(PO-159) (PO-159) Memoirs of Mattress Man: a tale of an unusual presentation of tactile hallucinations due to spinal cord compression

Background:

Hallucinations can be found in various psychiatric and neurologic disorders. Tactile hallucinations are commonly associated with substance intoxication or amputations (in the case of phantom limb pain) but they also can be caused by spinal cord pathology (Siddall, 1999). In this case, a patient presenting with tactile hallucinations (TH) was found to have severe spinal stenosis.

Case Presentation:

Mrs. C is a 70-year-old female who presented to the emergency department due to aphasia and hallucinations. Psychiatry was consulted due to new-onset TH that persisted despite resolution of aphasia and visual hallucinations. She reported that she felt like someone was touching her from beneath the bed, which she referred to as “Mattress Man.” Patient also described TH as being painful and sharp like a needle. She indicated that TH were located below her waist anywhere the mattress contacted her body. She became so distressed by her symptoms that she frequently asked staff to check under her bed and also requested a new mattress. Psychiatry recommended initiating haloperidol due to concern for lingering delirium due to acute kidney injury, possible urinary tract infection, polypharmacy and hypothyroidism. Patient reported benefit from haloperidol, however TH persisted despite medication titration and intact attention and awareness. After literature review of a case study of TH in a patient with syringomyelia, psychiatry recommended spinal imaging for further evaluation of patient’s symptoms (Wong, 2015). MRI spine demonstrated severe spinal stenosis at T12-L1 with compression of the conus medullaris, which required surgical repair. She was evaluated on post-operative day 1 and noted less frequent TH, which continued to improve until hospital discharge.



Discussion:

Previous studies have linked the presence of tactile hallucinations with syringomyelia or spinal cord injuries (Siddall, 1999; Wong, 2015). In this case, a patient with no previous psychiatric history developed TH in the setting of various medical comorbidities. Initially, there was concern for delirium however due to persistent symptoms with antipsychotic treatment, the pattern of symptom distribution as well as intact sensorium, there was concern for an underlying neurological cause for her symptoms. Spinal imaging was recommended which demonstrated severe spinal stenosis requiring surgical repair with improvement in hallucinations post-operatively.



Conclusion:

Hallucinations can be present in a variety of medical settings. Patients presenting with TH should be screened for possible neurological etiologies including spinal cord pathology.



References:
1. Siddall, P J, and J McClelland. “Non-painful sensory phenomena after spinal cord injury.” Journal of neurology, neurosurgery, and psychiatry vol. 66,5 (1999): 617-22. doi:10.1136/jnnp.66.5.617

2. Wong, T, and W K Lee. “Tactile hallucination in a case of syringomyelia.” The Journal of neuropsychiatry and clinical neurosciences vol. 27,1 (2015): e70. doi:10.1176/appi.neuropsych.13110349