Postural hallucinations? An unusual presentation of anaemia

The case of a 14 year old girl is reported, referred to Child Psychiatry with tearfulness and possible auditory hallucinations. Closer questioning revealed a history of low energy, sleeping excessively without refreshment, exertional dyspnoea, and poor growth. Psychologically, there was no evidence of low mood or negative cognitions despite the inexplicable tearfulness. Detailed enquiry revealed the "hallucinations" to be "whooshing" noises in her ears precipitated by standing. She was found to have a haemoglobin level of 55 g/l, attributed to a combination of poor diet and menorrhagia.Periodic, anaemic, cerebral hypoxia could be proposed to be the root of most, if not all, of the symptoms, illustrating the importance of marrying physical and psychological history taking with suitable investigations for an eminently treatable condition.