She's fine, but her M.R.I. He Presented a few Stones. What's wrong?


A 67-year-old woman recently flew back to her former hometown, Eugene, Ore., To pick up one extra box to ship to her new city, Homer, Alaska. As usual, the long-haul parking lot was nowhere to be seen, so she took her hand out of her luggage and threw it in the street at the now-famous airport. It was a long walk – maybe a half mile – but it was a beautiful afternoon.

The only woman walking down this rarely used route at the airport has caught the attention of Diana Chappell, an emergency medical technician who is out of their job to catch her flight. She looked up as the woman approached a building that had been at some of the E.M.T.s. And straightway the woman ceased. She got up on her toes and turned to look pretty, then his head looked like a gourd tree and she lay there.

Chappell jumped out of the car and ran into a woman. She was awake but could not sit. Chappell helped her move towards the street and took a quick video survey. The woman scratched her left eye while her glasses hit her face. His left knee was bleeding, and his left hand was swollen.

She threw the hand of one of her roll bags, the woman explained. When she tried to pick it up, it happened. But now it felt good. As she spoke, Chappell noticed that her speech was a little soft and that the left side of her mouth was not moving normally.

"I do not know you, but your speech is a little less," she said. “Did you drink?” No, not at all, the woman replied – wondering the question. Chappell introduced herself, then asked the woman if she could do a few quick tests to make sure she was O.K. Chappell asked her to laugh, but on the left side of the patient's mouth he didn't drive; She asked to help his shoulders and the left would not stay. You need to go to the hospital, the woman said. The woman protested; It was good.

At least let me call E.M.T. pals to check your blood pressure, Chappell insisted. After a fall like this, it can be high. The woman agrees, Chappell calls her friends. The woman on the ground was shocked by the flashing lights of the emergency vehicles but agreed to have her blood pressure taken. It was sky high. She really needed to go to the hospital.

It got darker when she was taken to the Health & Wellness Center of Health & # 39; of RiverBend. Doctors and nurses were ready. They knew her speech was poor but they said no more. When they asked her to smile, as E.M.T. had, noted that the left and right sides are now comparing. Although she was fine, the emergency room doctor was worried she would have a stroke. An IV was inserted, monitors were attached and she was taken to a CT scanner. CT scanning of her brain was normal, but Dr. E.R. consulted with a neurologist, who thought he should get M.R.I .; she can still have a stroke. M.R.I. showed that she really had it. She can't go home, and the doctor E.R. told him.

It was early this morning when a neurologist, Dr. Margareth Saldanha, introduced to the woman she had heard before. Saldanha also described the woman did not have any evidence about stroke tests, to have a simple blood over looga clearly visible M.R.I. She does not have to leave the hospital until she finds out why these strokes happened, to try to stop her from stopping them for much.

The woman was surprised by what she considered unnecessary anxiety; she wanted to go home. Saldanha dragged the keyboard to the patient's bed and showed M.R.I. numerous photos of white spots showing the damage to her brain despite normal brown changes. Shocked when she saw him, the woman agreed to stay.

Saldanha talked to the woman about her way of thinking. She has no known causes of stroke. She quit smoking decades ago. They did not have high blood pressure or diabetes or any other disease that makes them more likely to have a stroke. In addition, the traumatic nature of it – a spray of drops instead of a single large area – suggested that her brain was drained with a small blood clot.

This type of stroke is most commonly seen in patients with atrial fibrillation & # 39; In Afib, as it is known, the heart beats irregularly, allowing the blood to flow to the heart and forming small clots. When these bundles escape, they block the small veins in the brain and cause many small strokes. But the patient did not have AFib – her heart rate has been monitored regularly since she first saw E.M.T.s, and it is normal.

Saldanha suspected that the patient had a different complication leading to clots seen in M.R.I. Some people have a cavity between the right and left sides of the heart. This type of opening allows the blood and valves to move directly through the body from the brain to the brain, without going through the lungs. The pain can form in the legs during the non-life span, and Saldanha is surprised that the woman can wear clots during the long flight. If she had a hole in her heart, when she started walking, those clots would open, jumped out of the cave and ended up in her mind.

The patient underwent cardiac ultrasound, showing no cavities. But there was good research, and Saldanha wanted the woman to stay in the hospital for as long as she could. This test, called a & # 39; transesophageal echocardiogram & # 39;, involved the insertion of a camera in the esophagus – which runs right in the back of the heart – to get a closer look. The patient accepted. While it still feels good, these clear white areas of M.R.I. her fear.

The experiment was performed the following day. The test – an ultrasound camera, placed at the end of a long, flexible tube – was inserted into her mouth and throat, and then down to the position next to the heart, about half of her abdomen. From there, doctors can see many cardiac structures that are not visible from the front, where a standard echocardiogram is performed. As the cardiologist moved on to the camera to look for a suspicious hole, something suddenly happened and their vision came out: a tumor in her heart.

Cardiovascular tumors are rare. In a series of 12,500 studies conducted over 20 years, heart tumors were found in only 161 individuals. Most of them were growth-related cancers. The tumors usually arise from a stroke; by stopping the flow of blood, it created an opportunity for the clot to form. It should be removed both to stop the stroke and to allow the psychologist to determine if it was caused by a cancer hidden somewhere in her body or if it was a tumor in the heart, often dangerous. But looga out, they are forced to do open heart surgery.

Three days later, the surgeon removed an unusual ulcer in the shape of the size of a white tooth. When the patient recovered, she was concerned that she had some form of cancer. When she got a talk about psychology, it was good news. She had what is called papillary fibroelastoma – a very rare but very rare disorder that grows on the edge of the heart protector. The cause is still unknown. But when removed, it rarely comes back.

Sadly, perhaps, the patient feels lucky. Fortunately she had a stroke before reaching her car. Fortunately to have experience E.M.T. The psychologist made sure she needed to know why she had a stroke. I was really lucky to be back in life in Alaska and she is still very happy.