Peduncular hallucinosis: a polysomnographic and spect study of a patient and efficacy of serotonergic therapy.
Roberto Vetrugno, Alessandra Vella, Mario Mascalchi, Maria Alessandria, Roberto D'Angelo, Roberto Gallassi, Riccardo Della Nave, Andrea Ginestroni, Elena Antelmi, Pasquale Montagna
Sleep Medicine December 2009 DOI: 10.1016/j.sleep.2009.05.005 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Case study Case report Peer reviewed |
|---|---|
| Sample size | 1 |
| Population | A 72-year-old man with peduncular hallucinosis |
| Intervention | Citalopram |
| Duration | 4-week diary; 1-year history of hallucinations |
| Measures | Video-polysomnography (VPSG), brain magnetic resonance imaging (MRI), magnetic resonance angiography (MRA), proton magnetic resonance spectroscopy ((1)H MRS), single photon emission tomography (SPECT) |
| Topics | Serotonin |
| Key findings | The patient's visual hallucinations clustered during evening and night while supine, resembling hypnagogic hallucinations and sleep paralysis, and coincided with REM sleep behavior disorder. Imaging showed a dilated left internal carotid artery displacing the left subthalamus and metabolic and perfusion changes. The authors suggest the right opercular hyperperfusion may relate to the patient's awareness that the images were unreal. Hallucinations resolved with citalopram. |
Abstract
Peduncular hallucinosis (PH) consists of formed and coloured visual images, which the patient knows are unreal; it is often associated with lesions of the pons, midbrain and diencephalon. A 72-year-old man had noted the sudden onset of visual hallucinations one year before, specifying the time and body position in a 4-week, 24-h diary. Thereafter, he underwent video-polysomnography (VPSG), brain magnetic resonance imaging (MRI), angiography (MRA), proton spectroscopy ((1)H MRS), and single photon emission tomography (SPECT). Patient's diaries and VPSG showed a strong clustering of hallucinatory experiences during the evening/night time while lying in supine position, similar to hypnagogic hallucination and sleep paralysis in supine position. Repeated episodes of REM sleep behaviour disorder (RBD) occurred during the night. MRI and MRA showed an elongated and dilated left internal carotid artery displacing the left subthalamus upwards, and (1)H MRS relatively decreased N-acetyl-aspartate in the left subthalamus. Brain SPECT during PH revealed hypoperfusion in the right temporal region and hyperperfusion in the left occipital and right opercular regions (the latter possibly related to the patient's awareness of unreality). PH resolved with serotonergic (citalopram) therapy.
Comparable studies
Other case reports and case series on serotonin, most cited first.
| Study | Year | Design | Participants |
|---|---|---|---|
| Lasting Neuropsychiatric Sequelae of (??)Methylenedioxymethamphetamine (???Ecstasy???) in Recreational Users Persons who ingested large doses of MDMA | 1991 | Case study | n = 2 |
| Striatal serotonin is depleted in brain of a human MDMA (Ecstasy) user Chronic MDMA user | 2000 | Case study | n = 1 |
| Death following ingestion of MDMA (ecstasy) and moclobemide People who died after ingesting moclobemide and MDMA | 2003 | Case series | n = 4 |
| Ecstasy Intoxication: An Overlap Between Serotonin Syndrome and Neuroleptic Malignant Syndrome A 19-year-old woman and 15 other cases reported in the literature | 1996 | Case report and literature review | n = 16 |
| Recurrent seizures and serotonin syndrome following "2C-I" ingestion. 19-year-old male who insufflated 2C-I | 2013 | Case report | n = 1 |