A personal observation also makes us favor long-distance connection as a primary site for psychosis. The patient, a 45-year-old woman, had undergone, 15 years before presentation, irradiation for a low-grade glioma in the left inferior temporal lobe. She developed a postradiation leukoencephalopathy, mainly affecting the arcuate fasciculus connecting Broca's and Wernicke's areas. She was admitted for continuous verbal hallucinations in the form of the voice of a child speaking behind her, on her right side. She was so convinced of the existence of the child that she sometimes shouted at “him” during the examination, telling “him” to “shut up.” The symptoms quickly resolved with 5 mg of haloperidol. This clinical vignette fits in well with trait and state functional studies of hallucinations, all showing a reduction in functional connectivity between Wernicke's and Broca's areas.44-46 Moreover, in one study of white matter in schizophrenic patients, fibers seemed to be less well oriented in the arcuate fasciculus of hallucinating patients compared with controls. However, non-hallucinating patients presented with even worse orientation indices, which does not support our view (fractional anisotropy using DTI99).
