Neurologists in NSW have reported the unusual case of a man with an autoimmune CNS disorder who developed musical hallucinations that resembled hearing a radio station playing tunes by ABBA and the Village People.
The 50-year old man was found to have anti-IgLON5 disease but initially showed atypical sudden-onset features such as speech difficulties, headache and focal seizures, followed by visual hallucinations in which he saw shimmering patterns and discoloured faces.
He also had concurrent, brief episodes of impaired awareness and aphasia, with EEG showing right temporal lobe discharges consistent with seizure activity.
Writing in BMJ Case Reports, Dr Alan McDougall and Dr Nicolas Urriola of Liverpool Hospital said the man’s acute symptoms were successfully treated with anticonvulsants, but over the next few days he began to experience musical hallucinations in which he would hear popular songs as if they were playing on the radio.
The patient said the music he heard consisted of a constant rotation of recognisable songs from artists such as Dancing Queen (Abba), My Way (Elvis Presley) and You Can’t Stop the Music (Village People). The songs continued throughout the day and also included tunes by Milli Vanilli, Culture Club and various songs from the Saturday Night Fever soundtrack. Aside from an occasional perception that his phone was ringing he had no other auditory hallucinations.
The musical hallucinations were not accompanied by impaired awareness or abnormal EEG measures.
Blood investigations revealed no obvious cause to account for his symptoms. MRI of the brain showed haemosiderin deposition in the right temporal lobe, and there were patchy foci of T2 hyperintensity in the supratentorial white matter, but no evidence of acute ischaemia.
In their report, the clinicians said autoimmune encephalitis, with IgLON5 antibodies was diagnosed, and the patient was started on immunosuppressive therapy (prednisone), after which his musical hallucinations quickly resolved. He continued on azathioprine as prophylaxis.
They said the case was unusual as anti-IgLON5 disease usually had an insidious onset and prolonged course with distinct clinical manifestations including sleep disorders, bulbar symptoms, gait instability and abnormal movements. This was the first report of musical hallucination with the condition, they noted, though it had been reported in other autoimmune CNS disorders such as anti-NMDA receptor encephalitis.
“Neuroanatomically, the superior temporal sulcus has been suggested as a possible origin for musical hallucinations on functional imaging studies and it is unclear if the imaging findings in our patient were related or an ancillary finding,” they remarked.