The unusual case of a woman who heard voices with her own speech impairments in her head after a bicycle accident is examined in a case report in The Lancet. The woman was treated by Dr Daniela Hubl, University Hospital of Psychiatry, Bern, Switzerland, and colleagues.
It was in August 2006 that the 63-year-old woman, with no previous medical history, was brought to the hospital after falling from her bicycle and hitting her head and having a brain bleed, causing her to lose consciousness. Tests showed she had brain damage covering several lobes and an aneurysm, which was clipped, and she underwent a decompressive craniotomy. When she regained consciousness she had paralysis of the right side of her body (hemiplegia), and aphasia – difficulty in comprehending or speaking language due to brain damage involving the areas specialised to those functions.
Four weeks in intensive care substantially improved the paralysis, but the aphasia remained and the woman could only speak and understand single words or short sentences. These symptoms got worse at the end of October 2006, and electroencephalography (EEG) indicated she had epilepsy, which was treated with levetiracetam. Her speech improved to the point where she could again use short sentences. She was aware of her difficulties with speech and comprehension.
In December 2006, she began to hear her own thoughts aloud and also hallucinated the voices of hospital staff – in short sentences and single words, just as with her speech problems. She believed the voices to be external and real. The authors say: “The auditory hallucinations (AH) were thought likely to be caused by epilepsy.”
By Christmas 2006, the patient had been discharged and was only having AH once a week, but she returned to hospital in March 2007 again with serious AH and speech difficulties. EEG showed brain seizures, which were successfully treated. When last seen in June 2007, the patient was no longer suffering AH.
The authors conclude: “AH can arise not only in psychotic disorders, but also in neurological conditions affecting the parts of the brain used to process and monitor speech…..AH are widely thought to derive from inner speech that has been misidentified as coming from outside the self, because of defective monitoring. Our patient’s experiences are consistent with this hypothesis, since her AH had speech deficits that, so far as we could establish, were the same as her own.
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