Thread by @WillRinehart

The most interesting medical case I have ever heard:

"A previously healthy woman began to hear hallucinatory voices telling her to have a brain scan for a tumor. The prediction was true; she was operated on and had an uneventful recovery."

This story is amazing... 🧵

This story comes from the December 1997 issue of BMJ Clinical Research, and is titled, "A difficult case: Diagnosis made by hallucinatory voices" by Dr. Azuonye.

It is something, so strap in.

Born in continental Europe in the mid-1940s the patient, who is called AB, settled in Britain in the late 1960s. After a series of jobs, she got married, started a family, and settled down to a full-time commitment as a housewife and mother in the London area.

She rarely went to her general practitioner as she enjoyed good health and had never had any hospital treatment. Her children had also been in good health.

In the winter of 1984, as she was at home reading, she heard a distinct voice inside her head.

The voice told her, “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.”

AB had heard of the Children’s Hospital but did not know where it was and had never visited it.

Her children were well, so she had no reason to worry about them. 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 all true.

Still, she had already come to the conclusion that she had “gone mad.”

In a state of panic, AB went to see her doctor, who referred her to Dr. Azuonye.

He saw her at the psychiatric outpatient clinic and diagnosed her with a functional hallucinatory psychosis.

The doctor offered general supportive counseling as well as medication with thioridazine.

To her relief, the voices inside her head disappeared, and she went off on holiday.

While she was abroad, and still taking the thioridazine, the voices returned.

They told her that they wanted her to return to England immediately as there was something wrong with her.

She returned to London and after she arrived, the voices gave her an address.

Reluctantly, and just to reassure her that it was all in her mind, her husband took her by car to the address. It was the computerized tomography department of a large London hospital.

Tomography is a technique for displaying a cross-section of a body.

When she arrived there, the voices told her to go in and ask to have a brain scan for two reasons: she had a tumor and her brain stem was inflamed.

Because the voices had told her things in the past that had turned out to be true, AB went back to Dr. Azuonye.

Dr. Azuonye requested a brain scan, explaining that hallucinatory voices had told her that she had a brain tumor.

The request was initially declined and it was also implied that the doctor had gone a little overboard.

Eventually, after negotiation, the scan was done in April. The initial findings led to a repeat scan, revealing a left posterior frontal parafalcine mass, which extended through the falx to the right side.

It had all the appearances of meningioma, a tumor.

The consultant neurosurgeon to whom I referred AB noted the absence of headache or any other focal neurological deficits related to this mass, and discussed, with AB and her husband, the pros and cons of immediate operation.

In the end, it was agreed that they were going to proceed with an immediate operation.

AB’s voices chimed in. They were fully in agreement with that idea.

These were the notes of the operation, carried out in May 1984: “A large left frontal bone flap extending across the midline was turned following a bifrontal skin flap incision. Meningioma about 2.5” by 1.5” in size arose from the falx and extended through to the right side...”

AB later told the doctor that when she recovered consciousness after the operation the voices told her,

“We are pleased to have helped you. Goodbye.”

There were no complications.

Twelve years pass. Around Christmas time, AB calls up Dr. Azuonye to wish him a happy holiday season.

The doctor had completely forgotten this story, so he wrote it all up and presented it at a conference, which AB attended.

The crowd was split.

One group he called X-philes rejoiced since it was a clear instance of telepathic communication from two well-meaning people who had, psychically, found that AB had a tumour and sought to help her.

The X-phobes had a very different formulation.

According to the X-phobes, AB had been given the diagnosis of a brain tumour in her original country and wanted to be treated free under the NHS. Thus, the convoluted tale.

Yet another group argued, “She must have felt
something.”

This group suggested that a funny feeling in her head had led her to fear that she had a brain tumour. That fear had led to her experience of hallucinatory voices.

She may have unconsciously taken in more information about various hospitals than she realized.

The voices expressing satisfaction with the outcome of her treatment were her own mind expressing its relief that the emergency was over. And the total
disappearance of psychiatric symptoms after the
removal of the tumour showed that these symptoms
were at least related.

Regardless of the cause, I'd like to believe this story happened as the good doctor said.

The real world is much stranger than we can imagine.