|Diagnosis||Methyl bromide poisoning|
Medical History Edit
Fran has recently been to Venezuela where she used a scopolamine patch to combat airsickness. She drank tap water, as well as eating salads and other raw foods. In addition she drank mezcal, snorted cocaine, engaged in unprotected sex and obtained a tattoo.
Case History Edit
Robin called an ambulance and brought Fran to the Princeton-Plainsboro Teaching Hospital emergency room after Fran collapsed in her home. She was examined by Dr. Wilson who asked if she had suffered from a head trauma. She denied she had. However, he found a scopalamine patch on her neck which Fran had forgotten to remove. He told her that the scopalamine probably caused dizziness and blurred vision, resulting in her falling. Her unconsciousness was probably the result of hitting her head when she fell. He recommended that Fran go home and rest, but that Robin keep an eye on her. However, Fran insisted she was all right and could be left alone. However, as she stood up to leave, she collaped again and had a seizure. Dr. Wilson called for a crash cart and asked for Dr. House.
Fran was admitted and Dr. Wilson asked where she had travelled. She said Duluth, but Dr. Wilson noticed a fresh tattoo on her right ankle. She admitted she had been in Venezuela and engaged in several unhealthy activities. Dr. Wilson agreed one of these activities had probably made her sick.
Dr. House was in transit so Dr. Wilson called Dr. House's diagnostic team together. Dr. Chase and Dr. Cameron wanted to put the scopalamine patch back on, but Dr. Foreman noted that she couldn't use one indefinitely. However, Dr. Wilson agreed to put her back on the patch. Dr. Chase suggested a CT Scan to look for a brain tumor and Dr. Foreman suggested an environmental scan. Dr. Cameron thought it was unlikely that New Jersey rather than Venezuela was the source of the problem. Dr. Wilson ordered a tox screen, Chem 20, STD panel, and blood cultures followed by the CT Scan and the environmental scan.
Dr. Cameron found cadmium yellow paint at Fran's home, but Dr. Chase felt it was unlikely it was the cause unless she was ingesting it.
Unfortunately, all of the tests were negative. Dr. Foreman wondered if she even had a physical illness, but Dr. Wilson reported she was still having seizures. Dr. Cameron noted that the rate of seizures had decreased since the patch was put back on, and Dr. Wilson suddenly realized it could be breast cancer. Scopalamine and other similar drugs don't affect the cancer, but they would affect the severity of paraneoplastic syndrome. He rushed out to arrange a mammogram. He found Robin about to leave, but asked if she would stay to help Fran through the procedure. Robin agreed. However, Dr. Cameron performed the scan and suddenly Fran reported she couldn't see out of her right eye.
Fran was given an eye test and EEG. Dr. Wilson went to speak to Robin to report that the blindess ruled out breast cancer but did make it likely she had a neurological problem. However, Robin admitted she had only met Fran that morning. Dr. Wilson agreed that she had done more than enough for Fran and agreed she should leave. Robin asked that he call her when he knew more about Fran's condition.
During the test, Dr. Cameron noted polyspikes over O1 and O2 and Dr. Foreman noted burst suppression over every lead when Fran covered her left eye. Suddenly, Fran collapsed in the chair she was sitting in. Dr. Cameron and Dr. Foreman rushed to examine her and realized she was in a coma.
Dr. Foreman felt that Fran had intracranial pressure which was pressing on her brain. Dr. Cameron thought it might be nerve death, but Dr. Foreman noted that increases pressure could do that as well. He felt she was bleeding into her brain. Dr. Chase reminded him that the CT Scan was clear, but Dr. Foreman corrected him - it merely showed she had no tumors. If there were acute bacterial meningitis leading to a cerebral hemmorhage, the scan might have missed it. He recommended a burr hole to relieve the pressure. Dr. Cameron thought that was risky considering there was no evidence of bleeding, and that a lumbar puncture to test for red blood cells in the cerebro-spinal fluid was a better course of action. However, Dr. Foreman noted that an LP could cause herniation of the brain, resulting in death. When Dr. Chase was asked for an opinion, he noted they still hadn't found an underlying cause for her illness and it might be useful to know what was causing the problem. Dr. Wilson ordered the LP.
Dr. Cameron prepared Fran for the LP and Dr. Chase performed it. It was positive for red blood cells. They prepared Fran for the burr hole surgery. Dr. Chase still thought Dr. Foreman was wrong and the procedure would kill her. Suddenly, he remembered something about Fran's cat - his food bowl was full. Fran hadn't seemed to have eaten either. He thought the anorexia might be a symptom. Fran was put under anesthetic.
Dr. Chase went back to Fran's house, this time in protective gear. He found the cat's food bowl was still full and that the cat was dead, sitting on top of the same chest of drawer's in Fran's bedroom where he had seen it during their earlier scan. He started looking through the hosuse again and in the basement, he found an old electrical service. Dr. Chase traced the electrical connection and found it led to another house - they had once shared an electrical service. The other house was being fumigated with methyl bromide and he realized it had leaked into Fran's house, resulting in methyl bromide poisoning. He called Dr. Cameron on his cell phone, and she stopped the surgery just in time.
They explained to Fran that the scopalamine patch had masked the effect of the methyl bromide, which is why she didn't feel ill earlier. However, she would recover. Dr. Chase apologized for the cat, and Dr. Wilson apologized for having to shave off her hair to prepare her for the surgery. Fran found it ironic that she didn't get sick by going away, but by coming home. Dr. Wilson called Robin to give her the good news, and to ask if she was coming back to visit her.