Tuesday, October 4, 2011

Stump the expert

Okay, it's time again for you armchair neurologists out there to help me with a challenging case. Here is, verbatim, the first paragraph of my note. See if you can guess the diagnosis:

"When working outside in the Summer, or inside baking, she becomes warm, sweaty, and lightheaded. The symptoms resolve with drinking cold water and cooling down. They don’t occur if she keeps up on her fluid intake."

62 comments:

Kim said...

Seriously? Someone actually went to a doctor for that?

Grumpy, M.D. said...

Even better. They were referred to me by another doctor for it.

Flavius said...

Lupus! What do I win?

-Flavius

Anonymous said...

Menopause or perimenopause.

Lynne said...

It's never lupus. Must be sarcoidosis ;)

Sarah Glenn said...

Maybe the other doc thought that her inability to connect the dots was a sign of a deeper problem.

Rosie1925 said...

Plain ole dehydration. Good god! And, I am not even a medical pro. Merely an experienced Grandma.

Dr. Consult said...

"Thank you for this interesting consult."

Christine said...

Diabetes insipidus vs. primary adrenal failure.

RuralGP said...

addison's

Neuroscience PhD said...

Overexpression of TRPA channels linked to temporal lobe epilepsy, causing her to experience euphoria and a sense of "rightness" when cooled down.

Rick said...

Sounds like hypopandiculation to me. :-)

http://well.blogs.nytimes.com/2011/10/03/really-the-claim-yawning-cools-the-brain/?ref=health

Justin said...

I'll take Dehydration for $400 please

Dr. Billy said...

Hypothalamic glioma causing temperature dysregulation.

Taryn said...

Plain ole over-heating and dehydration!

Packer said...

Ka Ching syndrome.

I think it is the lightheaded part that concerned them---just saying.

When I work outside in the summer, not only do I become warm, sweaty but I start to take on an offensive aroma ---please help.

Old MD Girl said...

Syphillis!

Teri said...

Developmentally disabled.

Anonymous said...

Hypochondria, complicated by stupidity and generous health insurance.

SuFu PhD said...

malaria or yellow fever

Olivia said...

You'd better run about 100 tests to rule out all of the above. Then run them again, just to make sure. At which point, patient will see another doctor because you can't find anything "wrong", and my insurance rates will go up 10% this year.

Olivia said...

Hmmm, that's a tough one. Better run 100 expensive tests to rule out all of the above. Then repeat, to confirm because patient forgot to mention meds she was taking during tests. Then, after trying about 20 different expensive medications, patient will go to another doctor because you can't find anything "wrong." Shortly after, my insurance rates will jump by 15%.

thethingspatientssay said...

Reminds me of the consults for chest pain all the time.

"How long did the pain last for?"

"About a second."

"And you thought that warranted an 8-hour wait in the ER?"

Anonymous said...

Either dehydration and/or that syndrome, I can't put my name on it but the one where there's nothing in the space between the two ears??

So what's your treatment plan?

WOW!

Shrtstormtrooper said...

Nothing wrong except that you can't fix stupid.

Anonymous said...

don't blame the doctor who referred her to you, that doctor was just doing his/her job, aka CYA :p

Patrick said...

Could be a precursor to JFA

Li'l Azathoth said...

Medical ethics dilemma: what does a doctor do when the interests of the patient are directly opposed to the interests of the human race?

- said...

Multiple Sclerosis

bobbie said...

Sh** for brains syndrome...

Anonymous said...

TURF to endocrinology.

RSDS said...

Dehydration

I battle with it daily. It's the number one trigger for migraines, with overheating as the second.

wv: palifit --> pal i fit

Nota Docta said...

Seasonal Artisanal Hemorrhage

Anonymous said...

Meh. I'm gonna apply for a grant to study it. To validate the Common Sense Hypothesis.

Pssssttt, don't send that doc rural - he's been spoilt by the proximity of Grumpy and his ilk.

Or he / she has no balls.

Or he / she was UBER wise, cut their losses, and pointed her at you with an evil grin.

While America payed.

BBlart said...

A serious reaction to pediatric vaccinations

Jess said...

Dementia. It's time to notify the family.

Anonymous said...

Dehydration, secondary to stupidity.

John Woolman said...

Early Shy-Drager Syndrome?

medstudentitis said...

MEN II

Anonymous said...

one of two things. a tumor on the pituatary gland. or dehydration. My bet is dehydration

ArkieRN said...

Positive billfold biopsy (or really good insurance) and a patient who demands the doctor "do something".

The md did not want to lose the cash cow so he referred her so that she can be mad at you over her diagnosis (or lack thereof) and not him.

Anonymous said...

If she is actually experiencing heat and exercise intolerance beyond normal limits (which is possible even with reasonable water intake), she could have a form of orthostatic intolerance.

Dave said...

As a fellow neurologist I have experienced this too. Last month I was called by the ED about a young man who worked at a dry wall production plant where the temperature is hundreds of degrees. He reported he typically had to drink a gallon of fluids a day and sweated profusely at work. He was brought to the hospital after his second episode of passing out. The consult was for a positive Romberg and gait ataxia. I asked them three times to check orthostatic vitals, which they only did after I had seen him. After they were positive they still wanted to admit him to neurology!

terri c said...

Time for a Big Work-Up (tm)!!

Anonymous said...

I think you should write this one up and publish it. After all, you have reported to your loyal readers many examples of doctors publishing the f***ing obvious!

oceankisses said...

Cheese and Rice! I can't believe someone actually consulted a doctor....a high falootin' doctor too! I hope you charged this person double.

Anonymous said...

fibromylasia

hoodnurse said...

Well, somebody took MS, so I'm gonna go with Gullian-Barre.

Anonymous said...

I think she should stop working outside in the summer, at least until evening, and should stop baking unless and until her kitchen is air-conditioned. Please provide a billing address for my expert advice!

Anonymous said...

Energy Field Disturbance...duh. Probably some Risk for Sexual Identity Pattern.

Gotta love the nursing diagnosis!

GB, RN

Anonymous said...

I have these symptoms all the time FOU syndrome combined with ncltcg ncltgt= no chilrin left to cut grass
FOU=fat old and u

Anonymous said...

Leprosy.

Anonymous said...

Ok, this is a tuff one. Drink more water and set your a** down. that will 19.95 plus tax..

Bob@thenest said...

The referring doc knows you have a blog and the patient is his/her cousin?

X-Ray chick said...

Ohhh a tough one eh? Hmmmm OH! I bet it's a glioblastoma...or it could be dehydration...

Anonymous said...

I have a few addition questions prior to making my official diagnosis... Does she get cold when standing infront of an open fridge? Does she get wet when she goes swimming? Does she find these symptoms bothersome or concerning?

If so, I would recommend introducing her to your patient who couldn't see when she closes her eyes, and encourage them to initiate a support group for the terminally stupid. Preferably in a location where Darwin's Theory could get a little help.

Anonymous said...

Craniorectal impaction.

Anonymous said...

This is remarkable. If we've ruled in the possibility that fainting may require a valsava maneuver to relieve the excitation and stimulant effect of baking indoors and/or being outdoors--hot and sweatiness, then we'd want more info.

I would want more H and P, like what happens when she drinks water at room temperature, or hot water?

Or what happens if instead of drinking water, she drinks lemon squash.

This could very well be the acid-test.

What happens if she drinks water while sitting on a chair, on a couch or here or there? What happens if she drinks it anyhow, or anywhere?

The question for her, then, is not whether she has normal temperature-regulation to respond to ambient temperature, or even there's a snake skeleton in her closet, but how she likes her water.

In a tumbler or a glass, on the porch, or in the grass. And, whether drinking a four pints of Guinness would take care of it.

Anonymous said...

"Madam, what you describe is normal mammalian physiology. It is only pathological if you are, in fact, a Lizard Person."

Anonymous said...

Dr. Dick F---kin' Tracy!

Anonymous said...

POTS.

Anonymous said...

I second POTS. Send her for a tilt table test, and start fludrocortisone if it's positive.

 
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