Tuesday, January 12, 2016

A headache tale

A huge sense of relief washed over Brad Chesivoir when a Maryland emergency room doctor told him the good news: He had not suffered a heart attack or a stroke, as he had feared. Instead he was being discharged with a diagnosis of headache, although doctors weren’t sure of its cause.

Several hours earlier, on the day after Thanksgiving 2013, Chesivoir’s family had summoned an ambulance to their Montgomery County home after he became suddenly weak and unable to walk. But by the time he got to a hospital, the 60-year-old commercial property manager was feeling much better, walking and talking without difficulty. After undergoing CT and MRI brain scans as well as numerous blood tests, doctors sent Chesivoir home and advised him to follow up with his internist.

Less than five weeks later, Chesivoir was back in a hospital, his life measured in hours. “He was teetering on the edge,” recalled Edward Aulisi, the chairman of neurosurgery at MedStar Washington Hospital Center, who treated him there.

The emergency room doctors had been partly right — but Chesivoir’s problem turned out to be every bit as life-threatening as a stroke or a heart attack. And in the intervening weeks two specialists who saw him had missed it...

The doctors who reviewed his tests at the emergency room said the only thing of significance was evidence of a possible old brain bleed. Had he fallen or hit his head? Chesivoir told them that he had banged his head on the mantel putting wood in his fireplace and while roughhousing with his teenage sons — but never hard enough to see stars or lose consciousness. “They didn’t seem too concerned about it,” Chesivoir recalled. Doctors told him they suspected his head pain was caused by either migraines or cluster headaches.

After conferring with his internist, Chesivoir consulted a neurologist. Looking at the images Chesivoir had brought with him from his ER visit, he recalled that she seemed concerned that something on his spine might be causing the tingling. She ordered more tests and scheduled a follow-up appointment for Jan. 21.

By Jan. 2, 2014, the headaches were worse. Chesivoir called the neurologist’s office and saw a second specialist — the first was out of town — who told him that his problem was most likely an atypical migraine, which is not preceded by the aura many migraine patients describe. “I thought, ‘Finally I have a diagnosis,’ ” Chesivoir recalled. The neurologist prescribed amitriptyline, an antidepressant frequently used to prevent migraines. Chesivoir began taking the drug.

A few days later, he telephoned the new neurologist after developing double vision in his right eye. “We see this with this medication,” Chesivoir remembers the doctor saying. “Cut the dose in half.”

On Friday, Jan. 11, Chesivoir called the doctor again, minutes after his office opened. His double vision was worse and accompanied by zigzag lines; he was terrified that he was going blind. “I stressed to the doctor’s assistant who took the call that this was very serious,” said Chesivoir, adding that he was assured that the doctor would call him back. Chesivoir said he never heard from the neurologist.

On Monday morning Chesivoir called his wife’s ophthalmologist, who agreed to see him; she had an opening in her schedule that morning. Klein drove her husband to the office. Minutes after the doctor peered into Chesivoir’s dilated eyes, she issued terse instructions to Klein: Drive straight to the emergency room at Washington Hospital Center, where she was on staff. Don’t go home first or stop anywhere en route. Chesivoir had papilledema, a badly swollen optic nerve caused by excess pressure on his brain, and needed immediate attention...

Aulisi minced no words. Chesivoir had suffered a brain bleed, an acute subdural hematoma, which had grown so large it was now the size of an adult’s palm. Without brain surgery, which Aulisi planned to perform first thing the next morning, Chesivoir would probably die. Scans, including those performed on Thanksgiving weekend six weeks earlier, showed evidence of multiple bleeds, some old and some recent. Blood was pressing on brain tissue, causing his visual disturbances, weakness and searing headaches...

Klein said that her husband’s experience has shaken her faith in doctors. In retrospect, she said, she’s not sure what else they could have done. “There was nothing different to do,” she said. “We had gone to an ER and seen two neurologists. I felt like we covered the bases. There were so many misses.”


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