# When the Music Comes From the Brain: A Rare Case of Auditory Seizures Secondary to a Right Temporal Lobe Arteriovenous Malformation

## TL;DR

A 59-year-old man experienced unusual auditory hallucinations caused by a brain AVM, which was treated with medication and surgery.

## Contribution

This paper presents a rare case linking auditory seizures to a right temporal lobe AVM.

## Key findings

- The patient's auditory hallucinations were linked to a right temporal arteriovenous malformation.
- Treatment with antiepileptic drugs and stereotactic radiosurgery reduced AVM visibility and seizure frequency.
- Generalized seizures were controlled, but auditory seizures were only partially controlled post-treatment.

## Abstract

Focal seizures with subjective auditory phenomena, known as auditory seizures, are uncommon and can include simple to complex auditory hallucinations. We present a case of a 59-year-old man who presented with motor and non-motor seizures. He had a four-month history of hearing things resembling continuous metallic sounds, pennies dropping into a bank, persistent music after radio cessation, and the sound of a passing train. Brain MRI showed multiple serpiginous flow voids in the right temporal lobes, consistent with an arteriovenous malformation that was confirmed eventually with a diagnostic brain angiogram. The etiology of the seizures was related to a structural lesion in the setting of a right temporal arteriovenous malformation (AVM). Treatment with 2000mg of levetiracetam twice daily and 300mg of oxcarbazepine twice daily improved symptoms, and subsequent stereotactic radiosurgery ablation successfully treated the AVM. Post-treatment MRI showed reduced visibility of parasitized vessels, with controlled generalized seizures but partial control of auditory seizures.