Peduncular hallucinosis associated with a pontine cavernoma

Abstract

Peduncluar hallucinosis is a rare neurological disorder characterized by visual hallucinations, often described to be vivid and dream-like. While the exact pathophysiology has yet to be elucidated, most cases to date have suggested an etiology stemming from lesions to the thalamus or midbrain. Here presented is a case of a 54-year-old female with peduncular hallucinosis secondary to a pontine cavernoma hemorrhage in the setting of essential hypertension. The patient’s vivid visual and auditory hallucinations aligned temporally with the lesion’s discovery and resolved after pharmaceutical treatment. This case represents a rare form of peduncular hallucinosis secondary to a pontine cavernoma hemorrhage leading to vasospasm in the arteries feeding the brain-stem.

Peduncular hallucinosis associated with pontine hemorrhage in an adult patient

“…We found four case reports, including six patients with peduncular hallucinosis due to aneurysms in the posterior brain blood circulation, [8][9][10][11] and only one case due to a pontine carvenoma. 6 In all those cases, hemorrhage was present due to rupture of the vascular malformations, as seen in our patient, had occurred. In con-trast to our case, pontine carvenoma had already been previously diagnosed in the case described by Couse et al 6 and symptoms of peduncular hallucinosis developed after brainstem hemorrhage.…”

“…6 In all those cases, hemorrhage was present due to rupture of the vascular malformations, as seen in our patient, had occurred. In con-trast to our case, pontine carvenoma had already been previously diagnosed in the case described by Couse et al 6 and symptoms of peduncular hallucinosis developed after brainstem hemorrhage.…”

“…Furthermore, it is known that the dorsal raphe nucleus is also re- sponsible for the total sleep cycle (REM and non-REM sleep), which could explain sleep disturbances in these patients (nighttime wakefulness and hypersomnolence during the day) and correlate with the other clinical findings of the disease. [5][6][7] Peduncular hallucinosis associated with vascular malformations has been previously described in the literature. We found four case reports, including six patients with peduncular hallucinosis due to aneurysms in the posterior brain blood circulation, [8][9][10][11] and only one case due to a pontine carvenoma.…”

Alucinosis peduncular en esclerosis múltiple, síntoma poco común en la expresión de enfermedad desmielinizante

“…Las lesiones del núcleo del rafé dorsal, núcleo pedúnculo pontino tegmental producen una alteración en la transmisión de información del tálamo a la corteza occipital (se describe un fenómeno de liberación), lo que da lugar a las alucinaciones (17,19,26) (figura 3). Debido a la contigüidad de las vías reticulares ascendentes y los núcleos descritos previamente, estas lesiones también pueden producir trastornos del comportamiento del sueño REM, hipersomnolencia diurna, insomnio o fragmentación del sueño (4,19,(29)(30)(31).…”

“…tástasis) (30,32), y con el paso del tiempo múltiples causas como trauma, procedimientos quirúrgicos, infecciones, vasoespasmo, enfermedades desmielinizantes, epilepsia occipital,y mielinolisis osmótica (4,10,12,17,20,31,(33)(34)(35)(36)(37)(38)(39), así como más recientemente se ha descrito hasta en el 18,9 % de los pacientes con alucinaciones en recuperación de CO-VID-19 (39).…”