Earlier this year, a Canadian tourist became the first known civilian to exhibit symptoms consistent with a mysterious affliction previously only seen in U.S. and Canadian diplomats, dubbed “Havana syndrome” by researchers that leaves its victims with a range of neurological impairments and effects. Although speculation as to the cause behind this strange affliction continues to develop, the researchers studying the Canadian tourist’s case believe that she was inadvertently exposed to a toxic pesticide known to cause neurological damage.

This phenomenon began affecting embassy workers stationed in Havana in 2016, with at least 24 members with the American embassy reporting a range of concussion-like symptoms that included hearing loss, headaches, nausea, and tinnitus. A number of those affected also showed physical signs of brain swelling and concussions, and had difficulty with mental concentration and common word recall.

It was initially speculated that the effects were caused by an attack by a sonic weapon of some sort, with many of the patients reporting strange audio phenomena shortly before their symptoms set in, with many having heard a high-pitched chirp or grating metal sound; others experienced a low-frequency hum instead. These sounds were reportedly strong enough to rouse some of the patients from their sleep, yet others nearby apparently were unable to hear the sounds, indicating that the sounds may have been internally-generated symptoms, rather than part of the case of their ailments.

The diplomats showed signs of physical damage in brain scans, indicating that the effect didn’t stem from a psychological problem, with damage to the white matter tracts in the patients’ brains showing up in medical scans. This factor excluded sonic weapons as a potential culprit—sound waves are not capable of causing such damage to specific brain structures while leaving the surrounding tissue untouched—leading to the belief that this phenomenon might be caused by microwave-based surveillance equipment, due to a similarity with the symptoms experienced by U.S. embassy workers in Moscow. Havana syndrome also proved to not be confined solely to Cuba, with several staff members of the Consulate General of the United States in Guangzho, China, suffering similar symptoms.

This new case of a civilian suffering from the same symptoms is the first known instance of Havana syndrome occurring outside of U.S. or Canadian diplomatic staff: about two hours before departing Havana Airport the 69-year-old Canadian woman began to develop “generalized weakness, increased sweating, severe nausea, and vomiting” symptoms, with her condition continuing during her flight home. “In flight, she had lethargy, vomiting, and urinary incontinence,” according to the report, published in the Journal of the American Medical Association.

Upon arrival, the woman was rushed to hospital where she was described as “stuporous” and in need of intubation; however, a CT scan of her brain showed that both of her globus pallidi, sections on either side of the brain that control voluntary movement, showed up denser than normal. She regained consciousness a few hours later, but remained disoriented, with her facial muscles continuing to twitch, and experiencing difficulty in controlling her body movements.

Although the report doesn’t mention discovering the presence of the substance, the researchers diagnosed her with having been poisoned with an organophosphate-based compound, pointing to a “constellation of signs and symptoms” that coincided with heavy exposure to that class of chemicals. Typically used as an insecticide, organophosphates are also used for medical purposes, and can be weaponized as nerve agents. The researchers were unsure as to how the patient was exposed to an amount high enough to produce the severity of the symptoms suffered; typically, this level of exposure would only occur as part of one’s occupation, such as a farmer working with organophosphate pesticides, or the direct ingestion of such substances.

The Cuban government is currently conducting an “aggressive insecticide fumigation” program in order to prevent Zika outbreaks, according to the researchers. “The patient was the only one in her travel group to purchase and consume a sandwich (ham, cheese, lettuce, and mayonnaise) and bottled water at the airport, about 30 minutes before symptom onset,” they added: were the ingredients of the sandwich inadvertently contaminated with this toxic chemical?

Unfortunately, the patient continues to suffer from the effects of this phenomenon: at a checkup five months after she was first hospitalized, it was found that she had lasting neurological effects. She reported having lost 18 kilograms (39.7 lbs) due to anorexia, with “daily headaches, insomnia, impaired concentration and memory, tinnitus, and unsteadiness” with frequent numbness in her hands; she also reported a shortened attention span, with impaired executive function and memory.

“She failed to complete testing for spatial working memory and decision-making quality; both were found to be significantly impaired among Canadian diplomats with suspected acquired neurotoxicity secondary to [organophosphate] poisoning,” according to the report. Indeed, while many of the diplomats that experienced Havana syndrome have since recovered, there are others that appear to be suffering permanent neurological damage, unable to return to work due to their symptoms.

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