Dragon-like Facial Hallucinations Case Study
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Questions and Answers

What type of document is likely represented by the content?

  • A scientific case report or medical publication. (correct)
  • A legal contract outlining patient rights and confidentiality.
  • A philosophical essay on perception and visual disorders.
  • A marketing brochure for a neurology clinic.

The MRI brain scan described in the figure caption reveals what specific finding?

  • Two small white matter lesions in the centrum semi-ovale. (correct)
  • A large tumor compressing the optic nerve.
  • Wide spread cortical atrophy indicative of advanced dementia.
  • Evidence of a recent traumatic brain injury with associated hemorrhage.

Based on the information provided, what is the likely cause of the white matter lesions observed in the MRI?

  • Non-recent microvascular damage. (correct)
  • An acute inflammatory response due to a recent infection.
  • Direct trauma from a specific injury.
  • A congenital malformation present since birth.

What does the presence of references in the content indicate about its nature?

<p>The content is based on existing scientific knowledge and research. (D)</p> Signup and view all the answers

Why is it important to obtain written consent before publishing a case report such as this?

<p>To ensure the patient's privacy and grant permission to share their medical information. (D)</p> Signup and view all the answers

Which brain region was initially suspected to be the source of the patient's visual disturbances, based on EEG findings?

<p>Ventral occipito-temporal cortex (D)</p> Signup and view all the answers

What was the initial pharmacological intervention used to treat the patient's symptoms?

<p>Valproic acid (D)</p> Signup and view all the answers

Why was the patient's medication changed from valproic acid to rivastigmine?

<p>Valproic acid induced auditory sleep starts. (A)</p> Signup and view all the answers

What dose of rivastigmine was effective in managing the patient's symptoms?

<p>3 mg daily (C)</p> Signup and view all the answers

What non-pharmacological intervention was provided to the patient?

<p>Psychoeducation (A)</p> Signup and view all the answers

How long has the patient maintained employment at the same job following treatment?

<p>3 years (C)</p> Signup and view all the answers

Besides aberrant brain activity, what other condition was considered as a possible cause initially?

<p>Peduncular hallucinosis (D)</p> Signup and view all the answers

What positive outcome was reported regarding the patient's interaction with colleagues?

<p>Her interaction with colleagues greatly improved. (B)</p> Signup and view all the answers

What is the primary symptom experienced by the 52-year-old woman in the case report?

<p>Seeing people's faces transform into dragon-like faces and hallucinating similar faces. (C)</p> Signup and view all the answers

Which of the following best describes the patient’s insight regarding her hallucinations?

<p>She attributes her hallucinations to a brain disorder and understands they are not real. (B)</p> Signup and view all the answers

What specific changes did the patient report when actual faces transformed?

<p>Faces would turn black, grow long, pointy ears and a protruding snout, and display reptiloid skin with brightly colored eyes. (C)</p> Signup and view all the answers

Besides prosopometamorphopsia and hallucinations, what other symptom did the patient experience?

<p>A mildly depressed mood. (C)</p> Signup and view all the answers

The patient reported seeing dragon-like faces in various locations. Which of the following is NOT mentioned as a place where she saw these faces?

<p>Appearing on the television screen. (B)</p> Signup and view all the answers

What aspects of the patient's medical history might be relevant to understanding her condition?

<p>A history of birth with a caul, recurrent non-migrainous headaches, urinary tract infections, sensed presence, passage hallucinations and occasional zoopsia. (D)</p> Signup and view all the answers

How did the patient initially interpret her hallucinations during childhood, before understanding them as a neurological issue?

<p>In metaphysical terms as a consequence of being born with a caul. (B)</p> Signup and view all the answers

What led the patient to seek help at the psychiatric outpatient clinic?

<p>The patient was disturbed with her life-long history of seeing people’s faces change. (C)</p> Signup and view all the answers

What initial neurological tests were performed on the patient described in the text?

<p>Neurological examination, blood tests, and electroencephalogram (EEG) (A)</p> Signup and view all the answers

Which brain areas are MOST associated with facial recognition?

<p>Fusiform face area and occipital face area (B)</p> Signup and view all the answers

What did the MRI of the brain reveal?

<p>A few white-matter abnormalities near the lentiform nucleus and in the semioval center (A)</p> Signup and view all the answers

Prior to seeking help from experts what treatment did the patient receive that yielded no improvements?

<p>Citalopram and quetiapine (A)</p> Signup and view all the answers

What was the primary factor that led the patient to seek professional help?

<p>Further deterioration of her symptoms (A)</p> Signup and view all the answers

What is the MOST likely explanation for why prosopometamorphopsia is rarely reported?

<p>Despite the complexity of face processing, it is remarkable that prosopometamorphopsia has been reported only rarely (C)</p> Signup and view all the answers

What can prosopometamorphopsia typically be attributed to?

<p>Structural brain changes or functional disorders (C)</p> Signup and view all the answers

What impact did the patient's difficulty in sustaining stable perception of faces have on her life?

<p>It caused communication problems and recurrent conflicts, leading to frequent job changes (D)</p> Signup and view all the answers

Flashcards

Prosopometamorphopsia

A condition where faces appear distorted or changed.

Hallucinations

Seeing or sensing things that aren't really there.

Zoopsia

Seeing animal-like figures where they don't exist.

Sensed presence

The feeling that someone or something is nearby when you are alone.

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Passage hallucinations

Seeing movement out of the corner of your eye when nothing is there.

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Born with a caul

A thin membrane enclosing a baby at birth.

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Insight (Hallucinations)

Patient's understanding that their perceptions are not real.

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Reptiloid facial features

Describing dragon-like features (long ears, snout, reptilian s) on faces during prosopometamorphopsia.

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Fusiform Face Area (FFA)

Area in the brain mainly associated with face recognition.

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Electroencephalogram (EEG)

A diagnostic test that measures the electrical activity of the brain using electrodes attached to the scalp.

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Etiology of Transient Prosopometamorphopsia

Structural changes or functional disorders that can cause transient prosopometamorphopsia.

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MRI (Magnetic Resonance Imaging)

A brain imaging technique that uses magnetic fields and radio waves to create detailed images of the brain.

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Occipital Face Area

The occipital face area is involved in the early processing of facial features.

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Lentiform Nucleus

A pair of major nuclei deep in the brain that are part of the basal ganglia, involved in motor control, cognition, emotions, and learning.

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Semioval Center

White matter located in the cerebral hemispheres, containing many nerve fibers.

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White Matter Lesions

Areas of damage in the brain's white matter, often due to small vessel disease.

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Centrum semi-ovale

The white matter region of the brain located centrally in each hemisphere.

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Microvascular Damage

Damage to small blood vessels in the brain.

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Written Consent to Publish

The patient gave permission to share their medical details in a publication.

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MRI (brain)

MRI uses magnetic fields and radio waves to create detailed images of the organs and tissues in your body.

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Aberrant Electrophysiological Activity

Abnormal electrical activity in the brain.

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Ventral Occipito-Temporal Cortex

Area in the lower back part of the brain that processes faces and colors.

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Psychoeducation

Psychoeducation involves educating patients about their condition and its management.

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Valproic Acid

A mood-stabilizing medication used to treat various neurological conditions.

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Auditory Sleep Starts

Auditory sleep starts are sudden, loud sounds heard while falling asleep.

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Rivastigmine

Medication used to treat cognitive symptoms.

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Improved Functionality

Improved social interactions and functional abilities.

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EEG

Electroencephalography; a test that detects electrical activity in your brain using small, metal discs (electrodes) attached to your scalp

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Study Notes

  • In July 2011, a 52-year-old woman sought treatment at The Hague psychiatric outpatient clinic.
  • She had a lifelong history of faces changing into dragon-like visages and frequent facial hallucinations.
  • The woman could perceive and recognize actual faces, but after minutes, they turned black, grew pointy ears and a protruding snout, and displayed reptilian skin and huge colorful eyes.
  • These dragon-like faces drifted from walls, electrical sockets, or computer screens, both in the presence and absence of face-like patterns, and in the dark.
  • During her childhood, the faces were not bothersome, but in early adolescence, they became more prominent.
  • She realized that other people did not perceive faces as she did.
  • She became isolated, depressed, and struggled with alcohol abuse for many years.
  • The woman graduated from secondary school, married, had a daughter, and became a school administrator.
  • The patient's difficulty in perceiving faces led to communication problems and recurrent conflicts.
  • She sought professional help only after her symptoms worsened
  • A local psychiatrist prescribed citalopram and quetiapine without improvement.
  • She searched the internet for experts and emailed Prof Oliver Sacks, who referred her to a team in The Netherlands.
  • Her medical history included birth with a caul, recurrent non-migrainous headaches, urinary tract infections, sensed presence, passage hallucinations, and occasional zoopsia.
  • Psychiatric assessment, apart from the hallucinations, prosopometamorphopsias, and a mildly depressed mood, discovered no abnormalities.
  • The patient understood the hallucinatory nature of her perceptions, explaining them as a "brain disorder" and once interpreted it as a result of her birth with a caul.
  • Neurological examination, blood tests, and EEG were normal.
  • An MRI of the brain showed only a few white-matter abnormalities near the lentiform nucleus and in the semioval center.
  • Face recognition is complicated and tied to social functioning, mainly associated with the fusiform face area and the adjoining occipital face area, within the visual network.
  • Prosopometamorphopsia has been rarely reported, first described in 1947 by Bodamer and is usually transient, attributed to structural brain changes/functional disorders like epilepsy, migraine, or eye disease.
  • The patient's visual events were attributed to aberrant electrophysiological activity in the adjacent regions of the brain specialized for face and color in the ventral occipito-temporal cortex despite negative EEG findings.
  • Peduncular hallucinosis was another possibility considered
  • The patient received psychoeducation, ceased previous medication, and started 300 mg of valproic acid daily.
  • She had symptom-free days for the first time but developed an auditory sleep start (loud bangs after falling asleep); valproic acid was changed to 3 mg of rivastigmine daily.
  • Rivastigmine reduced the frequency of auditory symptoms and kept visual symptoms sufficiently and interaction with colleagues improved greatly.
  • An MRI of the brain shows white-matter lesions in the centrum semi-ovale, likely caused by non-recent microvascular damage.

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Case study of a 52-year-old woman experiencing lifelong facial hallucinations, where faces transform into dragon-like visages. The hallucinations caused isolation, depression, and alcohol abuse. This unique case provides insights into visual processing and neurological conditions.

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