Neurological dreams

When I was struggling with anxiety and constant panic attacks, I always noticed that I would get dreams involving one central theme the night before the attack would happen: weight, or having some sort of heaviness imposed upon me. As I tried to sleep after fighting worries enveloping me and thousands of horrible imaginary scenarios playing in my brain, I would often dream of having someone stepping on my chest with their heavy boots, or having to carry a heavy load while someone would stand on it, thus making it heavier. I reckoned it is pretty much understandable, seeing that panic attacks would often cause me an intense, heavy chest pain even long after the attack stops. After I recognised the patterns of my dreams, I decided that I would trust them and serve as a forewarning to navigate my day prior to an impending panic attack. I was often curious of these ‘warning’ and patterns, but I never got around to finding out about them much.

I just recently got a book of essays written by neurologist Oliver Sacks, of whose writing I love so much I could hug them to sleep. The book is called Everything In Its Place: First Loves and Last Tales, and it is full of neurological case histories and human behaviours written so thoughtfully without losing his own perspective of a neurologist’s. One essay called Neurological Dreams — which is, of course, about dreams serving as a warning about the state of your body and mind — caught my attention.

However dreams are to be interpreted — the Egyptians saw them as prophecies and portents; Freud as hallucinatory wish fulfillments, Francis Crick and Graeme Mitchison as “reverse learning” designed to move overlords of “neural garbage” from the brain — it is clear that they may also contain, directly or distortedly, reflections of current states of body and mind.

Thus it is scarcely surprising that neurological disorders — in the brain itself or in its sensory or autonomic input — can alter dreaming in striking and specific ways. Every practicing neurologist must be aware of this, and yet we rarely question patients about their dreams. There is virtually nothing on this subject in the medical literature, but I think such questioning can be an important part of the neurological examination, can assist in diagnosis, and can show how sensitive a barometer dreaming may be of neurological health and disease.

Some patients with migraine dream of ‘auras’:

Patients might dream of phosphenes or zigzags, of expanding scotoma or of colours or contours that wax and then fade. Their dreams might contain visual field defects or hemianopia, or more rarely, the phenomenon of “mosaic” or “cinematic” vision.

The phosphenes of migraine are often dreams of as fireworks displays, and one patient of mine sometimes embedded his nocturnal migraine auras in dreams of a nuclear explosion. He would first see a dazzling fireball with a typically migrainous, irisdiscent zigzag margin, coruscating as it grew, until it was replaced by a blind area (or scotoma) with the dream round its edge. At this point he would usually wake with a fading scotoma, intense nausea, and an incipient headache.

Patients may sometimes dream of the onset of a disease before it physically manifests:

… one patient of mine, with an angioma in his occipital lobe, knew that if his dreams were suddenly suffused with a red colour, if they “turned” red, he was in for a seizure.

A woman whom I described in Awakenings was stricken with acute encephalitis lethargica in 1926 and had a night and groteque and terrifying dreams about one central theme: she dreamed she was imprisoned in an inaccesible castle, but the castle had the form and shapte of herself. Her family had difficulty waking her the next morning, and when she awoke there was intense consternation: overnight, she had become parkinsonian and catatonic.

A personal account of Sacks’ shows that sometimes dreams could solve the very motor-neural problem the brain was confronted with:

While recovering from a leg injury, I had been told it was time to advance from using two crutches to just one. I tried this twice, and both times fell flat on my face. I could not consciously think how to do it. Then I fell asleep and had a dream in which I reached out my right hand, grabbed the crutch that hung over my head, tucked it under my right arm, and set off with perfect confidence and ease down the corridor. Waking from the dream, I reached out my right hand, grabbed the crutch that hung over the bed, and set off with perfect confidence and ease down the corridor.

It is very interesting that these accounts of dreams could give an insight into the state of bodies and minds of patients, of sometimes we otherwise would also overlooked. I also think that it is important for us not to invalidate any dreams or nightmares we have, especially if they affect our waking days, because these dreams might tell us something we don’t know.


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  1. Pingback: Panic! in the supermarket aisle – Two Kinds of Intelligence

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