Haemorrhagic Thalamic Stroke with Auditory Hallucinations Followed by Movement Disorder: A Misdiagnosed Case

Haemorrhagic thalamic stroke is a condition rarely found among all stroke patients. Thalamic stroke can manifest as psychotic symptoms, particularly visual hallucination and rarely as auditory hallucination, which can be misunderstood as functional psychosis. Post-stroke movement disorder is also uncommon after the incidence of stroke. When it does occur, it can also be mistaken as adverse reaction of antipsychotic in patients who are given antipsychotic medication. This is a case of 22-year old male who was presented with auditory hallucinations without any other neurological deficit. He was misdiagnosed as paranoid schizophrenia, and then developed severe muscle rigidity after an increased dose of haloperidol, leading to therapist into thinking that it was an adverse reaction of haloperidol and then stopping his antipsychotics. Later his hallucinations were suddenly gone and his functional level got better with no help of medication. He also admitted a headache since the onset of hallucinations. Due to these unusual events, therapist made a consultation to neurologist and the patient underwent brain CT-scan without contrast, showing area of haemorrhage in the right dorsal thalamus. He was immediately referred to bigger hospital with adequate surgical resources. This case shows the importance of thorough anamnesis in psychiatric patients, especially to rule out any possible organic condition which may underlie psychotic symptoms. Although this type of stroke is uncommon, psychiatrist must be wary of possible neurological disorder and other organic disease in psychiatric patients

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