Department of Psychiatry, Centro Hospitalar de Lisboa Ocidental EPE, Lisbon, Portugal
Centro Hospitalar Psiquiátrico de Lisboa, Lisboa, Portugal.
BMJ Case Rep. 2021 Nov 11;14(11):e245397. doi: 10.1136/bcr-2021-245397.
A 78-year-old woman with hypertension, diabetes mellitus type 2 and bilateral sensorineural hearing loss was referenced to geriatric psychiatry consultation. She presented cognitive dysfunction, erotomanic delusion and complex musical hallucinations (MH), described as hearing her neighbour singing a familiar church song along with bells in the background, making comments and talking to her. A computed tomography (CT) of the brain detected small right nucleocapsular and bilateral external capsules hypodensities of presumed vascular aetiology during hospitalisation. MH are a rare phenomenon with heterogeneous aetiology. Most frequently, the cause is hearing impairment; other causes include social isolation, cognitive dysfunction, vascular risk factors and medication. Studies suggest that some brain areas related to musical memory circuitry might be related and not fully mapped. Auditory verbal hallucinations with a voice that either comments, talks or sings to the patient have never been described in the literature, making this clinical case attractive.
一位 78 岁的女性，患有高血压、2 型糖尿病和双侧感觉神经性听力损失，被转介到老年精神病学咨询。她表现出认知功能障碍、钟情妄想和复杂的音乐幻觉（MH），描述为听到邻居在背景中伴随着钟声唱一首熟悉的教堂歌曲，并发表评论和与她交谈。住院期间的脑部计算机断层扫描（CT）显示右侧核壳和双侧外囊的小范围低密区，推测为血管病因。MH 是一种罕见的具有异质性病因的现象。最常见的原因是听力障碍；其他原因包括社会孤立、认知功能障碍、血管危险因素和药物治疗。研究表明，一些与音乐记忆回路相关的大脑区域可能存在关联，但尚未完全映射。文献中从未描述过有声音对患者进行评论、交谈或唱歌的听觉言语幻觉，这使得这个临床病例很有吸引力。
