A 52-year-old woman from The Hague, Netherlands, visited an outpatient psychiatric clinic and told doctors about hallucinations she had been experiencing since childhood.
When she looked at people's faces, they would transform into the faces of dragons. The dragon faces would also suddenly appear before her eyes, even when no one was around.
The hallucinations have affected her ability to interact with other people. According to the patient, the human faces seemed normal at first, but then they turned black and grew "long, pointy ears and a protruding snout." The skin became reptilian, and there were huge, round eyes in colors like red, yellow, green and blue.
The doctors conducted blood tests and a neurological examination. They also used a brain-scanning technique called an electroencephalogram (EEG). The results all came back normal. But an MRI of the patient's brain found several lesions located near the lentiform nucleus.
Damage to this area of the brain has been associated with cognitive impairments, including problems with memory and attention, which are often linked to schizophrenia.
The lesions were present in the white matter of the brain. They may have been caused by ruptures in small blood vessels in the brain. However, the damage was not recent.
The doctors suspected that the hallucinations were the result of atypical electrical activity in the regions of the brain that process faces and colors, particularly the ventral occipitotemporal cortex, which is located in the back of the brain and helps with object recognition.
The lesions in the woman's brain may have been present since her birth. They could be due to temporary oxygen deprivation right before or after her birth.
It was determined that she suffered from a form of prosopometamorphopsia (PMO), a rare condition that affects the perception of human faces.
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It makes normal facial features appear extremely distorted. Features may look overly large or shrunken; they might droop, extend in different directions, or drift out of position.
Individuals with hemi-prosopometamorphopsia, or hemi-PMO, only see one side of the face being affected. With full-face PMO, the whole face appears distorted.
The patient was prescribed with daily doses of valproic acid, an anticonvulsant that prevents seizures from occurring and alleviates migraines and symptoms of bipolar disorder.
The treatment was successful in managing and reducing the woman's visual hallucinations. But then, she started experiencing auditory hallucinations in her sleep, such as banging sounds.
The doctors switched her to a drug called rivastigmine to take daily. The drug is commonly used to treat symptoms of dementia caused by Alzheimer's disease or Parkinson's disease.
It helped make the woman's auditory hallucinations less frequent, and her visual hallucinations were brought under control.
After three years of this treatment, the woman said that her social life had improved and her work situation was stable. Her case is rare, as only 81 cases of this kind have been described over the past century.
The medical report of this case was published in The Lancet.