234
Pascal de Raykeer R, Hoertel N, Manetti A, Rene M, Blumenstock Y, Schuster JP, Limosin F. A case of chronic peduncular hallucinosis in a 90-year-old woman successfully treated with olanzapine. J Clin Psychopharmacol. 2016;36:285-6. https://doi.org/10.1097/JCP.0000000000000497
Talih FR. A probable case of peduncular hallucinosis secondary to a cerebral peduncular lesion successfully treated with an atypical antipsychotic. Innov Clin Neurosci. 2013;10:28-31.
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