THE PATIENT: Marjorie*, a 69-year-old retired accountant
THE SYMPTOMS: Intense headache and nausea
THE DOCTOR: Nicholas Pimlott, Associate Chief, Department of Family and Community Medicine, Women’s College Hospital in
AROUND 1 A.M. on a Saturday in February 2015, Marjorie rose with severe nausea and was violently ill. She blamed the oysters she’d eaten during a dinner out the previous evening and fell back asleep. Two hours later, she was jolted awake by a headache that kept her up till morning. When that pain didn’t disappear after three days, she called her doctor.
Such a headache, says Dr. Nicholas Pimlott, Marjorie’s long-time GP, “can be ominous. A doctor’s first concern is that it could be an intercranial hemorrhage or a stroke.”
When Marjorie arrived at Women’s College for her appointment, she was seen by a resident who conducted a neurological exam. The patient’s speech and gait were normal and she didn’t exhibit any overt signs of stroke, such as facial drooping.
But she couldn’t easily point back and forth between the tip of her nose and the doctor’s index finger.
Marjorie’s headache abated on its own, but an MRI revealed a bleed on the right side of her brain. She was transferred to Toronto Western Hospital to consult with the neurosurgery unit, where she was diagnosed with moyamoya disease, a rare, chronic, progressive disorder in which vessels at the base of the brain narrow, reducing blood flow and causing a stroke. (The tangle of vessels at the