Friday, August 5, 2011

Think, think... Brain blast!

Okay, it's time for all you armchair neurologists to help me solve a particularly difficult case. The following is, without any changes, the admitting note from Dr. Hospital, who asked for my help on this challenging case:

"88 year old male who woke from a nap with bilateral visual loss. Symptoms resolved when he
opened his eyes. We will admit for stroke work-up, and consult neurology."

44 comments:

terri c said...

OhfertheloveofGod. It wasn't April 1 was it?

Anonymous said...

Blepharectomy.

JoAnna said...

Please tell me you're not serious.

Grumpy, M.D. said...

I am serious. And don't call me Shirley.

Dr. Student said...

Perhaps the workup shouldn't be for the patient but for Dr. Hospital

Karlini said...

Neuroconsult for the admitting doctor - rule out functional anencephalia

Not House said...

Ortho patient, no doubt.

Snarky Scalpel said...

I'm thinking internal medicine patient...

webhill said...

Dear Doctor,
Thank you for the interesting referral. I have examined our mutual patient Mr. Jim Smith, an 88 year old man with an unremarkable medical history, save for increasingly long naps. You admitted Mr. Smith for stroke workup and neurology consult because he woke from a nap recently with bilateral visual loss which resolved when he opened his eyes. I'm pleased report my careful examination of Mr. Smith revealed no significant findings. It is my considered opinion that his admitting physician obtain a neurology consult as soon as possible to rule out dementia vs a severe case of ass-covering. Thank you again for the interesting referral!

Sincerely,
Ibee NotKiddingAround

SumDood said...

Well, you'd have to compromise both optic and both occulomotor nerves, which is incredibly unlikely.

I'm going with TIA of the ascending aorta.

Dr Killpatient said...

Obviously a really severe but transient vertebral artery dissection.

Pam said...

Did the referring doc just purchase a new boat?

Anonymous said...

Ooh, ooh, me, me, pick me! The 88 year old male patient was pregnant! TADA!

Anonymous said...

Must be related to the a patient I had last summer who called 911 because her husband stated she "passed out in her sleep".

Jess said...

That's a tough one Doc. Do you think it may have something to do with his eyelids?

Anonymous said...

I feel left out, i guess I'm not "neurologist smart". Wait a minute...he got better from his loss of vision once he open his eyes?? as in he couldn't see because his eyes were closed?? really?

Anonymous said...

"Patient also reported being chased through Berlin by his old third-grade teacher, even though she's been dead for half a century, Berlin looked more like the local shopping mall than like any of the usual pictures you see of it, and for some reason he'd forgotten to put on clothes and was completely naked. Symptoms resolved when he opened his eyes."

M said...

Bilateral you say? - Ancient Aliens
Or possibly the patient was the creepy monster from Pan's Labyrinth? (pic related)

http://www.sgnewwave.com/main/wp-content/uploads/2008/07/pan-2.jpg

Mrs A said...

pure genius! did you ask if the symptoms were transient? or just nocte?!

Dana said...

I think the patient will have a complete recovery every time he opens his eyes. Think of the joy of knowing from a real, live brain doc that a person can heal themselves. Praise that referring doctor. You gave this patient a real gift.

Loren Pechtel said...

I'm not sure if this is neurology or not. Obviously the real problem is sensory--he couldn't feel that his eyes were closed!

bobbie said...

And what did your note back say???

Grumpy, M.D. said...

Thank you for this interesting consult.

Anonymous said...

Utterly miraculous recovery.

Amanda said...

And there you have it, a legitimate reason for insurance oversight. Le sigh.

Watercolor said...

A bitchy high powered accompanying family member with connections who refused to listen to reason? So an admit to get them out of their hair?

Becky said...

Obviously you are all missing the bigger picture here. The really concerning part of the consult is this constitutes a CHANGE in the patient. Before this, he could see with his eyes closed.
I'd refer him on to psych...

Amy D. said...

Ooo! I know what the problem was: Dr. Hospital is an idiot. (and I didn't even have to go to med school for that diagnosis)

Officer Cynical said...

Similar case here:

http://www.youtube.com/watch?v=ScGPRsHSkaE

a.generic doc said...

I believe this case could be the beginning of a medical paper:

"Transient Oculooclusive Blindness Cured By Eye Opening."

The Journal of Irreproducible Results would probably publish it.

While the condition is probably common, I doubt there are many (if any) peer reviewed articles on the problem.

A second paper could be written on "Transient Nocturnal Blindness Cured By Turning On Lights."

The Bus Driver said...

I would test for alzheimers... maybe he "forgot" to open his eyes. LOL and then call a psych consult since the doc who ordered all the useless tests must be crazy.

Marco said...

Good thing he wasn't wearing blackout eyeshades...that would have made the diagnosis much more confounding.

Anonymous said...

Is this an ongoing problem, or new onset? How frightful for the patient and his family. Good to know there are medical personal with years of post-secondary education to crack this case wide open. Perhaps you could do some reasearch and then publish. Are you sure it's not contageous? I'm scared to close my eyes now.

Mal said...

Psych consult for coming in to the ER with this complaint.

Wayne Conrad said...

I think I saw this one on House.

Cue the 3d animation flying through the patient's brain, zooming in on the evil little gnome who's pulling the plug on the optic nerve at random intervals and plugging it back in whenever the neurologist is around.

In comes House who, after making sure nobody forgets that the average toddler has better social skills than him, orders every test ever known (and a few he makes up on the spot). Making the wrong diagnosis four times in a row, each time with more expensive tests, he finally notices that the patient never takes sugar in his coffee and makes the brilliant diagnosis only he could make.

Everyone is suitable impressed, since House, having graduated from the John Edwards school of Jedi Mind Tricks, has erased from everyone's memory his frequent incorrect diagnoses and the numerous times he's nearly killed a patient.

The county sheriff deliver an eviction notice to the gnome and everybody lives happily ever after, except the patient with the $1,200,982.78 bill for the world's most expensive workup, ever. And, of course, the now homeless little gnome.

Anonymous said...

Dr. Grumpy. Sadly you are a man of science and not a man of faith. Can you not see a miracle when it is staring you in the face. The man was blind and now he sees Hallelujah.

Anonymous said...

So...was it lupus?

Sassy said...

It's Lupus.

Ben S said...

Those must have been some heavy eyelids.

Wick E. Scratch said...

Sassy - you beat me to it!!!!!

Although, upon further review, I believe that a Recto-Craniectomy be performed.

On the person who wrote the admitting note.

Anonymous said...

Oh my God, I've got it too! I never even realized it was abnormal!

Kattie said...

Gosh Darn! Are you sure that wasn't me after 'my grumpy doctor' had just tried for the 4th time to explain why he had not faxed in my BP meds after returning from his vacation!!!!! ....It happens you know!

Lois said...

LOL, as funny as that sounds, I actually had a similar experience once. Throughout my entire life, I have always opened my eyes AS I awakened. One morning I woke up without opening my eyes, and actually didn't realize it. I lay there for some time, thinking it was before before dawn because it was dark in the room. When something made me open my eyes, I was shocked that the room was bright and sunny. (This was probably before I got my CPAP machine, and I imagine I was just plain tired.)

Anonymous said...

Put me down for blepharospasm with spontaneous remission. I just love playing doctor.

 
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