Coma alarm dreams

Intensive Care Medicine has published a wonderfully written and vivid account from a teenager who spent time brain injured and hallucinating in an intensive care unit.

The writer describes how he was admitted to intensive care at the age of 15 after suffering a head injury and had intense and bizarre hallucinations which are, as we know now, surprisingly common in critical care patients.

My experience of the time under sedation can be split into two. There was what I could perceive of the real world around me, and then there was my dream world.

In the real world, the most constant feature was sound. I could hear the nurses talking, understanding everything they said. They always spoke their names. They were always kind, conscious I think that I might hear them. They helped me to relax. I could hear the noises of the ward, tones of voices and alarms. The alarms made me tense. I can remember Mum talking to me a lot and Dad reading me ‘The Hobbit’, although I still can’t remember the names of all the dwarves. Mum and Dad’s voices always came from the left.

My other senses were not wholly switched off either. Things were put in my mouth: tubes, sucky things, wet watery pads and a toothbrush. Someone moved my hair about. I felt furry and silky toys placed under my fingers. My brother and sisters had brought a knitted tortoise and a horse for me. My feet were moved about and stretched, which felt really good. I remember that the rolled-up bed sheets were uncomfortable.

Other sensations were less good. The constant, repetitive shining of a bright light in my remaining eye really annoyed me – I am sure I can remember every single time.

Then there was my dreaming. I lived in the dream world nearly all the time and it went on and on. The dreams were vivid, terrifying and very disturbing. There were some good ones but unfortunately for me a lot of really bad ones. I can still remember most of them even now, more than a year since.

At the sound of an alarm, a giant monster appeared with a meat cleaver and pursued me around the sports hall. I had to protect a girl and prevent an army from crossing a river. The whole river and hall were aflame. I was burning from the heat.

In another I had to stop an alarm-driven colossal centipede from crossing a bridge. I could see the shadow of monsters looming towards me behind a curtain. I knew the monsters were there and about to consume me, but I lay transfixed, unable to move, and I remember feeling myself sweating with excruciating fear. I was then on the bridge of a nuclear submarine with maniacs trying to blow up the world, there was a huge explosion. Then it ended.

I was aboard a flying craft. I was there to stop green-coated aliens from creating human missiles. The aliens were forcing people into missile tubes. They were going to drop the human bombs from the aircraft.

Then there was a shape-shifter leopard beast chasing me and my friends. We were working in a fast-food place on a ship. It cornered us, and the Kentucky Fried Chicken sign burst into red lightning.

But I knew when something really nasty was going to happen. I could always hear the same alarm going off. It was a signal for the monsters to appear, for the centipede to attack, for bombs to be dropped, I would be sacrificed…I was very afraid. Tension would build to some hideous climax. Looking back, I suspect the pressure in my brain was causing both the nightmares and the alarm to go off.

I have made a great recovery from my injuries due in large part to the excellent care that was taken of my brain in intensive care. I have been into see the team a few times but I never stay too long. Those alarms still make me feel nervous!

As I noted in a recent article, these sorts of hallucinations were thought to be a distressing but ultimately irrelevant part of recovery but more recent studies suggests that have longer-term psychological impact that can be problematic in its own right.
 

Link to locked article ‘Coma alarm dreams on paediatric intensive care’

Bomb disposal for the brain

New Statesman has an excellent profile of the wise, funny and acerbic neurosurgeon Henry Marsh.

Marsh was the subject of the fantastic 2007 documentary The English Surgeon but he’s now one year away from retirement and has clearly decided that diplomatic responses are no longer a tactical necessity.

The piece also gives a vivid insight into the working life and daily challenges of a consultant neurosurgeon.

It’s also wonderfully written. This is pure joy:

When he finally went to medical school, at the Royal Free Hospital in London, he wasn’t sure about his choice. “I thought medicine was very boring,” he says bluntly. Henry is not a man to refrain from speaking his mind. “I didn’t like doctors. I didn’t like surgeons. It all seemed a bit dumb to me.” In Do No Harm he writes of his revulsion at what much surgery generally entails: “long bloody incisions and the handling of large and slippery body parts”.

But while working as a senior house officer, he observed a neurosurgeon use an operating microscope to clip off an aneurysm – a small, balloon-like blowout on the cerebral arteries that can cause catastrophic haemorrhages. It is intensely delicate work, using microscopic instruments to manipulate blood vessels just a few millimetres in diameter. It is also, as Henry says, like bomb disposal work, in that it can go very badly wrong – with the crucial difference that it is only the patient’s life at risk, not the surgeon’s. If this or any other kind of serious neurosurgery goes right, however, the doctor is a hero. “Neurosurgery,” he smiles, “appealed to my sense of glory and self-importance.”

Marsh has just written an autobiography called Do No Harm which I’ve just started reading. I’m only part way through but it’s already gripping and wonderfully indiscreet.
 

Link to New Statesman profile of Henry Marsh.

A balanced look at brain scanning

Bioethics think tank The Hastings Center have published an excellent open-access report on ‘Interpreting Neuroimages: The Technology and its Limits’ that takes a critical but balanced look at the use of brain scans for understanding the mind.

They’ve commissioned leading cognitive neuroscientists to write chapters including Geoffrey Aguirre, Martha Farah and Helen Mayberg, as well as having a chapter by some legal folks who discuss whether neuroimaging can teach us anything about moral and legal responsibility.

The chapter by the brilliant Martha Farah is particularly good and takes a level-headed look at the critiques of fMRI and is essential reading if you want to get up to speed on what brain scans are likely to tell us about the mind and brain.

The report is all in academic writing but if you’re a dedicated neuroscience fan, it probably won’t pose too much of a problem.

 

Link to ‘Interpreting Neuroimages: The Technology and its Limits’.

Frozen nightmares

The Devil in the Room is a fantastic short film about the experience of hallucinatory sleep paralysis – a common experience that has been widely mythologised around the world.

Sleep paralysis is the experience of being unable to move during the process of waking – when you have regained consciousness but you’re brain has not re-engaged your ability to control your muscles.

The reason the experience has been widely associated with mythological creatures is because in some people it can lead to intense emotions and hallucinations.

The name ‘sleep paralysis’ is a bit confusing because this also refers to normal sleep paralysis – where your brain disengages control of your muscles during REM sleep to stop you ‘acting out’ your dreams.

The film is part of the Sleep Paralysis Project, which has much more about the experience on their website.
 

Link to ‘Devil in the Room’ on vimeo.

Loving you is easy because you’re beautiful

Neuroscape Lab, we salute your next generation of brain visualisation, that looks like something out of a sci-fi film where the director is a bit obsessed with correctly representing the anatomy of the brain.

They describe the visualisation like this:

This is an anatomically-realistic 3D brain visualization depicting real-time source-localized activity (power and “effective” connectivity) from EEG (electroencephalographic) signals. Each color represents source power and connectivity in a different frequency band (theta, alpha, beta, gamma) and the golden lines are white matter anatomical fiber tracts. Estimated information transfer between brain regions is visualized as pulses of light flowing along the fiber tracts connecting the regions.

But honestly, who cares? It’s a glowing rotating brain with golden streaks of light flowing through it.

In fact, after 25 years, science has finally scanned the brain from The Orb’s ambient techno classic ‘A Huge Ever Growing Pulsating Brain That Rules from the Centre of the Ultraworld’.

It’s as if the rave generation stumbled out of life’s warehouse at 7am and ended up being neuroscientists.
 

Link to Neuroscape Lab’s awesome brain visualisation.
Link to the original Orb track (or the classic Orbital remix)

The Society of Mutual Autopsy

The Society of Mutual Autopsy was an organisation formed in the late 1800s to advance neuroscience by examining dead members’ brains and to promote atheism by breaking sacred taboos.

It included some of the great French intellectuals and radicals of the time and became remarkably fashionable – publishing the results in journals and showing plaster-casts of deceased members brains in world fairs.

In October 1876, twenty Parisian men joined together as the Society of Mutual Autopsy and pledged to dissect one another’s brains in the hopes of advancing science. The society acquired over a hundred members in its first few years, including many notable political figures of the left and far left. While its heyday was unquestionably the last two decades of the century, the society continued to attract members until the First World War. It continued its operations until just before World War II, effectuating many detailed encephalic autopsies, the results of which were periodically published in scientific journals.

The quote is from a fascinating but locked academic article by historian Jennifer Michael Hecht and notes that The Society was partly motivated by self-nominated ‘great minds’ who wanted to better understand how brain structure related to personal characteristics.

It was no backwater project and attracted significant thinkers and scientists. Most notably, Paul Broca dissected brains for the society and had his brain dissected by them, despite apparently never joining officially.

Part of the motivation for the society was that, at the time, most autopsies were carried out on poor people (often grave robbed) and criminals (often executed). The intellectual elite – not without a touch of snobbery – didn’t think this was a good basis on which to understand human nature.

Also, these bodies usually turned up at the dead of night, no questions asked, and no one knew much about the person or their personality.

In response to this, the Society of Mutual Autopsy functioned as a respectable source of body parts and also requested that members write an essay describing their life, character and preferences, so that it could all be related to the shape and size of their brain when autopsied by the other members.

There was also another motive: they were atheists in early secular France and they wanted to demonstrate that they could use their remains for science without consideration of religious dogma.

As with most revolutionary societies, it seems to have fallen apart for the usual reasons: petty disagreements.

One person took exception to a slightly less than flattering analysis of his father’s brain and character traits. Another starting flirting with religion, causing a leading member to storm off in a huff.

In a sense though, the society lives on. You can donate your body to science in many ways after death:

To medical schools to teach students. To forensic science labs to help improve body identification. To brain banks to help cure neurological disorders.

But it’s no longer a revolutionary act. Your dead body will no longer reshape society or fight religion like it did in 1870’s France. The politics are dead. But neither will you gradually fade away into dust and memories.

Jennifer Michael Hecht finishes her article with some insightful words about The Society of Mutual Autopsy which could still apply to modern body donation.

It’s “both mundane – offering eternity in the guise of a brief report and a collection of specimens – and wildly exotic – allowing the individual to climb up onto the altar of science and suggesting that this act might change the world”.
 

Link to locked and buried article on The Society of Mutual Autopsy.

A reality of dreams

The journal Sleep has an interesting study on how people with narcolepsy can experience sometimes striking confusions between what they’ve dreamed and what’s actually happened.

Narcolepsy is a disorder of the immune system where it inappropriately attacks parts of the brain involved in sleep regulation.

The result is that affected people are not able to properly regulate sleep cycles meaning they can fall asleep unexpectedly, sometimes multiple times, during the day.

One effect of this is that the boundary between dreaming and everyday life can become a little bit blurred and a new study by sleep psychologist Erin Wamsley aimed to see how often this occurs and what happens when it does.

Some of the reports of are quite spectacular:

One man, after dreaming that a young girl had drowned in a nearby lake, asked his wife to turn on the local news in full expectation that the event would be covered. Another patient experienced sexual dreams of being unfaithful to her husband. She believed this had actually happened and felt guilty about it until she chanced to meet the ‘lover’ from her dreams and realized they had not seen each other in years, and had not been romantically involved.

Several patients dreamed that their parents, children, or pets had died, believing that this was true (one patient even made a phone call about funeral arrangements) until shocked with evidence to the contrary, when the presumed deceased suddenly reappeared. Although not all examples were this dramatic, such extreme scenarios were not uncommon.

This sometimes happens in people without narcolepsy but the difference in how often it occurs is really quite striking: 83% of patients with narcolepsy reported they had confused dreams with reality, but this only happened in 15% of the healthy controls they interviewed.

In terms of how often it happened, 95% of narcolepsy patients said it happened at least once a month and two thirds said it happened once a week. For people without the disorder, only 5% reported it had happened more than once in their life.

Although a small study, it suggests that the lives of people with narcolepsy can be surprisingly interwoven with their dreams to the point where it can at times it can be difficult to distinguish which is which.

If you want to read the study in full, there’s a pdf at the link below.
 

Link to locked study at Sleep journal (via @Neuro_Skeptic)
pdf of full text.