ORIGINALLY WRITTEN: February 2021
DISCLAIMER: I am not a licensed medical professional or neurologist. This post is just based off of research I have personally done in the past.
CONTENT WARNINGS: Detailed Medical Discussion, Detailed Medical Diagrams
It’s made clear throughout the Legion’s quest line that Caesar has a brain tumor which causes him to have seizures that are characterized by an absence in attention.
Ironically, this is my second version of this post because preliminary research made me believe that Caesar was suffering from atypical absence seizures. The game classifies his condition as absence seizures, however based on the research I have done I want to say that this is a misclassification, due to the symptoms shown. The two are very similar and, like I said, I even initially believed that these were absence seizures without that line of dialogue. However, some things don’t add up in my opinion, such as:
NOTE: I was talking with a friend about this post as I was writing it, and we know Caesar’s episodes get worse, with the first being a migraine and massive pain to the actual loss of focal awareness and the statement that it has begun to happen more frequently. The classification and diagnosis of (atypical) absence seizures can very well be valid, as most (especially the Legion) would have limited medical knowledge due to research being lost in the Great War and the fact that the seizures worsen over time. Additionally, canon alludes to Caesar’s closest seeing that he spaces out frequently, meaning he could very well have had been valid and simply worsened over time. More into that later.
For the medical analysis of this post, I’ll be referring to the Epilepsy Foundation's webpage on focal onset impaired awareness seizures.
Let’s start by defining these seizures before detailing his symptoms.
According to the webpage, “ These seizures usually start in one area or group of brain cells, most often in the temporal lobe or frontal lobe of the brain. They can also start in other areas too. ”
Looking at this diagram, also found on the website, we can confirm that the seizure begins within the temporal lobe. Given the fact Caesar’s communication is the most affected during these episodes, we can try to narrow the seizure down to the right temporal lobe.
Typical symptoms of focused onset impaired awareness seizures (especially those that begin in the temporal region) include:
On top of these symptoms, these types of seizures do share similar motor function to atypical absence seizures, which include:
Also on top of these symptoms, in certain circumstances, some focused onset awareness impaired seizures can spread to both sides of the brain, leading to what’s called focal to bilateral tonic-clonic seizures. These seizures have two primary characteristics:
Just to aid in this analysis, here’s a video of all of Caesar’s dialogue.
So now that we know exactly what is happening, or as exactly as we can for someone with zero medical background or training, let’s look at the why.
Anybody can have these types of seizures, however, they are more common in individuals who have had a head injury, brain infection, stroke, or brain tumor.
Knowing that Caesar is confirmed to have a brain tumor in canon, we know that this is the cause. How did Caesar develop a brain tumor?
Let’s dive into that.
According to the Johns Hopkins Medicine website, the most common brain tumors are called meningioma tumors. These tumors make up approximately 30% of all brain tumors, and in most cases where meningioma tumors are present, they are benign (non-spreading). However, analyzing canon dialogue (link provided further down on the post linked above), it can be reasonably assumed that the tumor is spreading.
As for causes though, it’s really unknown.
More often than not, tumors and cancer happen due to genetic changes. Cancer involves the reproduction of cells, which involves the replication of DNA. This could be due to radiation poisoning, and is the most likely bet given the Fallout universe and the Legion’s vehement refusal of chems and modern medicine (re: eating irradiated food and being exposed to radiation on missions without actually curing any of the radiation).
Moving on though-
Meningioma tumors are often found in these portions of the brain, and as we can see they do happen within the temporal lobe:
The main treatment or meningioma tumors, and the treatment that Caesar can be given via the auto-doc, is surgery. Specifically, a craniotomy. This procedure involves the surgical removal of part of the bone from the skull to expose the brain. Specialized tools are used to remove the section of bone called the bone flap. The bone flap is temporarily removed, then replaced after the brain surgery has been done.
Thankfully (depending on who your allegiance is with, of course), it’s hinted at in canon that the tumor doesn’t return, and according to the Johns Hopkins site linked above “ about 90 percent of patients who have had a meningioma have not seen a recurrence if the tumor is removed completely, including the part of the brain lining from which it grew. ”
Needless to say, it’s no surprise why the Courier would need a high medical skill or the assistance of an outsider with medical knowledge (re: Arcade, who can be sold to the Legion to become Caesar’s personal doctor).