ALT 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 true, but this did not help because she had already come to the conclusion that she had “gone mad.” In a state of panic, AB went to see her doctor
![In order to reassure her, I requested a brain scan, explaining in my letter that hallucinatory voices had told her that she had a brain tumour, that I had not, personally, found any 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, on the grounds that there was no clinical justification for such an expensive investigation. It was also implied that I had gone a little overboard, believing what my patient’s hallucinatory voices were telling her. Eventually, after some negotiation, the scan was done in April. The initial findings led to a repeat scan, with enhancement, in May, revealing a left posterior frontal parafalcine mass, which extended through the falx to the right side. It had all the appearances of a meningioma. [Note: cut short because of character limit]](https://pbs.twimg.com/media/FiBMVvtWQAMLDoB.png?name=orig)
ALT In order to reassure her, I requested a brain scan, explaining in my letter that hallucinatory voices had told her that she had a brain tumour, that I had not, personally, found any 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, on the grounds that there was no clinical justification for such an expensive investigation. It was also implied that I had gone a little overboard, believing what my patient’s hallucinatory voices were telling her. Eventually, after some negotiation, the scan was done in April. The initial findings led to a repeat scan, with enhancement, in May, revealing a left posterior frontal parafalcine mass, which extended through the falx to the right side. It had all the appearances of a meningioma. [Note: cut short because of character limit]
ALT AB later told me that when she recovered consciousness after the operation the voices told her, “We are pleased to have helped you. Goodbye.” There were no postoperative complications. The dosage of dexamethasone was halved every four days, and then it was stopped. She was on prophylactic anticonvulsants for six months. Antipsychotic medication was discontinued immediately after the operation, and there was no return of the hallucinatory voices or the delusions which she had expressed. AB telephoned me last Christmas to wish me and family a merry festive season, and to tell me that she had been completely well in the 12 years since the operation. It was this telephone call that brought this case to mind again.
