title: Auditory hallucinations and migraine of possible brainstem origin.
abstract: BACKGROUND
  Concurrence of migraine and hallucinations is extremely rare and the underlying mechanism is poorly understood.
  
  
  METHODS
  We report a 22-year-old man with migraine associated with auditory hallucinations. Concurrent psychotic illness has been excluded.
  
  
  RESULTS
  Brain MR scans showed a stable, patchy FLAIR hyperintensity over the posterolateral aspect of the left cerebral peduncle, just below the level of the red nucleus. This was felt to represent an area of gliosis based on the interval stability over 19 months. There was absence of features for aggressive neoplasms, such as lesional high cellular turnover (choline/NAA ratio >1.0) or high cerebral blood volume on advanced MR imaging with MR spectroscopy and dynamic perfusion MR. EEG and brainstem auditory evoked potentials were unremarkable.
  
  
  CONCLUSIONS
  To our knowledge, there are no reports to date on similar auditory hallucinations in adult migraine patients, as well as with associated MRI brainstem lesions. The peduncular lesion could represent a previous migrainous infarct, and a possible analogy can be drawn from the descriptions of peduncular hallucinosis. Brainstem lesions, particularly in the midbrain and pons, have rarely been associated with this condition. It has been postulated that the damage to ascending reticular systems or thalamocortical circuitry may contribute to its pathogenesis.
authors.affiliation: Department of Neurology, National Neuroscience Institute, Singapore General Hospital, Outram Road, Singapore. gnrlyl@sgh.com.sg
authors.forename: Y L
authors.initials: YL
authors.lastname: Lo
authors.forename: S
authors.initials: S
authors.lastname: Hameed
authors.forename: H
authors.initials: H
authors.lastname: Rumpel
authors.forename: L L
authors.initials: LL
authors.lastname: Chan
mesh_terms: D001933:Brain Stem / Q000473:pathology*; D006212:Hallucinations / Q000150:complications* / Q000473:pathology*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008881:Migraine Disorders / Q000150:complications* / Q000473:pathology*; D055815:Young Adult