Social Psychiatry, Vol. 54 No. 2, 2026.
Meeting abstract
https://doi.org/10.24869/spsih.2026.254
Musical Hallucinations After Neurosurgical Treatment of a Cerebral Aneurysm: Differential Diagnostic and Therapeutic Challenges
Dora Vukorepa
; Department of Psychiatry, University Hospital of Split, Spinčićeva 1, 21000 Split, Croatia
*
Ana Rađa
; Department of Psychiatry, University Hospital of Split, Spinčićeva 1, 21000 Split, Croatia
Mariano Kaliterna
; Department of Psychiatry, University Hospital of Split, Spinčićeva 1, 21000 Split, Croatia
* Corresponding author.
Abstract
Musical hallucinations are a rare form of complex
auditory hallucinations that can occur in the
context of neurological, psychiatric, and sensory
disorders. They are more commonly described in
older women and are not necessarily associated
with a primary psychotic disorder. Their etiology
is often a diagnostic and therapeutic challenge. A
71‑year‑old female patient with a long-standing
history of migraine with aura was hospitalized in
2020 at the Department of Neurology, University
Hospital of Split, due to intense left-sided headache,
retro-orbital pain with tearing of the eye and
rhinorrhea. Diagnostic workup revealed an unruptured
aneurysm of the left middle cerebral artery,
and neurosurgical clipping of the aneurysm was
performed. There were no psychiatric disorders in
her personal or family history. After the surgery, she developed auditory phenomena in the form of
acousmas, followed by persistent musical hallucinations.
She described constant auditory hallucinations
in the form of classical music, notably having
also been professionally involved with music.
The patient had insight and understood that this
was a phenomenon occurring without an external
auditory stimulus. Postoperative recovery proceeded
without complications. A follow-up brain
CT scan after 6 months was normal. Risperidone
was initially introduced into treatment without
clinical improvement, followed by fluphenazine,
also without significant effect. With the addition
of mirtazapine, improvement in sleep quality and
a reduction in difficulties with falling and staying
asleep were achieved. The patient continues
to be followed in an interdisciplinary setting by
a neurologist and a psychiatrist. At her most recent
neurological examination, she reported episodes
of “floating” and a feeling of losing control
over herself. This case report further supports
the hypothesis of an organic basis for musical
hallucinations after neurosurgical treatment of
an aneurysm and demonstrates that they are not
necessarily a manifestation of a primary psychotic
disorder. Timely recognition of an organic etiology
can significantly influence the diagnostic and
therapeutic approach.
Keywords
auditory hallucinations; middle cerebral artery aneurysm; case report
Hrčak ID:
352912
URI
Publication date:
15.6.2026.
Visits: 0 *