A case of peduncular hallucinosis presenting as a primary psychiatric disorder
A 63-year-old female patient was admitted to the psychiatry emergency clinic for hallucinations, nervousness and agitation, which had started abruptly before 2 days. She was described to be a little bit aggressive and conversable person before but neither the patient nor her family had a previous history of psychiatric disease. She was consulted to neurology as a late-onset psychiatric disorder to rule out an organic etiology. She had hypertension and had an ischemic cerebrovascular accident before and stopped taking acetylsalicylic acid treatment for 3 days.\nBefore 2 days, she had suddenly seen her sister was plastering the house she lived before and it had lasted nearly 5-6 min. After a few hours later, she had seen her dead mother calling her “come here” and this also had lasted nearly 5-6 min. After several hours, she had heard some voices calling “get out and walk” and she had walked aimlessly in the house. Then, she had become agitated and had thrown her grandson's toys around and had broken a window. After that she had attempted to jump down from the balcony and had slapped her daughter's face while she was trying to hold her. After she had calmed down, she had recognized these all as hallucinations and her children had brought her to the psychiatry emergency clinic.\nAt the neurological examination, she was cooperative, orientation for the person and the location was normal, but she was disoriented to time and couldn’t distinguish night and day. Cranial nerves were intact; there was no paresia other than a left upper monoparesia, which was the sequel of a previous ischemic cerebrovascular accident. She was aware of the hallucinations that she had.\nThere was no metabolic abnormality in blood examination; electrocardiogram and electroencephalogram (EEG) was normal, no acute pathology was found in cranial computed tomography. Acute infarction was found at the left side of pons with diffusion weighted magnetic resonance imaging (MRI) investigation [Figures and ].\nShe was diagnosed as a cerebrovasculer accident presenting with pedincular hallucinosis and was treated with heparin and 100 mg/day acetyl salicylic acid and ketiapin 50 mg/day was given for hallucinations. One week later, her hallucinations were resolved almost completely.