Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal.
Faculdade de Ciências Médicas, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil.
J Med Case Rep. 2021 Sep 9;15(1):449. doi: 10.1186/s13256-021-03039-2.
Musical hallucinations are a particular type of auditory hallucination in which the patient perceives instrumental music, musical sounds, or songs. Musical hallucinations are associated with acquired hearing loss, particularly within the elderly. Under conditions of reduced auditory sensory input, perception-bearing circuits are disinhibited and perceptual traces released, implying an interaction between peripheral sensory deficits and central factors related to brain dysfunction.
A 71-year-old Caucasian man with hearing loss complained of memory difficulties and resting tremor of the right upper limb in the previous 2 years. He already had difficulties in instrumental activities of daily life. Neurological examination showed Parkinsonian signs and hypoacusia. Neuropsychological examination identified deficits in executive functions and memory tests. Brain computerized tomography and nuclear magnetic resonance scans showed mild cortical and subcortical atrophy. The clinical diagnosis of possible dementia with Lewy bodies was established. Five years later, the patient began complaining of musical hallucinations. There had been no previous change in medication. An otorhinolaryngologist diagnosed age-related hearing loss and prescribed bilateral hearing aids. After using the hearing aids, the patient did not hear the songs any longer, only some tinnitus, described as a whistle. However, at the same time, the patient started experiencing visual hallucinations he never had before.
To our knowledge, the immediate shift of hallucinations from one sensory modality to another sensory modality when perception is improved has not been previously described. This report emphasizes the interaction between brain pathology and sensory deficits for the genesis of hallucinations, and reinforces the theory that attention and control networks must couple properly to the default mode network, as well as integrate and select adequately peripheral signals to the somatosensory cortices, in order to keep a clear state of mind.
The clinician should bear in mind and let the patient know that improving one sensory modality to ameliorate hallucinations may sometimes paradoxically lead to hallucinations in a different sensory modality.
音乐性幻觉是一种特殊类型的听觉幻觉，患者感知到器乐音乐、音乐声音或歌曲。音乐性幻觉与获得性听力损失有关，特别是在老年人中。在听觉感觉输入减少的情况下，感知承载回路被去抑制，感知痕迹被释放，这意味着外周感觉缺陷与与大脑功能障碍相关的中枢因素之间存在相互作用。
一名 71 岁的白人男性，有听力损失，在过去 2 年中抱怨记忆力困难和右上肢静止性震颤。他已经难以进行日常的器乐活动。神经系统检查显示帕金森病征象和听力减退。神经心理学检查发现执行功能和记忆测试缺陷。脑计算机断层扫描和磁共振扫描显示皮质和皮质下轻度萎缩。临床诊断为可能的路易体痴呆。五年后，患者开始抱怨音乐性幻觉。在此之前，药物治疗没有任何变化。耳鼻喉科医生诊断为年龄相关性听力损失，并开了双侧助听器。使用助听器后，患者不再听到歌曲，只听到一些耳鸣，描述为哨声。然而，与此同时，患者开始出现以前从未有过的视觉幻觉。
据我们所知，当感知得到改善时，幻觉从一种感觉模态立即转移到另一种感觉模态，这种情况以前没有被描述过。本报告强调了大脑病理学和感觉缺陷之间的相互作用对于幻觉的发生，以及注意力和控制网络必须与默认模式网络正确耦合，以及充分整合和选择外周信号到体感皮层，以保持清醒状态的理论。
临床医生应该牢记并让患者知道，改善一种感觉模态以改善幻觉有时可能会导致另一种感觉模态的幻觉。
