I cannot picture it in my mind: acquired aphantasia after autologous stem cell transplantation for multiple myeloma
DOI: 10.1093/omcr/omab019
Tags:
Bumgardner, A. L., Yuan, K., & Chiu, A. V. (2021). I cannot picture it in my mind: acquired aphantasia after autologous stem cell transplantation for multiple myeloma. Oxford Medical Case Reports, 2021(5). doi:10.1093/omcr/omab019
Abstract
Aphantasia, the loss of mental imagery, is a rare disorder and even more infrequent when acquired. No previous cases have been identified that were caused by transplant-related treatment. We describe a case of acquired aphantasia in a 62-year-old male with refractory IgG kappa multiple myeloma after receiving an autologous stem cell transplant (ASCT) following high-dose melphalan with a complicated hospital admission. The etiology of aphantasia remains unidentified, but we provide viable explanations to include direct effects from ASCT treatment and indirect effects from transplant-related complications.
Authors
- Adam L Bumgardner1
- Kyle Yuan1
- Alden V Chiu1
What This Study Is About
Aphantasia is the inability to visualize in the mind's eye. It can be present from birth or acquired later, which is rarer; earlier acquired cases often followed direct brain damage such as a stroke. This case report describes a man who lost his imagery during a hospital stay for a stem cell transplant, the first case, the authors say, linked to transplant-related treatment.
How They Studied It
- A single patient: a 62-year-old man with multiple myeloma (a blood cancer) that had not responded to treatment, admitted for a second autologous stem cell transplant, in which his own stem cells were returned after a high dose of the drug melphalan.
- His stay was complicated. On Day 8 he moved to intensive care with fever and no neutrophils (infection-fighting white blood cells); he had a bloodstream infection, a suspected bowel inflammation and, on Day 9, a collapsed lung (pneumothorax).
- Imagery was measured with a modified, 16-question Vividness of Visual Imagery Questionnaire (VVIQ), on which 16 is the lowest score, with follow-up at six months.
What They Found
On Day 9 he began to report an "inability to picture things in my head when I close my eyes." When he tried to see a recent meal or mentally practice his golf putts, he saw only blackness. He scored 16 on the VVIQ, and still 16 the day before he went home on Day 20. At six months he reported mild improvement but not recovery, with a score of 23.
What This Might Mean
The authors list possible causes: the transplant process (a study of 29 patients linked this treatment to later concentration and memory problems), changes in gut bacteria from more than five antibiotics, low blood oxygen from the collapsed lung and the infection, and a psychological cause, given his stress. They judge a brain injury from low oxygen most likely, and a reaction to the stem cell preservative DMSO possible but unlikely. The cause remains uncertain: this is one patient, and no fuller work-up, such as brain imaging, was done; they suggest one for future cases.
One Interesting Detail
Three days after the loss, back from intensive care, he said his imagery was improving because he now saw "constantly morphing shapes" when he closed his eyes. Yet his questionnaire score the day before discharge was still the minimum, 16.
This summary was generated by AI and may contain errors. Always refer to the original paper for accuracy.