# Case Report: Acute hallucinations and delusions following an argument, attributed to temporal lobe hypoperfusion

## TL;DR

A 61-year-old man's hallucinations and delusions improved after fluid therapy restored blood flow to his temporal lobe, suggesting hypoperfusion can cause psychiatric symptoms.

## Contribution

Demonstrates that temporal lobe hypoperfusion can manifest as acute psychiatric symptoms and that fluid therapy can lead to recovery.

## Key findings

- Fluid therapy improved the patient's hallucinations and delusions within eight days.
- PWI showed significant recovery in cerebral blood flow and volume in the left temporal lobe after treatment.
- No recurrence of symptoms was observed over five years after stopping anti-psychotic medication.

## Abstract

Hallucinations and paranoid delusions are common psychiatric symptoms that can lead to dangerous behaviors such as self-harm and aggression. The temporal lobe is a key region for emotional processing, and its impairment can cause symptoms such as anxiety, depression, cognitive deficits, hallucinations, and delusions. The main purpose of this article is to discuss the effect of improved hypoperfusion on one patient’s psychiatric symptoms.

A 61-year-old male with untreated hypertension was transferred from the neurology department after developing hallucinations and persecutory delusions following a domestic argument. Perfusion-weighted magnetic resonance imaging (PWI) showed hypoperfusion in the temporal lobe.

Fluid therapy was immediately initiated to improve temporal lobe perfusion, and a low dose of anti-psychotic medication was maintained for a short time. After eight days of fluid therapy, the patient’s hallucinations and delusions had substantially improved. A subsequent PWI revealed a marked improvement in both the relative cerebral blood flow and relative cerebral blood volume in the left temporal lobe. After discharge, anti-psychotic medications were stopped after one month. No recurrence of psychiatric symptoms was observed during a subsequent five-year monitoring period.

The initial appearance of psychiatric symptoms requires vigilance for an underlying organic cause. Emotional agitation can cause insufficient cerebral perfusion in stenotic vessels, and hypoperfusion of the left temporal lobe may present as hallucinations or delusions. PWI and similar methods can help to differentiate organic brain disease from primary psychiatric disorders, and early restoration of cerebral blood flow often correlates with a good prognosis.