Medical History[edit | edit source]
The patient has a lifelong history of unexplained seizures.
Case History[edit | edit source]
Dr. House knew Kyle as a visitor to the coma ward. He had noticed that Kyle was suffering from intermittent akinetopsia, the inability to see moving objects. By flashing the lights in the room, he was able to induce a seizure. Kyle was admitted.
Dr. Cameron did a physical exam and Kyle said he wasn't having any trouble seeing. The patient was aware of his seizures, had been tested, and there was no diagnosis. Dr. Cameron asked if he had a family history of epilepsy, but the patient did not have a good grasp of his family's medical background as he had been raised by a guardian after his mother's death and father's vegetative state, both caused in a fire. He did not know how to contact his mother's family, his father had no siblings, and his grandparents were dead. The patient asked for his backpack and Dr. Chase discovered it was full of alcohol.
Dr. Cameron thought it might be an infection. Dr. Foreman suggested a brain tumor, but Dr. Cameron pointed out his previous CT Scans had been clear. Dr. Chase thought it was an unreported trauma. Dr. House thought it might be genetic because the patient's father showed similar brain patterns on his EEG. He ordered them to test the father's DNA for genetic diseases, starting with adrenomyeloneuropathy. He also ordered an environmental scan.
Dr. Chase's scan showed no toxins, leaks or mold. The MRI and lumbar puncture were inconclusive. The test for myalaneuropathy was negative. Dr. House ordered genetic tests for Unverricht-Lundborg disease and late onset lafora disease, overruling Dr. Chase's objection that they would take too long.
Dr. Foreman talked to the patient again, asking if anyone else he knew had been sick. However, the patient had not had contact with anyone for over a month, apart from a very healthy pizza delivery guy. The only person he is close to his father. All of a sudden, the patient felt nauseous and Dr. Cameron realized his liver was probably failing. The patient started coughing up blood. Dr. Foreman ordered packed red blood cells.
Kyle lost consciousness and was headed for a coma with his responses on the RLAS scale gradually declining. Dr. House ordered all treatment stopped as the drugs weren't helping, even though he did not believe Kyle's symptoms were induced by the treatment either. Given that the patient's liver was in bad shape from a combination of his disease and alcoholism, anti-seizure medication was contraindicated. Dr. Foreman announced that he had started Kyle on dialysis, which meant his kidneys were failing as well. Although trauma had been ruled out, it could still be an infection, a neurological issue or a genetic disease. Dr. House realized he needed a better medical history.
As a result, Dr. House went to give Kyle's father L-Dopa and amphetamines to try to get him out of his vegetative state. Despite Dr. Cuddy's protests, Dr. House proceeded anyway. In a few moments, the father, Gabe, came out of his vegetative state and asked for a steak.
Gabe had all his mental faculties. Dr. House asked if he had a family history of seizures or liver disease, but he replied in the negative to both questions. He also denied that his wife's side of the family had a history of seizures. Gabe was told that Kyle was in critical condition. However, it didn't seem to register emotionally with him. Dr. House thought this was unusual.
Kyle was taken off of all drugs except antibiotics. His liver was barely functioning. He was still sliding into coma.
Dr. House went to question Gabe again, this time about his son's measles vaccination. However, Gabe had learned he only had about a day of consciousness and he was both upset that Dr. House had not told him and that he thought he would want to waste that day answering his questions. He wanted to go to Atlantic City to get a hoagie. Dr. House pointed out he had no transportation or money. They agreed that Dr. House would drive him to Atlantic City if Gabe answered questions. However, as only Dr. Wilson's car was available, Dr. Wilson insisted on coming along.
Dr. House started talking about the possibility of toxic exposure. Gabe mentioned he was allergic to berries, but Dr. House realized it probably wasn't relevant. Dr. House asked about where they had lived, but they had spent their entire lives in New Jersey. Gabe refused to answer more questions unless Dr. House answered questions about himself posed by Gabe.
Kyle dropped to a 3 on the RLES scale, showing only localized response. Dr. Chase called Dr. House to inform him.
Gabe's factory made luxury boats. Dr. House confirmed he used mildew resistant paint, which contains mercury. He called his team to have them treat Kyle for mercury poisoning and test for mercury.
Later, when Dr. Wilson asked why Gabe didn't want to return to Princeton to see Kyle, he said it was because his son had turned into a drunken loser, just like everyone on his mother's side of the family. Dr. Wilson realized that Gabe didn't know about Kyle's drinking until after they left to go to Atlantic City. However, Gabe refused to tell them why he left Kyle.
Kyle's blood pressure started to drop and his blood oxygen level fell to 70%. Dr. Foreman administered epinephrine. Dr. Cameron feared this would increase the bleeding, but Dr. Foreman realized it wasn't Kyle's liver, but his heart that was causing the problem. Dr. Foreman advised Dr. House that the mercury test was negative. Dr. House ordered an echocardiogram.
Dr. House started questioning Gabe again about all of his relatives and asked how all of them died. His grandmother died of heat stroke. His sister-in-law with diabetes died in a traffic accident coming home from a baseball game. His father died of heart failure due to old age. His wife's father died in a hit-and-run accident walking his dog. However, Gabe was obviously starting to lose his reflexes.
Kyle had a seizure and Dr. Chase ordered 20mg of diazepam. Kyle's heart rate skyrocketed and became irregular. Dr. Cameron wondered if it was an allergic reaction, but Dr. Chase feared his heart had failed. They defibrillated the patient and stabilized his heart beat.
Dr. House asked Gabe about the fire. It was started when Kyle dislodged some embers from the fire in the fireplace while he was popping corn. Gabe finally admitted he left the hospital and Kyle because he had failed to keep his family safe and he didn't want to be around being helpless while Kyle died. Dr. House wondered how the embers became dislodged and it turned out that Kyle had dropped the popcorn popper. Kyle had been complaining it was too heavy. He asked if the hit-and-run that killed the father-in-law was at night. Gabe said that it had. So had the auto accident after the baseball game. Dr. House realized it was MERRF syndrome, a genetic disease that causes people to drop things, muscle weakness and poor night vision. It makes sufferers seem accident-prone, uncoordinated and careless. It is transmitted through the mother's mitochondria. The wife's family weren't drunks, they were all suffering from the same genetic disease. Kyle's liver failure and seizures could be explained by his alcoholism. Dr. House called Dr. Foreman and ordered a test for MERFF. However, Dr. Foreman told him it wouldn't matter - Kyle had severe alcoholic cardiomyopathy. He would need a heart transplant and his alcoholism ruled that out.
Gabe asked to give his heart to Kyle, even though it would result in his death. Dr. Wilson objected, but Dr. House pointed out he was going into a vegetative state again in a few hours. Dr. Wilson pointed out that Gabe could still be treated, and MERFF was treatable, but not curable.
Dr. House asked Dr. Cuddy to agree to the procedure, but she flatly refused.
Dr. House sent Dr. Wilson out of the room and told Gabe about the options for suicide that would be most likely to preserve the heart. Strangulation would be best. Gabe realized that he would be back in a vegetative state before they reached Princeton again. He asked Dr. House to leave the room. Wilson returned and they heard a thump from inside.
Kyle responded well to the transplant and was soon conscious again. Dr. House told him his father said "you were right, you did the right thing". He also told him he didn't know what it meant. In reality, it was what Dr. House had always wanted his father to say to him.