Monday, December 15, 2008

A Sad Case

Patient R. X., a 30-year-old white male surgical House Officer was admitted to the University Medical Center Emergency Room with depressed sensorium and focal seizure activity. The onset of symptoms occurred suddenly when the patient, present at a medical fraternity party, observed an inebriated female lab technician dancing naked on the piano. Those individuals present stated that the patient manifested an acute loss of reality contact, staring and fixed conjugate gaze, drooling and smacking of the lips, and pseudochoreiform movements of the fingers.

When first seen in the Emergency Room his blood pressure was 200/150, his pulse 160 and bounding, and he exhibited Kussmaul's Breathing (1). He was noted to have considerable proptosis (36/36 over 102).

The oculocephalic reflex was exaggerated. The tongue was protruding and deviated to the right. Auscultation over the precordium revealed an obscene murmur. There was rigidity of the abdominal musculature. The cremasteric reflexes were hyperactive, resulting in a gubernacular hernia on the left. The remainder of the physical examination was censored.

His past medical history was remarkable in that the patient had experienced several petit mal seizures when watching young women in mini-skirts. Reportedly he once suffered a grand mal seizure while on a beaver-shooting expedition in Focal Point, West Virginia.

Seizure activity was ameliorated by cooling 3 liters of saline to 5 degrees Centigrade and pouring it directly on the umbilicus.

He was admitted for observation and further diagnostic studies. Routine lab studies revealed a mild increase in Serum Porcelain (28.2 mg/L -normal 0 to 18) and a Horni titer of 1 :256. There was a ten-fold increase in delta-4-androstenedione as measured by immunoflourescent assay utilizing the seminal fluid from the Lithuanian Hairy-Necked Jackal (Lupus heavihungus horribilis).

Electroencephalography revealed paroxysmal three-per second spike and dome activity in the right temperoparietal leads when exposed to Playboy centerfolds. Brain scan utilizing labeled Acnesium240 (Acne244) demonstrated uptake only in the central facies. Cerebral angiography revealed a superior displacement of 3 capillaries of the right lenticulostriate system. Magnetic resonance imaging revealed impingement on the anterior horn of the right lateral ventricle.

Symptoms did not improve and on the 52nd hospital day, having been cancelled 38 consecutive times by the Anesthesia Department, he was taken to the operating room where a right temperoparietal craniotomy was performed. A cystic 4 x 6 centimeter mass was discovered adjacent to the amygdala in the Corpus Hornii. This was removed intact. Radioassay of the specimen with Low-Activity-Radio-Detection-Assay-Scintillating-Substance (LARD/ASS) revealed a weight-wet tissue Testosterone level 1,400 times normal. Tissue blocks were referred to the AFIP where microscopic exam revealed palisades of well-differentiated oxyphilic cells resembling abnormal Leydig cells. AFIP pathological diagnosis was "Functioning Ectopic Intracranial Testicular Adenoma." Histological diagnosis at this institution was "Normal Gallbladder."

The postoperative course was complicated by optic constipation leading to irreversible blindness. The patient was left with severe deterioration of intellectual function and was presented to the Department of Vocational Rehabilitation for disposition. As a result of extensive testing which revealed severe, generalized impairment of cerebral function he was given a scholarship to Law School, from which he graduated summa cum loudly. He is now gainfully employed as legal counsel for the Tip-Top Grill (2) where he spends his days reading the Kama Sutra in Braille and seeking olfactory ecstasy among the bar seats.
1- Seymour Kussmaul. a local "breather" well known to the Telephone Company and the County Pervert Patrol.
2- A local establishment frequented by randy ER nurses and tenured faculty.

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