Hearing one's voice in your speech: An unusual case of palinacousis due to acute intracerebral hemorrhage

Introduction: Palinacousis or auditory perseveration is a form of acquired auditory perceptual disorder that occurs rarely due to an acute intracranial process. The condition mimics psychotic hallucination, seizure, or other behavioral disorders, potentially causing management delay. We describe an unusual form of palinacousis resulting from acute lobar intracerebral hemorrhage. Case Report: A 70-year-old right-handed white man with history of hypertension, ischemic cardiomyopathy, and atrial fibrillation on anticoagulation developed a rare form of palinacousis, on which he hears the previous speaker's voice on the current speaker's speech due to right parietal intracranial hemorrhage. Cranial imaging revealed right parietal intracranial hemorrhage likely secondary to cerebral amyloid angiopathy or hypertension. Extensive workup and thorough clinical examination ruled out dementia, psychosis, seizure, or other behavioral disorders. The condition gradually improved without any specific intervention. Conclusions: Abnormality in auditory processing due to intracranial lesions affecting auditory cortical projections causes a variety of symptoms that mimic other conditions such as psychotic hallucinations, and ictal and postictal behavioral changes. Thorough characterization with detailed examination and workup may help in distinguishing one from the other. A rare form of palinacousis may occur after unilateral nondominant parietal lesion. The condition is self-limiting and requires no specific management. Ruling out seizure disorder or psychiatric condition may prevent unnecessary workup and treatment.