The Hallucinations That Predicted Her Brain Tumor

The Hallucinations That Predicted Her Brain Tumor

Picture this: You're at home, reading a book, minding your own business, when BAM! A random voice starts talking to you inside your skull. Is it God? Is it the devil? Or is it your dead grandma watching you disappointed because you married a 5'4" guy? 

Nope, it’s something way weirder. Something way more obscure

This is the true story of HV, the woman whose hallucination led to the diagnosis of her brain tumor.

HV was your classic '60s housewife. She was born in Oui Oui baguette country in the 1940s, moved to the UK, and had a bunch of kids. She was always as healthy as a '60s housewife can be, so she avoided going to her GP like he was a tax collector. In the winter of 1989, she was at home reading some boring ass book when her brain decided: "You know what’s missing? Some good old psychosis!"

The voice was polite, even friendly—like an old Chinese lady who sells dog kebabs. 

Please don't be afraid. I know it must be shocking for you to hear me speaking to you like this, but this is the easiest way I could think of. My friend and I used to work at the Children's Hospital, Great Ormond Street, and we would like to help you.

It was shocking indeed. The woman jumped out of her chair in panic and fell into the fireplace next to her dusty-ahh armchair. HV had heard of the Children's Hospital but did not know where it was and had never taken her kids there because she didn’t believe in “conservative medicine” (A few of her children died of smallpox, but that’s not important). 

This made it all the more frightening for her, and the voice intervened again: “To help you see that we are sincere, we would like you to check out the following”—and the voice gave her three separate pieces of information, which she did not possess at the time. She checked them out, and they were true, but this did not help because she had already come to the conclusion that she had “gone mad.” 

In a state of panic, HV went to see her GP, who referred her urgently to a psychiatric center. The shrink gave her Thorazine- an antipsychotic medication that blocks dopamine receptors in the mesolimbic system of the brain, which is a part of the brain responsible for reward, motivation, and pleasure. It is also responsible for psychotic symptoms like hallucinations. After a few days, the voices vanished. 

HV thought, ‘Great! I’m cured!’ 

Like every normal adult, she celebrated with a cruise vacation with her husband and remaining alive children to the Caribbean. She drank margaritas and Cuba libres, took photos, and yelled at her children for being children. Just as she forced her blue-collar alcoholic husband to recreate the Titanic “I’m flying” scene, the voices suddenly returned:

Return to the street stabbing, tea sipping, bad oral hygiene country immediately! Something is wrong with your brain! And you left the stove on!

She returned to London and saw her psychiatrist again at the outpatient clinic. By this time, the voices had given her an address to go to. HV’s husband, threatened by the fact he might not get any later that day, reluctantly agreed to take her to the address given by one of the voices: the computerized tomography department of a large London hospital. As she arrived there, the voices told her to go in and ask to have a brain scan for two reasons—she had a tumor in her brain and her brain stem was inflamed

In order to reassure her, the neurologist at the department requested a CT scan, explaining to his boss that hallucinatory voices had told her that she had a brain tumor, even though the neurologist found no physical signs suggestive of an intracranial space-occupying lesion, and that the purpose of the scan was essentially to reassure the patient. The request was initially declined (no wonder) on the grounds that there was no clinical justification for such an expensive investigation. 

Eventually, after some negotiation, the scan was done, and the initial findings led to a repeat scan, with enhancement, revealing a left posterior frontal parafalcine mass, which extended through the falx to the right side. It had all the appearance of a meningioma. HV was referred to the consultant neurosurgeon, who weighed the pros and cons of immediate surgery. Just as the neurosurgeon was about to decline her request, she started violently convulsing, and she fell on the floor with all her might, hitting her head in the process. 

She was quickly rushed to another CT scan, where intracranial hemorrhage around the meningioma was confirmed, and the surgeon decided to operate on her.

These were the notes of the operation: “A large left frontal bone flap extending across the midline was turned following a bifrontal skin flap incision. A meningioma about 2.5 by 1.5 inches in size arose from the falx and extended through to the right side. A small area of tumor appeared on the medial surface of the brain. The tumor and the surrounding blood were dissected out and removed completely along with its origins in the falx.

HV later recounted that she heard the voices once again as she was waking up from post-operative anesthesia: “We are pleased to have helped you. Goodbye.” 

Yes, the voices ghosted her just like that one Torta ghosted me after she found out my uncle works at the immigration department. There were no postoperative complications. 

The dosage of dexamethasone, which is a corticosteroid medication used for brain swelling, was halved every four days, and then it was discontinued. HV remained on prophylactic anticonvulsants for six months, and antipsychotic medication was discontinued immediately after the operation.

HV had no recurrence of her psychotic symptoms.

But how could this happen?

Let me explain!

Brain tumors can present with all kinds of symptoms, including visual or auditory hallucinations. In this case, a brain tumor called meningioma caused auditory hallucinations, meaning the patient heard the voices that don’t exist in reality. Meningioma is the most common type of primary brain tumor, representing about 30% of all brain tumors. These tumors develop in the meninges, the three outer layers of tissue located between the brain and the skull, which serve to cover and protect the brain.

Although the majority of meningiomas are benign, these tumors can grow slowly until they are very large if left undiscovered, and, in some locations, can be severely disabling and life-threatening. 

Auditory hallucinations caused by brain tumors are usually found in the temporal lobe of the brain since this part of the brain is responsible for processing sound. Similar symptoms are noted in people suffering from temporal lobe epilepsy.

Another part of the brain that can produce hallucinations is the occipital lobe, where a tumor might cause visual hallucinations by directly pressing on or invading brain areas responsible for sensory processing.

Tumors may also provoke seizures, which can lead to transient hallucinatory experiences, also known as auras, as the brain’s neurons temporarily misfire during seizure activity. 

Increased intracranial pressure from a growing tumor can disrupt overall brain function, while some tumors can alter levels of neurotransmitters like dopamine, serotonin, or glutamate.

HV had a frontal lobe tumor, which rarely causes symptoms like hallucinations and is more likely to cause personality and behaviour changes. There are only a few documented cases where a frontal lobe tumor causes hallucinations, but this is the only case in which hallucination leads to a diagnosis. 

It is important to mention that people can hallucinate various objects and ideas. This case may seem like a divine intervention where the tumor saved the woman’s life, but the truth is not that simple.

In the medical field, there are algorithms and rules for obvious reasons. If we take 100 people who say that their inner voice is telling them that they have a tumor inside their brain, at least one will indeed have a tumor inside their brain.

This doesn’t mean that we have to rush to do a CT or MRI of the brain just because someone is feeling that something is wrong with them. This applies to other diagnostic methods, especially invasive ones. If doctors ran every test for everyone, it would harm the patient because of the unnecessary risks, like ionizing radiation, for example.

This also applies to less harmful diagnostic tests because not every test is perfect, and there is a chance for a test to be false positive, meaning the test showed something is wrong with the patient, but the patient is fine. This leads to overdiagnosing the patient and more invasive and riskier procedures later on. 

For this reason, doctors usually do less invasive tests to prove their suspicions about certain diagnoses and then use further tests if needed.

Even though this is a remarkable case that renders everyone speechless, be wary of overdiagnosing yourself or your patients.

Thanks for reading.