Department of Neurology, National Neuroscience Institute, Singapore General Hospital, Outram Road, Singapore.
J Headache Pain. 2011 Oct;12(5):573-5. doi: 10.1007/s10194-011-0355-z. Epub 2011 Jun 4.
Concurrence of migraine and hallucinations is extremely rare and the underlying mechanism is poorly understood.
We report a 22-year-old man with migraine associated with auditory hallucinations. Concurrent psychotic illness has been excluded.
Brain MR scans showed a stable, patchy FLAIR hyperintensity over the posterolateral aspect of the left cerebral peduncle, just below the level of the red nucleus. This was felt to represent an area of gliosis based on the interval stability over 19 months. There was absence of features for aggressive neoplasms, such as lesional high cellular turnover (choline/NAA ratio >1.0) or high cerebral blood volume on advanced MR imaging with MR spectroscopy and dynamic perfusion MR. EEG and brainstem auditory evoked potentials were unremarkable.
To our knowledge, there are no reports to date on similar auditory hallucinations in adult migraine patients, as well as with associated MRI brainstem lesions. The peduncular lesion could represent a previous migrainous infarct, and a possible analogy can be drawn from the descriptions of peduncular hallucinosis. Brainstem lesions, particularly in the midbrain and pons, have rarely been associated with this condition. It has been postulated that the damage to ascending reticular systems or thalamocortical circuitry may contribute to its pathogenesis.
偏头痛和幻觉同时发生的情况极为罕见，其潜在机制也尚未被充分理解。
我们报告了一例偏头痛伴听觉幻觉的 22 岁男性患者。已排除同时存在精神疾病。
脑部磁共振扫描显示，在左大脑脚的后外侧，刚好在红核下方，存在一个稳定的、斑片状的 FLAIR 高信号区域。根据 19 个月的间隔稳定性，认为这代表了一个胶质增生区域。该病变没有侵袭性肿瘤的特征，如高级磁共振成像上的病变高细胞周转率（胆碱/NAA 比值>1.0）或高脑血容量，以及磁共振波谱和动态灌注磁共振。脑电图和脑干听觉诱发电位无明显异常。
据我们所知，目前尚无关于成年偏头痛患者出现类似听觉幻觉以及相关脑桥 MRI 病变的报道。该患者的大脑脚病变可能代表了以前的偏头痛性梗死，可能与peduncular hallucinosis 的描述类似。脑干病变，特别是中脑和脑桥，很少与这种情况有关。有人提出，上行网状系统或丘脑皮质回路的损伤可能导致其发病机制。
