Med­i­cal Mys­tery

Reader's Digest International - - Contents - BY SYD­NEY LONEY

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

Toronto, Canada

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

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