Treatments

Ghost In The Brain: An 'Apparition Hemorrhage'

When EMTs brought the 68-year-old man to the Boston hospital, he was in a deep coma. Suspecting a brain hemorrhage, doctors ordered a CT scan and were startled by what they saw. The New England Journal of Medicine reproduces the picture in its current issue, and we feature it here with their permission.

A CT scan shows a ghostly brain hemorrhage. i i

hide captionA hemorrhage in an elderly man's brain revealed itself in a startling way.

The New England Journal of Medicine (c)2009
A CT scan shows a ghostly brain hemorrhage.

A hemorrhage in an elderly man's brain revealed itself in a startling way.

The New England Journal of Medicine (c)2009

After the scan showed a massive hemorrhage, surgeons decided there was nothing they could do to save the man's life, and his family decided to withdraw respirator care. He died shortly after.

We talked about the spectral image with neurologist Joshua Klein of Brigham and Women's Hospital, who was involved in the case. Here's an edited version of our conversation.

What did the image look like to you?
To me it looked like a ghost. That's exactly what I thought it was. At first I was thinking, "Is this the angel of death?" I was showing it to my colleagues. They were calling it an "apparition hemorrhage."

Apparition hemorrhage? Is that a medical term?
That was a new-coined term. It's not a real thing. We see many hemorrhages all the time. It's just a very unusual thing to see one take the shape of something...something so human. It was an image that kept coming into my mind.

Have you ever seen anything like this before?
I've never seen one in the shape of a ghost before. There's actually a long tradition in radiology of naming things after real objects to describe what they look like. Different types of food or shapes of animals, things like that.

What are some examples?
One of the very old ones is when you look at the spine from an oblique view, sort of a diagonal view, what you see ... is this pattern that takes the shape of a Scottie dog. It's still used to this day to teach anatomy—the different parts of the vertebral column.

Given the fact that the man was about to die, doesn't the image seem almost poetic? I think it is in some way. It did seem like it was rising out of the brain in a very non-medical way. It just made me keep thinking about it. I think the fact that they've decided to publish it around Halloween is also interesting.

Did the family ever see it?
I haven't contacted the family. In cases like this, where there's no possibility of identifying the patient based on the scan, there's typically no reason to let the family know.

Did you weigh the pros and cons of imparting this kind of information to them? I did, actually. And in the end, I decided that it's certainly not something I would have shown them the night of the incident. I would have shown them if they had asked.

Is that because this might have been something that could haunt them, as it were.
Yes, I think it's a very interesting question. In this particular case, I'm not sure it would have had any positive impact.

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