Imagine looking at your friend’s face and, within seconds, watching it change. The skin darkens, ears stretch into sharp points, and eyes glow an eerie shade of yellow or red. To most of us, this sounds like a scene from a fantasy film, but for a woman in the Netherlands, it was everyday life.
She wasn’t dreaming, nor was she delusional. She was living with a rare neurological condition called prosopometamorphopsia (PMO), which warps the way the brain processes human faces. Scientists have only documented about 80–100 cases worldwide in more than a century, making it one of the rarest known visual disorders.
The woman’s case stood out because the faces she saw didn’t just look “demonic” or “melted,” as others have described. Instead, they transformed into dragon-like creatures, a first-of-its-kind description that gave doctors novel insight into how fragile and unusual our face-recognition system can be.
A Peculiar but Treatable Condition
The woman, then 52 years old, first visited a psychiatric clinic in The Hague after her hallucinations began interfering with her daily life.
She explained that when she looked at people, their faces would slowly morph, skin turning reptilian, ears lengthening, snouts protruding, and eyes shining in unnatural colors. Sometimes, even when no one was around, dragon faces would appear, drifting toward her from walls, sockets, or screens.
Doctors started with standard checks, including blood tests, a neurological exam, and an electroencephalogram (EEG), which measures electrical activity in the brain. The results of all these tests were normal.
However, an MRI scan revealed lesions near the lentiform nucleus, a brain region involved in cognition, memory, and attention. These lesions, in the brain’s white matter (nerve fibers that connect different brain regions), were likely caused by tiny blood vessel ruptures long ago, possibly even at birth, due to oxygen deprivation.
The team theorized that these old injuries disrupted normal signaling between the brain’s ventral occipitotemporal cortex — the area that helps us recognize objects and faces — and other visual circuits. In effect, the woman’s brain was misfiring only when interpreting human faces, not inanimate objects. This explained why she could see furniture or animals normally but couldn’t trust her perception of faces.
Doctors diagnosed her with full-face prosopometamorphopsia. This means the distortions affected the entire face rather than just one side (a variant known as hemi-PMO). For treatment, they first prescribed valproic acid, a drug used for epilepsy, migraines, and bipolar disorder.
This reduced her visual hallucinations but triggered a new problem — loud banging sounds in her sleep. So, they switched her to rivastigmine, a medication normally used in Alzheimer’s or Parkinson’s disease. With this adjustment, her visual symptoms became manageable, the nighttime noises lessened, and within three years, she went back to living a normal life.
PMO Still Remains a Mystery
Cases like this highlight just how mysterious the brain’s face-recognition system is. For most people with PMO, the distortions last only days or weeks. For others, they linger for years. Symptoms often resemble psychosis, which can lead to misdiagnosis and inappropriate treatment.
Yet PMO is not a delusion. Patients know their perception is altered and describe it as a visual glitch, not a belief about reality. That distinction is vital for doctors trying to separate rare visual-processing disorders from psychiatric illnesses like schizophrenia.
Scientists still don’t know exactly why PMO happens. Some patients have brain lesions, strokes, or a history of migraines or epilepsy, while others show no structural changes at all. In the future, researchers hope to use more advanced brain imaging and computer simulations to recreate what PMO patients see, as was done in 2024 for the first time.
Such tools could not only improve diagnosis but also shed light on broader questions, from how we recognize each other to how the brain invents hallucinations.
