Peduncular hallucinations in brainstem encephalitis drawn by a patient

摘要

A 74-year-old man presented with acute cerebellar ataxia, ophthalmoplegia, left facial dysesthesia and weakness, dysarthria, dysphasia, and hyperreflexia. Episodic evening hallucinations occurred, triggered by eye closing, and lasted minutes; they were unaccompanied by paranoia, delusions, or REM sleep behavior disorder. We diagnosed brainstem encephalitis, apparently immune-mediated because IV im-munoglobulin and corticosteroid therapy improved his symptoms. MRI excluded infection, tumor, or infarction of brainstem; the CSF was normal except for protein of 59 mg/dL. After recovery, he sketched vivid, colorful pictures (figure) of the hallucinations.