No, but we work very, very closely with him. One might say that we know his mind better than just about anyone. One might also say that we are flat and ribbonlike and each have 800 to 900 proglottids capable of producing oncospheres that, when ingested, can hatch and burrow into human brain tissue
CC (Chief Complaint): Conduction aphasia and grand mal seizure
Dx (Diagnosis): Neurocysticercosis
(I’ll be writing definitions/explaining each medical term mostly because its fun and good practice for me, thanks. It’ll go in chronological order for the episode even if it doesn’t pertain to the final diagnosis, which I’ll then explain itself.)
Conduction aphasia:
Patient is unable to articulate full words, she starts speaking gibberish
What’s important is that she recognizes that she isn’t able to form her words properly and that she’s still able to write on the white board legibly (”Call The Nurse”)
The previous point is important because there are different types of aphasia - “the loss of ability to understand or express speech”, I won’t go too in detail about all the different kinds except for what I reasonably think matches the patients symptom and another complementary type.
Broca’s aphasia, aka Expressive aphasia: the loss of the ability to produce language, although comprehension generally remains intact. So, in context of the episode, that’s why she wasn’t able to form full words/sentences, but was able to recognize it and write down a legible call for help.
Wernicke’s aphasia, aka Receptive aphasia: wherein individuals have difficulty understanding written and spoken language. Can demonstrate fluid speech but lacking meaning, for example, “Sugar may be house phone.” It’s technically grammatically correct, but doesn’t mean anything in context of a conversation. The individual might also be unaware of the lack of meaning in their speech (more in s2e10 “Failure to Communicate”)
I like to think of the previous two as “opposites” concerning types of aphasia. Which might be obvious by their names Expressive versus Receptive :)
Both types are common after an infarct (loss of blood supply to a specific region resulting in death of tissue), aka a stroke.
Grand mal seizure:
The most common types of seizures are as follows:
“Grand Mal” or generalized tonic-clonic: the one shown on all TV shows and movies (probably because it’s the most visually interesting), includes unconsciousness, convulsions, and muscle rigidity
Absence: a brief loss of unconsciousness
Myoclonic: Sporadic (isolated), jerking movements
Clonic: Repetitive, jerking movements
Tonic: Muscle stiffness, rigidity
Atonic: Loss of muscle tone
If you’re familiar with latin roots a lot of the medical mumbo jumbo makes a lot more sense, for example these seizure names all look the same at first glance but the prefix a- means without, so knowing that tonic means “continuous muscle contraction”, you already know what kind of seizures tonic and atonic will be just from the name. P.S. myo- is for muscle.
Pulmonary edema:
Simply put, it’s when there is excess fluid in the lungs, so that it’s difficult for the oxygen exchange to occur. Meaning that the patient can’t get rid of the carbon dioxide inside their body and they can’t get new oxygen into their blood.
Can lead to a whole lot of complications because everything in the body needs oxygen and an abundance of carbon dioxide can cause respiratory acidosis (which is a whole other post because I love how the respiratory system works)
aka lung congestion, lung water, and pulmonary congestion
The most common cause is congestive heart failure (CHF), which is when the heart can’t properly pump blood throughout the body, so a backup of blood builds up, increasing the pressure in the small blood vessels of the lungs, causing a “leakage”
Symptoms will depend on the type/etiology of the pulmonary edema, but generally the patient will have a hard time breathing (technically it’s an issue with the oxygen exchange, not the actual mechanics of breathing) which means their body will try to compensate by breathing faster, aka hyperventilating (there are also so many different types of breathing which I won’t go into, but my favorites are Kussmaul breathing and Cheyne Stokes)
The patient “had an allergic reaction to the dye used in the contrast study.”
I’m not saying they’re wrong but...
People allergic to contrast dye usually show adverse reactions cutaneously, meaning skin symptoms: rash, redness, swelling, etc., and usually more than 24 hours after injection.
For the most severe reactions, which is what the patient might have had, anaphylaxis and death is a small possibility. It’s a 0.008% chance to develop pulmonary edema as a complication to contrast media.
It’s not a true allergy, rather a pseudoallergy, because there is no antibody that causes the reaction. It’s the contrast dye itself that directly stimulates histamine release.
... so they’re not wrong really, just super unlucky.
Vasculitis
I don’t even know why they suggested this as a differential and then started treatment for it. They don’t even mention what type of vasculitis it might be. I’m reasonably sure they only included this so that they’d start treatment with steroids (prednisone) so that they patient would get better then worse again.
Neurocysticercosis
First and foremost, the way that he phrases it in the episode, he would have realized it was neurocysticercosis sooner, if not for the fact that he believed she was jewish (because Wilson lied to get him to take the case)
Reasoning behind this: that the parasite for neurocysticercosis, Taenia solium, is mostly found in pork (which religious jewish people are not supposed to eat). Which, first of all, as a non-religious jew myself, that’s some supposition right there. Immediately thinking all jews are religious and/or don’t eat certain foods because other jews don’t.
And secondly, that he didn’t double check her religion status, so immediately discarded a diagnosis based on that erroneous fact. Like, I get it’s the pilot and they wanted to establish personalities and relationships right off the bat, but that’s the one annoying part of the show, if only he had gotten to know his patient he probably could have diagnosed her earlier (but that’s why we love House, his charming personality)
Life cycle: Eggs or gravid proglottids (pregnant segments of the adult parasite [tapeworms as a whole have different segments to their body called proglottids, their “head” is called a scolex and is mostly different for each species, the head is connected to the neck, which then connects to the first immature proglottid. Depending on the species they all have different amounts of proglottids, ranging from 5 to 1000. The further away from the scolex they get the more mature they become, and when fully mature they’re impregnated, one segment at a time, with each segment breaking off from the previous so that they can find a nice home in the body]) are found in feces and passed into the environment, from there they’re ingested by an intermediate host, usually a pig, but in the case of cysticercosis, a human. The eggs hatch and liberate larvae, aka oncospheres, which penetrate the intestinal wall and circulate to musculature. They mature into cysticerci over 60-70 days, and can migrate to the central nervous system, which is what causes neurocysticercosis.
The same parasite can cause another disease called taeniasis. This differs primarily through the acquisition of the parasite. The pig is the intermediate host in this case and a human the definitive host. It is ingested through uncooked/undercooked pork containing cysticerci. Wherein they will evaginate and attach to the small intestine by their scolices (head and suckers). This disease will normally only cause intestinal issues.
A primary infection of taeniasis with Taenia solium can cause a secondary infection of cysticercosis which can lead to neurocysticercosis. So it is possible for the patient to have neurocysticercosis even though they explained it using taeniasis.
Neurocysticercosis is one of the main causes of epileptic seizures in many less developed countries (not so much for a pre-school teacher in New Jersey)
Treatment can include steroids (which is what they gave her for vasculitis, and the reason why she seemed better for a time) but ultimately an anti-parasitic is needed, suggesting albendazole or praziquantel for about 2 weeks.
so i was scrolling on twitter and came across that post you answered to and - you're so incredibly beautiful! absolutely wonderful, i love your brows and your eyes and just !!!! sometimes i miss tumblr, not the toxicity and the negativity of it but such humble and very heartwarming writers like you! so i decided to leave you a little message, just reminding you that you are so very worth every praise and love that you get and MUCH more. please take care and have so much fun with life! 💖💖
I only came by to wish you a wonderful day despite you having to stay 'til 9 pm and don't forget to stay hydrated and enjoy every break you have! you can do this :D
awwww you are the cutest, sweetest bean of all time!!! haha im just complaining, but then i get to skype date w/ @hyacinth-ink tonight and i get the next few days off so it’s all worth it :)
Thank you so much my dear and I hope you take it easy and eat well and sleep and take care of yourself bc i would be really worried if anything happened to you <3
finally, after years and years of planning, the brain worms have installed one of our agents at the highest levels of government. the helminths send their regards 🪱🔪
@ the anon w/ the hot guy in the class w/ a smile like tae: at least you're not crushing on a married man who's got two kids!!! BUT WHAT CAN I SAY OLDER MEN ARE HOT CRIES
ahhh guys let’s try to leave married men alone. I don’t feel comfortable even discussing this ^^;;;
More references, now for Paravirus. Tae is a biology student just trying to get by until Hirudi, a man made parasite, takes up residence in his body. The basic plot would be a monster of the week format- Hirudi reveals the lab he came from has engineered other parasites, which have escaped and infected other people.
The idea for Paravirus came from a dream. In the original dream, I had come across people talking about an old DS game, a bit of a cult classic. It was styled like Bowser's Inside Story, you were on the inside controlling Hirudi (who looked more like a black drippy blob with eyes). They would start out pretty uncaring for the body, wreaking general but not fatal havoc, since they were living there. But at a certain point they'd discover another parasite, their sibling, who was much more deadly and set on world domination. So the rest of the game involved Hirudi contacting Tae through his nervous system and working together to defeat their sibling.
The plot and characters have certainly changed now, but the bones of the dream are still there.
