In the winter of 1984, a healthy woman living in Britain was reading at home when a voice spoke inside her head. Over the following months, the voices told her she had a brain tumor and sent her to the scanning department of a large London hospital. Her psychiatrist found no physical signs of a tumor. A scan found one anyway.
The case, published in the BMJ in December 1997 by consultant psychiatrist Ikechukwu Obialo Azuonye, has been retold again this summer and resurfaces online every few years. Its revival lands in the middle of a live practical question: when someone develops psychosis for the first time, should a brain scan be routine?
The Voices Offered Proof, Then a Diagnosis
Azuonye's patient, identified only as AB, was born in continental Europe in the mid-1940s and settled in Britain in the late 1960s. She rarely saw a doctor. The first voice told her not to be afraid and said that it and a friend used to work at Great Ormond Street children's hospital and wanted to help her.
To prove its sincerity, the voice gave her three pieces of information she did not know. She checked them, found them true, and concluded she was losing her mind. Azuonye diagnosed a functional hallucinatory psychosis and prescribed the antipsychotic thioridazine, and the voices faded within a couple of weeks.
They came back while she was on holiday abroad and still taking the drug, urging her to return to England for treatment. Back in London, the voices gave her an address. Her husband drove her there to reassure her it was all in her mind. It was the CT scanning department of a large hospital, and the voices told her to ask for a scan because she had a brain tumor and an inflamed brain stem.
A Scan Request That Was First Turned Down
Azuonye requested a scan mainly to reassure her and said so in his referral letter, noting that he had found no physical signs of a mass. The request was initially declined as clinically unjustified for such an expensive test, and he wrote that colleagues implied he had gone too far in taking the voices seriously.
After negotiation, a scan in April 1984 and a repeat scan in May revealed a mass arising from the falx, the fold of tissue that separates the brain's two hemispheres, with all the appearances of a meningioma. The neurosurgeon noted that she had no headache or other focal neurological deficit. Surgeons removed the tumor, about 2.5 by 1.5 inches, that May.
AB later told Azuonye that when she woke from surgery, the voices said they were pleased to have helped and said goodbye. Her antipsychotic was stopped, the voices never returned, and when she phoned him 12 years later, she had been completely well. The report describes no findings related to the brain stem claim.
Azuonye called it "the first and only instance I have come across" of voices behaving this way. When he presented the case at a conference, some attendees read it as telepathy, while others suspected she had invented the story to get free treatment, which Azuonye rejected because she had lived in Britain for 15 years. A third group offered a more ordinary explanation: a tumor that large may have produced a vague sensation that fed her fear, with half-forgotten knowledge about hospitals resurfacing in the hallucinations. As a single case, it cannot establish any mechanism.
Routine Scans Rarely Change Care in Young Adults
Meningiomas pressing on the frontal lobes can grow large while producing little beyond gradual changes in personality or thinking, as the authors of a report on two such patients noted. Both first came to psychiatrists with what looked like depression. The harder question is how often routine imaging finds something that matters.
A JAMA Psychiatry meta-analysis pooling 12 studies and 1,613 people with first-episode psychosis found some abnormality on 26.4 percent of MRI scans and a clinically relevant finding in 5.9 percent. About 18 people needed to be scanned to find one. Tumors were rare, roughly one per 1,000 scans. The authors concluded that their results support offering MRI to everyone presenting with first-episode psychosis.
A study in BMC Psychiatry published in February found a lower yield in younger patients. Researchers at the University Hospital of Psychiatry Zurich reviewed records of 812 adults aged 18 to 40 admitted with a first psychotic episode over a decade. The hospital aimed to scan everyone, yet only 421 had an MRI; in a one-year sample, most unscanned patients had asked to leave early or declined the test. Of the scans, 20 percent showed abnormalities, most often white matter changes. Only five patients, or 1.2 percent, had findings that changed their diagnosis or treatment, including one case of multiple sclerosis and one of HIV encephalopathy. A benign tumor found in one patient was not considered the cause of the psychosis.
The team estimated a cost of about $80,000 for each finding that changed care. The study was retrospective, drew on a single hospital and did not systematically record which patients had neurological warning signs.
Guidelines Still Split on Who Gets Scanned
According to the Zurich team, Germany's schizophrenia guideline recommends MRI for everyone with a first psychotic episode, while Britain's NICE and Choosing Wisely Canada advise imaging when an organic cause is suspected. The researchers suggested prioritizing scans for people with neurological symptoms, atypical features, treatment resistance or other red flags. In three of their five treatment-changing cases, a separate reason for imaging already existed.
AB had no such red flags, which is part of why her story still grips readers. It is also a single report from four decades ago, and new hallucinations are far more often tied to psychiatric illness, substance use or other medical conditions than to tumors.
Anyone with new hallucinations, especially alongside headaches, seizures, weakness, confusion or personality change, should be evaluated promptly by a clinician, who can decide whether imaging is warranted.
Key Questions Answered
What happened in the BMJ case?
In 1984, a woman began hearing voices that eventually told her she had a brain tumor. A scan found a meningioma, surgeons removed it, and the voices stopped for good.
Did the voices actually diagnose the tumor?
No one can say. Her psychiatrist found no physical signs, and some colleagues suggested she may have sensed something was wrong. A single report cannot prove a mechanism.
Can brain tumors cause psychiatric symptoms?
Sometimes. Frontal meningiomas and other tumors can present with changes in mood, behavior or perception, but most hallucinations have psychiatric, substance-related or other medical causes.
How often does a brain scan change care after a first psychotic episode?
A 2023 meta-analysis put the figure near 6 percent. A 2026 Zurich study of adults aged 18 to 40 found 1.2 percent.
Should everyone with new psychosis get an MRI?
Guidelines disagree. Germany recommends routine MRI, while Britain and Canada favor scanning when red flags suggest an organic cause.
What should someone with new hallucinations do?
See a clinician promptly, especially if symptoms come with headaches, seizures, weakness or confusion. The clinician can judge whether tests or imaging are needed.
