Involuntary Vocalisations and a Complex Hyperkinetic Movement Disorder Following Left Side Thalamic Haemorrhage

Abstract

A variety of involuntary speech phenomena as for example palilalia have been described as consequences of neurological disorders. Palilalia is the involuntary repetition of syllabels, words and phrases in ongoing speech. We describe a 73 year old woman who suffered from a hypertensive thalamic haemorrhage. MRI revealed that the lesion was predominantly located within the pulvinar, extending to the lateroposterior thalamic nuclei and to the pretectal area with possible involvement of the medial geniculate body. Few months after the event she developed involuntary vocalisations with whole words and meaningless syllables being rapidly reiterated. In contrast to typical palilalia these vocalisations were not meaningfully related to the ongoing speech of the patient. In addition, the patient developed a complex hyperkinetic movement disorder with right-sided painful hemidystonia and bilateral clonic jerks and a right-sided postural tremor.

Palilalia, echolalia, and echopraxia–palipraxia as ictal manifestations in a patient with left frontal lobe epilepsy

“…Palilalia or echolalia has been associated with various disorders involving cortical or subcortical structures, including autism, Alzheimer’s dementia, Tourette syndrome, Parkinson’s disease, and cerebrovascular diseases (Rubens, 1975; Bogousslavsky et al., 1985; Ackermann et al., 1989; Duffy, 1995; Dietl et al., 2003; Christman et al., 2004). However, these unique behaviors have seldom been reported to be associated with epilepsy disorders.…”

“…Palilalia is an unsolicited reiteration of utterances recognized as a kind of motor perseveration involving the speech mechanism, frequently occurring with stereotypic prosody, accelerated rate, elevated pitch, or decreasing volume (palilalia aphone), whereas echolalia is defined as involuntary repetition of others’ utterances (Duffy, 1995; Dietl et al., 2003; Christman et al., 2004).…”

“…Magnetic resonance imaging revealed encephalomalacia on the left superior frontal gyrus and ictal single photon emission computed tomography showed hyperperfusion just above the lesion, corresponding to the left supplementary motor area (SMA), and subcortical nuclei. This result suggests that the neuroanatomic substrate involved in the generation of these behaviors as ictal phenomena might exist in the SMA of the left frontal lobe.Palilalia is an unsolicited reiteration of utterances recognized as a kind of motor perseveration involving the speech mechanism, frequently occurring with stereotypic prosody, accelerated rate, elevated pitch, or decreasing volume (palilalia aphone), whereas echolalia is defined as involuntary repetition of others' utterances (Duffy, 1995;Dietl et al, 2003;Christman et al, 2004).Although rarely reported, repetitive speech behaviors such as palilalia and echolalia have occurred as ictal or postictal manifestations in seizure disorders. However, the neuroanatomic correlates of those speech behaviors as ictal phenomena have not been determined.We present a case with ictal palilalia, echolalia, and echopraxia-palipraxia arising from the left frontal lobe, which was successfully documented by video-electroencephalography (EEG) monitoring and neuroimaging modalities.…”

The spectrum of involuntary vocalizations in humans: A video atlas

“…In patients with typically advanced parkinsonism, palilalia may also be observed either irrespective of their medication status or in association with peak doses of levodopa and as a side effect of bilateral stereotaxic thalamotomy, most likely as the effect of lesions . Focal brain lesions, typically affecting thalamic and/or midbrain structures, may also lead to the expression of palilalic behaviors . A family with extensive intracerebral calcification was reported to present palilalia, and indeed patients with Fahr syndrome, an etiologically heterogeneous disorder, will often present this clinical sign.…”

“…76 Focal brain lesions, typically affecting thalamic and/or midbrain structures, may also lead to the expression of palilalic behaviors. 34,60,62,[76][77][78][79][80][81][82][83][84][85] A family with extensive intracerebral calcification was reported to present palilalia, 86 and indeed patients with Fahr syndrome, an etiologically heterogeneous disorder, 87 will often present this clinical sign. Further, palilalia was reported as ictal, 88 autoimmune, 89 and drug-induced phenomenon (eg, with clozapine 90 or cefepime 91 ).…”