For over a decade, Dr. Lisa Sanders has been putting readers to the test with her Diagnosis column in the New York Times. For those who aren’t familiar, each month, she writes a story about a real patient whose diagnosis confounded doctors, briefing readers on the symptoms the patient experienced, tests the doctors ran and any relevant backstory. Her work is truly commendable; Dr. Sanders has found a way to bridge the gap between physicians and their patients, by giving ordinary people the chance to piece together a diagnosis using the same clues doctors have. The only downside is that the column only runs once a month. As my contribution to Odyssey, I’ll be writing a very similar column, but on a weekly basis (if readers like you seem to enjoy it)!
Note: These scenarios are based on true stories, but all names, identifying features, and situations have been changed to fictionalize the case and preserve privacy.
Our first patient is a 13-year-old girl, who goes by the name Elise. Until about a month ago, Elise was happy, healthy teenager. However, one Saturday afternoon, Elise found herself lying on the floor of her family home, paramedics surrounding her as she came to from her first seizure. Over the next few days, Elise was subjected to test after test, and the frequency of her seizures continued to worsen.
The local hospital ultimately put her on anti-epileptic medications. Her seizures subsided, and Elise was discharged a few days later. Her parents, however, remained perplexed. During her hospital stay, Elise had become increasingly agitated. She was extremely short-tempered with her doctors, had begun mumbling frantically to herself, and seemed to be hallucinating frequently. On more than one occasion, Elise had tried to escape the hospital room. Nurses caught her rushing out of the bed and toward the 3rd floor window, dragging the hospital's monitoring equipment with her, and insisting that she saw 'friends' calling to her. Furthermore, Elise had, in the month prior to her first seizure and sudden shift in personality, experienced a significant weight gain, and an increase in facial hair. For the most part, Elise's doctors chalked this up to a byproduct of puberty. After her discharge from the hospital, Elise remained difficult to control, but the family was determined that her behavioral changes were a result of stress and hormones.
Unfortunately, Elise had become a danger to herself: her hallucinations were life-threatening. When the family stopped one afternoon at a fast food restaurant, weeks after Elise's discharge, Elise took the opportunity to sprint into oncoming traffic. Fortunately, neither she nor other drivers were injured, but given the circumstances, Elise’s mother saw no other option. The next morning, she tried to check Elise into a psychiatric hospital. By this point, the family had entertained ideas of numerous psychiatric disorders, suspecting some form of schizophrenia to have suddenly manifested itself. Her doctors contested; schizophrenia does not develop so suddenly in an otherwise normal teenager. Furthermore, Elise's EEG and MRI results returned normal: Elise’s diagnosis was not psychiatric in nature.
Now it's your turn: leave a comment guessing the patient’s diagnosis! If you have any questions, perhaps results from a test you as a doctor would run on the patient, feel free to pose those as well and I will answer to the best of my ability. Best of luck!
