A 45 yo female arrived by ambulance with her two sons with a chief complaint "she's not right." I arrived into the room with 3 med students and began my assessment. First, I asked the sons about her medical history and the events leading up to her "not being right." The sons stated that she has no medical problems, takes no medicines, and was last seen acting normal earlier that day. When they arrived home later that evening, the bedroom door was locked, and their mother was screaming for help. They broke down the door to get in and found her in bed screaming for help with her nightgown on.There were no signs of a trauma or blood anywhere. They then called "911" for help.
I examined the patient and started with the head and shouted to the medical students who were helping document. "Ears clear, pupils reactive 3-->2 but sluggish, mouth clear." When I examined her head, I felt around the top of skull and felt something squishy. I then moved over the light and tried to get a better look. Unfortunately her hair was covering the area. I shouted, "Okay I feel a large skull defect but no bleeding or bone fragments." The last time I felt something like that was during neuroanatomy in med school.... but surely it couldn't be brain! I then poked it a couple more times and she screamed "Ouch, ouch!" both times.
I screamed out, "Well guys, this feels like brain!" The entire room feel silent and the medical students thought I was crazy. One med student said "but there's no blood or bone fragments or trauma anywhere on the patient." I said, "I know, it doesn't make sense."
I ordered a CT scan of her brain and sure enough, she had a large skull defect with brain coming out! She had a bacterial brain abscess which ate her skull from the inside which explained why no bone fragments were found. When the abscess got big enough, it ruptured causing her to faint. She then fell exactly on the spot of the abscess and popped her brain! She ended up returning to work without any long term complications.
-Doc Sensitive
20 comments:
Holy Crap!?!?!?
Now I want to google "symptoms of bacterial brain abscess" so that this does not happen to me. I have to stop reading med blogs.
*GASP* How does one get a bacterial brain abscess?? Would she display any symptoms before 'she's not right?'
Some people have all the fun. On the other hand, I wouldn't want your job for all the tea in China. Or a million bucks.
I'm (obviously) not a doctor but I was under the (perhaps mistaken) impression that there were no pain sensors in the brain. What caused the pain when you smooshed her gray matter?
gross.
If she went back to work after her brain exploded, she obviously works for the government
Did they do any kind of intervention other than antibiotics? Bone cement? Something?
And also, good job on you for actually feeling her head! I certainly might not have done that.
Awesome and gross
Would the pain have been caused by the margins? As in, when you palpated, pushing on the edges of the skull defect, which DOES have pain sensors? or from the fact that you were displacing the brain when palpating, causing it to press against the inside of the skull?
Truly amazing Doctor...very well done!!!
The cranial meninges (dura, arachnoid, pia) that cover the brain can sense pain. If the infection was in the epidural space (between the dura and the cranial vault) she could still feel pain.
How is it that she did not have meningitis, or any symptoms prior to 'popping her brain'?
WILD!
Delicious.
This is doc sensitive- she did not have meningitis and had a headache for about 6 months with a low grade fever. The primary source was from an old dental procedure 7 months prior.
gShe was also put on iv antibiotics. I believe plastics created a bone flap to cover the defect. She was out of work for 6 months.
Best story ever of "Brain Drain" I've ever heard. Glad she's OK, the human body is just amazing.
Wow got to say I've never heard of this and might I also add never want to see it either!
Thanks. As if seeing the dentist isn't scarey enough, now I have to worry about my brain exploding.... And my appointments next week! LOL
"Well guys, this feels like brain!" I honestly can't stop laughing.
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