The neurologist who could not stop rhyming and rapping

Abstract

.A neurologist, at age 55, developed an irrepressible urge to rhyme after a series of strokes and seizures. His strokes included right posterior cerebellar and right thalamic infarctions, and his subsequent focal-onset seizures emanated from the left frontotemporal region. On recovery, he described the emergence of an irresistible urge to rhyme, even in thought and daily speech. His pronounced focus on rhyming led him to actively participate in freestyle rap and improvisation. This patient's rhyming and rapping may have been initially facilitated by epileptiform activation of word sound associations but perpetuated as compensation for impaired cerebellar effects on timed anticipation.

Keywords: Rhyme; brain; epilepsy; rap; rhythm; vascular cognitive impairment.

FIGURE 1:. Magnetic Resonance Imaging (MR) of the Brain

MRI scan obtained during the patient’s hospitalization for encephalopathy at age 68. The top two images are fluid-attenuated inversion recovery scans, in the axial plane, showing a right posterior-inferior cerebellar hemisphere stroke, a right white matter infarction, and evidence of scattered white matter hyperintensities, some located in the left inferior frontal region. The bottom two images are T2 scans, also in the axial plane, more clearly showing the right cerebellar stroke and the right thalamic stroke.

FIGURE 2:. Fluorodeoxy-Positron Emission Tomography (FDG-PET) of the Brain

FDG-PET scan obtained after recovery from his encephalopathy at age 68. The images are in a the axial plane. The first more ventral scan shows a region of hypometabolism in the right posterior inferior cerebellar hemisphere. The second more dorsal scan shows a right thalamic region of hypometabolism and relatively increased metabolic activity in the striatum.