Neurology Case Challenge: Visual and Auditory Hallucinations in a Patient With Parkinson Disease

Lee Neilson, MD; Elena Cecilia Rosca, MD, PhD; Simu Mihaela, MD, PhD; Chirileanu Ruxanda Dana, MD, PhD


January 21, 2022

Editor's Note: The Case Challenge series includes difficult-to-diagnose conditions, some of which are not frequently encountered by most clinicians but are nonetheless important to accurately recognize. Test your diagnostic and treatment skills using the following patient scenario and corresponding questions. If you have a case you would like to suggest for a future Case Challenge, please contact us.


A 72-year-old man is brought to the neurology clinic by his family after a 1-month history of episodic altered mental status, agitation, and hallucinations. The patient reports having insomnia, nonthreatening visual hallucinations (most frequently of people), and rarely, auditory hallucinations. His wife remarks, "Some days he is not himself, and the next day he is fine."

Seven months earlier, the patient was diagnosed with Parkinson disease and started on a carbidopa/levodopa combination; however, he experienced only a mild response to medication.

His medical history includes asymptomatic lacunar infarcts, stage 2 hypertension, orthostatic hypotension, ischemic cardiomyopathy, coronary artery bypass surgery, and dyslipidemia. He has no history of underlying psychiatric disorder. His current medications include carbidopa/levodopa, clopidogrel, ramipril, metoprolol, spironolactone, furosemide, isosorbide dinitrate, and simvastatin. He does not smoke, drink alcohol, or use illicit drugs.


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