Intracranial hypertension after MECT: successful transition to rTMS for refractory auditory hallucinations: a case...

A 21-year-old female patient with schizophrenia, whose primary symptom was refractory auditory hallucinations, developed intracranial hypertension syndrome following her first session of modified electroconvulsive therapy (MECT), presenting with severe headache, projectile vomiting, diplopia and meningeal signs. She subsequently received 1 Hz repetitive transcranial magnetic stimulation (rTMS) applied to the left temporo-parietal cortex with each session delivering 1,500 pulses at 74% of the resting motor threshold. Her auditory hallucinations diminished markedly 3 days after completing rTMS and resolved completely 1 week later, accompanied by improved social functioning. No recurrence was observed during 3 weeks of follow-up. This case primarily demonstrates that rTMS may represent a safe and effective alternative for patients with refractory auditory hallucinations who are intolerant to MECT. It serves as a clinical reminder to maintain vigilance for elevated intracranial pressure following MECT, particularly in patients with a history of migraine.