Peduncular hallucinosis secondary to central pontine myelinolysis

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Psychiatry and Clinical Neurosciences 2012; 66: 618–621

doi:10.1111/j.1440-1819.2012.02399.x

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Peduncular hallucinosis secondary to central pontine myelinolysis Mark Walterfang, MBBS, PhD, FRANZCP,1,2* Anita Goh, BSc, DPsych,1,3 Ramon Mocellin, MBBS, MSc, MPM, FRANZCP,1,2 Andrew Evans, MBBS, MD, FRACP1 and Dennis Velakoulis, MBBS, MMed, DMedSci, FRANZCP1,2 1 Neuropsychiatry Unit, Royal Melbourne Hospital, 2Melbourne Neuropsychiatry Centre, University of Melbourne and North Western Mental Health and 3Academic Unit for Psychiatry of Old Age, University of Melbourne, Melbourne, Australia

Peduncular hallucinations are generally associated with lesions in the midbrain. They have rarely been associated with central pontine myelinolysis, a condition associated with rapid alterations in serum sodium and chronic alcoholism. Described herein is the case of a 46-year-old man who developed typical peduncular hallucinations, whose imaging

demonstrated central pontine myelinolysis. After alcohol cessation and neuroimaging resolution, the patient’s hallucinatory phenomena abated.

OMPLEX VISUAL HALLUCINATIONS (CVH) can result from a variety of processes that disturb the transmission, processing and modulation of visual information.1 We describe a case of CVH resulting from central pontine myelinolysis (CPM), in which both the hallucinosis and the pontine lesion resolved concomitantly.

walls, mostly during periods of low light. Figures would approach him and stare. These periods were not during periods of alcohol withdrawal, and did not occur on the periphery of sleep. He described some memory problems and reported drinking half to one bottle of spirits per day. He denied other substance use. He began to drink during a period of depression following divorce 10 years previously, but had not used alcohol for more than 1 week. His blood alcohol level at assessment was zero. On mental state examination, he was cooperative and language was intact with no word-finding difficulty/thought disorder. He described complex visual hallucinations, in addition to simple auditory hallucinations of male voices. Insight was limited. Neurological examination indicated no focal signs other than reduced vibration sensation and proprioception peripherally, broad-based gait and positive pout/palmomental reflexes. He scored 57/100 on the Neuropsychiatry Unit COGnitive assessment tool (NUCOG),2 with greatest deficits in memory, attention and executive functioning; a score on the NUCOG of
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