Musical hallucinations in elderly patients with visuospatial impairment: two case reports

Musical hallucinations are an uncommon type of auditory hallucinations, they widely occur in elderly. Our group analyzed medical history, pharmacological therapy, neuropsychological pattern, audiometric testing, electroencephalogram, cerebral magnetic resonance and cerebral fludeoxyglucose-positron emission tomography (FDG-PET) of two patients. FDGPET showed in both patients hypometabolism pronounced in posterior regions. In particular the medial-inferior temporal cortex and the occipital associative areas were affected. Moreover, neuropsychological pattern suggested a visuospatial-executive deficit, conformed to the occipital involvement. Our reported cases might suggest that musical hallucinations have been arisen from a combination of peripheral and central dysfunction. A further explanation might be that musical hallucinations result from multiple white matter lacunar lesions due to small vascular events. A question is whether musical hallucinations might be primarily associated with occipital areas hypometabolism and visuospatial alterations typically associated with Levy body dementia (LBD).