House – Episode 10 (Season 2): “Failure to Communicate”
This medical review of House contains lots of words (probably too many) and several spoilers, so don’t say I didn’t warn you…
Fletcher Stone, a famous journalist, is at an office function when he falls and hits his head on a desk. There is some confusion whether he tripped or fell. He was knocked unconscious briefly, and when he came to he was unable to speak normally. He had developed aphasia and he only spoke in random words. He could understand what was being said, but was unable to talk intelligibly. When he was later examined in the hospital, he was also noted to have agraphia, the inability to write. Both aphasia and agraphia are signs that something very bad is going on in the brain.
Stone had apparently been the stereotypical “wild journalist” for most of his life. He had volunteered for risky assignments, drank copious amounts of alcohol, and indulged in frequent recreational drug use. He gave up all his vices when he got married a few years before the episode occurs.
House is away in Baltimore and Cuddy wants to transfer Fletch to another hospital. Foreman convinces her to let the rest of the team handle the case, though they keep in touch with House by phone for most of the episode. They initially suspect that Fletch may have had a stroke, suffered a seizure, or may be having a medication reaction. A carotid Doppler was normal as was an EEG. Fletch suddenly develops a coughing spell and has trouble getting oxygen. He is emergently intubated and placed on a ventilator. A chest x-ray shows pulmonary edema (fluid build-up in the lungs). He is given a diuretic (a “water pill”), which apparently worked very well because he is never shown intubated or having breathing problems again.
Meanwhile, his drug screen has come back positive for amphetamines. His editor confesses that Fletch had found difficulty sleeping in his new married life, so he started taking sleeping pills. Those made him too tired during the day, so he started taking amphetamines. Of course his wife knows nothing about this.
Fletch starts running a fever of 101. The team is now concerned about infection (encephalitis or meningitis) or an autoimmune disease. The treatment for these two conditions is very different, and treating both would be counterproductive, so they have to choose one treatment and go with it. House suggests treating the suspected infection with antibiotics and antivirals. He also insists the team obtain an MRI. The MRI shows brain swelling; it also shows scarring in the brain — as if from an old injury — but not in the areas of the brain that would cause aphasia.
Feeling they’ve reached a dead end, the team falls back on an old House standard: breaking and entering. Foreman and Chase search Fletch’s office and home. They find the sleeping pills and amphetamines, as well as a bottle of Topamax (officially a seizure medication, though it has many unofficial uses). At the hospital, Fletch starts complaining of a metallic taste and Cameron realizes that he is going into kidney failure (a metallic taste in the mouth is a symptom of kidney failure).
A lumbar puncture is performed. This can be a dangerous procedure on a patient with elevated intracranial pressure or brain swelling. When the puncture is performed, a sudden drop in intracranial pressure can occur. In patients with swelling, this can be enough to smash the brainstem against the spinal column, causing death. Luckily, Fletch’s test is performed safely and shows some non-specific signs of infection.
Belatedly, the team realizes that Fletch is hiding some of his past from his wife. They lure her out of the room and are able to discover that Fletch has bipolar disorder, which is why he had been taking the Topamax (one of its unofficial uses is as a mood stabilizer). To “cure” his bipolar disease before getting married, he had crossed the border into Mexico or the Caribbean and had an experimental brain surgery designed to cure bipolar. It didn’t work, but it did cause the scarring that the MRI revealed. Also, while he was “south of the border” he contracted malaria, and that is the underlying disease that had been causing all his problems. Fletch is soon cured of malaria, but sadly, his wife had left him because he kept too many secrets from her.
The writers played very loose with the diagnosis of aphasia. The symptoms shown by Fletch (sentences seemingly composed of random words – yet retaining understandable syntax) are not common in any type of aphasia, particularly the “expressive aphasia” Cameron mentioned. In addition, the idea that one can “decode” aphasia is simply ludicrous.
The final solution of malaria was a bit of a letdown as well. Malaria can certainly cause kidney failure and pulmonary edema, but it’s very rare and only in very severe cases. I’m not certain how the malaria caused the aphasia — a stroke maybe? — as that part was conveniently left unexplained. I find it hard to believe that malaria severe enough to cause renal, pulmonary and neurological disease would not have been easier to diagnose; there are many more common early symptoms including the classical cyclical fever (a high fever recurring like clockwork every 24-36 hours). According to the timeline of the episode, Fletch would have to have had malaria for several years without knowing it — something unheard of. While a mechanically tested blood sample would not show malaria specifically, it would show other abnormalities that could be picked up on. Finally, intravenous quinidine is not routinely available in the United States and must be shipped directly from the CDC so the hospital would not just have some on hand.
The soap opera aspect consisted of House and Stacey flying to Baltimore to defend House’s Medicare billing. A snowstorm leaves them stranded in Baltimore and in a single hotel room. There is some mutual smooching going on, but then the case intervenes. Things are left up in the air between House and Stacey, but with a definite “this is never going to work” undertone. I’m not sure why they had to fly to Baltimore (except to get them together and out of the hospital). The billing inquiry could have been handled over the phone or by mail.
I give this episode a B+ for the mystery, bot only a C- for the solution. The medical content also earns a below-average C- (mostly for the “decode the aphasia” scenes). The soap opera earns a B.
January 11th, 2006 at 1:29 am
Asymptomatic malarial infections do occur and the individual can be infected for years. My father lived in India for years and never took any malaria medication nor did he ever have nay symptoms but he did get infected with the malaria parasite. Practically everyone in the tropics has malaria.
January 11th, 2006 at 7:46 am
Actually, they stated that he was going to Baltimore in regards to his MEDICAID billing. While CMS (located in Baltimore) *does* oversee Medicaid somewhat, he would have had to go through his state (NJ) for discrepancies in Medicaid billing, and they certainly wouldn’t have called a “conference” that he’d only need 1 lawyer for. ;) Not to mention that most audits are done when the people in the suits show up in your medical records deparment and start pulling charts.
But I don’t watch House for the realism. :)
January 11th, 2006 at 1:05 pm
Did you think it was neurosyphilis when you saw those spirochetes at the end? Cerebral malaria was such an improbable diagnosis. Especially if you were sick enough to have renal failure you wouldn’t be awake to talk gibberish, Wernicke-wise or otherwise.
January 12th, 2006 at 12:21 am
links for 2006-01-12
Congrats to Susan Mernit joining Yahoo! as Senior Director, Product, for the Personals team, starting January 23rd (tags: susan mernit yahoo) Polite Dissent review of House – Episode 10 (Season 2) (tags: medical TV review) via betsyDevine: HowTo: Make…
January 12th, 2006 at 10:06 pm
Even though Fletcher couldn’t write, was there any reason why they couldn’t have given him a typewriter or a Speak ‘n Spell? Or would his typing skills be inhibited too?
January 13th, 2006 at 4:30 pm
Official Comment
David,
I was so thinking it was syphilis — I even told my wife it had to be. Malaria never crossed my mind…it’s like in a mystery when the cousin they’ve never introduced or even mentioned ends up being the murderer.
Loren,
For most people with aphasia, the communication block affects all forms of outgoing communication. He might be able to draw a picture since that uses a different part of the brain, but for the most part words are words.
January 14th, 2006 at 9:57 pm
My late brother-in-law (a physician) had an enormous fight with Medicare over using the write codes in his billing. He was actually billing LESS by using the “wrong” codes, but it took years and lawyers to get Medicare not to ban him, and to admit he didn’t owe them large quantities of money.
January 15th, 2006 at 11:43 pm
Are a aphasia and dysphasia still different things? I’ve seen a lot of things classified as aphasia that I thought was dysphasia. I had originally learnt that aphasia meant one couldn’t speaking, and dysphasia was the ’saying strange and random things’ one. My learning has been quite sporadic, though, so it could have been wrong there.
June 9th, 2006 at 7:55 pm
I was reading about aphasia, and it apparently seems that you CAN decode aphasia… but only certain kinds of it. Drawing from the information given in the link you (or, I think it’s you…) provided with the word on this page, intonation, identification of spoonerisms, associations, and even rhymes, can be used in decoding it. But… not all different kinds… so it depends (or depended, in Fletch’s case) on what kind of aphasia it is. It’s interesting. :D
(Also, your House reviews are astounding. ^_^)
June 12th, 2006 at 5:17 pm
It seems to me that they could have solved the “decoding aphasia” problem quite easily by going by the route that was used in “The Count of Monte Cristo”: going through the dictionary. Would have taken some time, but still shorter than the time it took for House and his team.
July 21st, 2006 at 12:32 am
I’m a microbiologist and did a presentation on malaria for a class in college once. Scott, as for the cause of aphasia, it seems it was a case of “cerebral malaria”. And they do say so on the show. Cerebral malaria is a know complication of malaria, apparently caused by enlarged red blood cells obstructing capillaries in the brain. That causing aphasia, though, might be a stretch.
The same phenomenon can happen in other organs like liver and kidneys. The liver is also part of the Plasmodium’s life cycle (Plasmodium being the parasitic protozoa that causes malaria).
The disease taking years to present is far from unheard of! It’s quite typical actually. The primary attack can happen up to a year after infection (via mosquito byte), with relapses occurring up to 3 years. Malaria should be considered for any patient showing high fever that has been in central/south America, sub-saharan Africa, and southern parts of Asia, in the last 3 years.
What I found weird in this episode is that the cyclical fever didn€™t tipped them off to Malaria sooner, and that the parasites on the microscope examination of the patients blood looked nothing like the photos I€™ve seen (much like the one you posted, Scott). I think one even needs special colorants in other to see the parasites inside the red blood cells… a normal smear wont do.
I love these medical reviews of House. They have become a must after watching an episode. Thank you Scott!
November 7th, 2006 at 8:06 pm
As a speech-language pathologist, I can tell you that the language output of people with aphasia cannot be decoded. It’s a disorder of symbols…even their gestures are affected (undifferentiated — they tend to use the same gestures for anything they are trying to communicate). Further, they cannot use a dictionary to look up the words they are tryinig to say. People with aphasia WISH there were such a nice answer…there is not. In the case presented on House, the pt clearly thought his expressive language was appropriate…he did NOT recognize his errors. How could a person like that use a dictionary to find the right word? He thinks what he said was right! You cannot decode aphasia.
January 4th, 2007 at 6:42 pm
My grandmother, who had recently been hospitalized when she fell and broke her hip, suffered a bout of aphasia last month, and has only been home about a week. It was fairly disturbing to see a patient on “House” behaving in much the same fashion. (She also collapsed, though it was after I had noticed her speech impairment and called the paramedics.) Even as a total layman, the “decoding” scenes seemed a bit ridiculous. A question – in the hospital, my grandmother claimed to remember not being able to speak correctly, but someone with aphasia believes they are. Is it possible, or is this an example of House’s theory that “everybody lies?” (Believe me, it wouldn’t be the first time – my grandmother still denies that she’s diabetic.)
Also interesting in this episode to see Cameron displaying a modicum of cynicism. I’ve never liked Cameron – which isn’t to say that she’s a bad character. She’s always been an interesting counterpart to House. She’s just as unprofessional – but in her case it stems from her being *too* empathetic, as if House is lacking in bedside manner because it’s all been stolen by Cameron.
January 4th, 2007 at 6:59 pm
Official Comment
Max,
There are different kinds of aphasia. Usually, the person thinks that they are speaking sense when in reality they are speaking nonsens. Sometimes, the patient does realize that it is not coming out right. Often, this is from the reactions of others, but there are occasions where the patient realized exactly what is wrong but can do nothing about it.
February 6th, 2007 at 9:33 pm
For him to have cerebral malaria with multiorgan failure (although he was FAR too well for someone who has cerebral malaria and multiorgan failure) this would most certainly be Plasmodium falciparum malaria. And that one doesn’t incubate for years. And although I’m not completely sure of this, I think the primary agent of malaria in Mexico is Plasmodium vivax – which also doesn’t incubate for long periods of time.
On the contrary, I disagree when you state malaria does not incubate for too long. Plasmodium malariae, which usually causes mild disease or a well tolerated chronic infection, as the ability to incubate for many years – as long as 30 years, actually.
Just my two cents.
May 31st, 2007 at 10:27 pm
For interesting reading on what a transitory attack of aphasia feels like to the person suffering through it, may I suggest this entry?
He was aware that the words were coming out wrong, although I understand that that is not necessarily the case.
June 28th, 2007 at 7:33 am
I have only watched a few episodes of ‘House’ so far, sadly not sure if I can tolerate any more! I know that many medical professionals (including myself) can turn into ’spotters’ when watching medically based dramas, but at least dramas like ‘ER’ seem to do their factual research more thoroughly. I know it is all about entertainment – it is a TV show after all, but that said, I do think the shows researchers have a lot to answer for…perhaps they need to get an updated version of ‘Noddy visits the doctor’.
August 22nd, 2007 at 12:32 pm
Thank you so much, Scott!
Your medical reviews make the show so much more interesting.
November 20th, 2007 at 11:55 am
One does occasionally see patients with the classic “Wernicke” aphasia this patient has. This means that their speech is fluent and sounds “right”, but the words are either totally wrong or intelligible. It is rare, though. Speaking as a geriatrician.
December 27th, 2007 at 6:55 pm
Hari:
From what I remember from my parasitology course,
Although it’s true that P. falciparum doesn’t have a long incubation time, it can go dormant for years after initial symptoms. P. malariae, from what I can remember, can stay dormant for much longer (like the 30-40 years that you mentioned).
The cause of this is that the Plasmodium sporozite (the infectious stage of the organism) does not always go on to develop into the full adult form (go check out the CDC site for the full life cycle.. it’s long, complicated, and I don’t remember as much of it as I wish I did). These “hypnozites” stick around in your liver and can cause relapses in malaria after your body cleans out the initial batch of adult Plasmodium.
However, cerebral malaria (most likely cause by P. falciparum) would definitely be preceeded by other malarial symptoms like cyclic fever before it got to the point of being cerebral.. So yeah, malaria was kinda out-of-the-blue.
January 27th, 2008 at 6:45 pm
Hey, if you see Topamax, you don’t think “weight loss”, you think “major brain thing”. Official uses are temporal lobe epilepsy and migraines; it’s probably most often prescribed for bipolar disorder, though. I can’t see how they can just dismiss Topamax.
March 22nd, 2008 at 12:12 pm
Да, что то намудрили они с малярией и связью её с афазией.
April 2nd, 2008 at 4:44 pm
I’ve had an episode of transient aphasia—diagnosed as an atypical migraine—and it was an extremely weird and scary experience. I actually first noticed it while I was typing on my computer: I couldn’t get words to come out correctly or in the correct order. I could see that they were wrong, but not fix them. With great difficulty, I managed to call my flatmate’s name, and spent the next while trying desperately to express myself while she was trying to find out what was wrong. After about 5 minutes, I was gradually able to put words together again if I thought about it carefully and kept the sentences simple. After another few minutes, I was back to normal. I was very definitely aware of what was happening, and I was able to think quite coherently about health insurance worries.
October 2nd, 2008 at 8:21 pm
Many people have transient aphasia after suffering a stroke. Scott did mention this as a possible cause for the aphasia; however, Fletch was unware he had aphasia, which is fairly atypical after a stroke (to the best of my limited knowledge).
But it is possible, then, that he could have suffered a fairly minor stroke that solely affected his speech, that result in aphasia which, as is common, resulted in using words associated with the correct word, as well as the less common lack of awareness.
But that may be a bit of a stretch.
November 4th, 2008 at 4:15 am
I am reposting this because the page reloaded, so appreciate…
This episode interested me from the first time I saw it. Aphasics in real life have no “dictionary” to work from, but the dialogue for the episode was created by writers. What do you think the original intention of each of Fletcher’s lines were? I’ve included my thoughts below, betwixt all of the lines he spoke as an aphasic.
“I flung the investment. Why I can sign?” / “… Why consign?” (different interpretations) = lit. I screwed that up. Why concern, e.g. What’s the matter, why are you looking at me like that?
“It’s proficient! Why disqualify the rush? I’m tabled.” = It’s excessive, e.g. unnecessary! Why raise a panic? I’m stable.
“I displaced my function. Back late.” / “… Accolade.” = I lost purpose. Previously (I drank).
“I grapple average. Cancer glisten.”
“Of golf.” = Of course.
“What is the durable?” = What is the problem?
“I teal indigent!”
“Keep the stain, knife can’t force.” = Keep the dirty secret; my wife will divorce me.
“They took my stain! I couldn’t tackle the bear.” = They cut my brain! I couldn’t overpower, e.g. overcome my bipolarity.
“I dissuade the tournal category.” / “… tarnal category.” = I deny that damned accusation.
“I dine valor the lever!”
My ramblings are, of golf, far from definitive. Feel free to add your thoughts and interpretations!!
January 2nd, 2009 at 12:18 am
I just wanted to comment about aphasia. My son is 6 years old and has a condition called receptive Aphasia as the result of a stroke. In most cases he is able to speak clearly. but has severe difficulty comprehending oral language. However, when he does have trouble with expressive language he just keeps repeating the same thing over and over. He knows what he wants to say and that is what he hears himself saying, even though that is not what is coming out. I think every case is different, but in his case, we have had a lot of success with using sign language., particularly in the area of receptive/ comprehension.
I enjoy your reviews.
March 24th, 2009 at 4:34 pm
Although there were mistakes in the medicine part of the show, it is still one of my favorite episode.
April 11th, 2009 at 7:13 am
I don’t think it should be quinidine, but quinine. Quinidine is an anti-arrhythmic, white quinine is used for malaria
April 14th, 2009 at 1:24 pm
Your statement that the patient’s speech when aphasic is not characteristic of any sort of aphasia is incorrect. It accurately describes jargon aphasia – http://en.wikipedia.org/wiki/Jargon_aphasia
June 21st, 2009 at 8:41 am
As for malaria, it can be diagnosed pretty late with a touch of bad luck.
My dad started to be sick on Tuesday. Like, badly sick, with fevers and vomiting and whatever. He thought it was from some lousy food he ate at some party the day before. Then the temperature fell, he started to feel better for a day or so, then the fevers were back – but there was no apparent rhythm – three or four days, depending on the exact species of Plasmodium it would be. On Saturday, Mom dragged him to the hospital with subcutaneous bleeding. Since he insisted that he ate something bad, the docs thought it was sepsis. And since we’re rather North and malaria is not a daily thing even in the university hospital, it just didn’t occur until quite a while later when mom mentioned that dad had been to Kenya two weeks ago. Sure, panic followed that it may be some of them evil haemorrhagic fevers and as it sometimes happen, the only lab tech who was able to run tests for tropical diseases was somewhere for the weekend and nobody knew where – this happened some ten years ago, before everybody had two cellphones. I don’t remember whether they brought someone else from another hospital or found the tech somehow but then, the first test for malaria was falsely negative to complicate matters and since the regular pattern of fevers was not present, the docs remained pretty puzzled.
As it goes, when the docs were puzzled, they wanted to get rid of the patient so after some logistic problems (clouds too low for the helicopter, -2 and raining so the roads changed into one big ice rink…) he ended in another hospital with a tropical diseases team, where it was discovered that he had both three-day and four-day malaria, the four-day one being the worst of those available ones and that three or four Europeans had survived it before him. And that it was the Plasmodium falciparum that ate his platelets, resulting in the subcutaneal bleeding.
And yeah, there was indeed pulmonary edema and kidney failure and several other life-threatening complications but if I remember well the explanation, that Plasmodium falciparum migrates in the body, settling in one organ or another and basically knocks it out of the function. I’m not a MD so maybe it’s oversimplified but basically, it always took those four days for one issue – blocked biliary duct (in a guy without one single platelet, I don’t want to know what did the insurance say when they were presented the bill for calling a hematologist from Vienna in case they needed to operate because nobody closer by had experience with such a case), then pulmonary edema, some sort of heart problems, I forgot what exactly, liver failing, kidneys failing…
And should anyone want to know, dad is still alive and kicking, without any permanent damage, and he’s proud of being in all relevant medical textbooks around the country.
January 30th, 2010 at 11:46 pm
I can’t imagine why anyone would think “weight loss” when seeing Topamax. It’s used very often for bipolar disorder (though Trileptal is used more, because it is a derivative of Topamax and is less likely to cause drops in sodium and low white blood cell count) despite that being an off-label use. Seeing that would, I’d imagine, make a doctor think either epilepsy or bipolar. I can’t imagine why they wouldn’t think of it sooner.
February 23rd, 2010 at 5:50 pm
This episode actually has a pretty big medical error. There are two types of aphasia, Broca’s and Wernicke’s. Has full ability to form words, and complete understanding of what people are telling him, but does not realize that he is using the wrong words to answer. These symptoms do not all fall under one form of aphasia. In Broca’s aphasia, the patient will understand what is being said to him, but will lack to ability to form the proper words to answer, and will be fully aware, and very frustrated. In Wernicke’s aphasia, the patient will have no understanding of what is being told/asked of them, but will have the ability to form words, albeit the wrong ones, and will not realize that there is anything wrong with their speech. The patient in this episode has some sort of weird mix of the two, which does not exist.
Not saying it is a bad episode though, I think it is hilarious.
March 23rd, 2010 at 9:41 pm
Hm. I just went through a script of the epi i found online, and i see that “conduction aphasia’ is what is suggested, not expressive aphasia. Does that put a different spin on the discussion?
April 17th, 2010 at 3:04 pm
Excellent Review…
But a Good episode also, House smooches ;-)
May 15th, 2010 at 2:41 pm
I’ve been doing psycholinguistic analysis of stroke aphasia syndromes full-time for the past 4 years, funded by the NIH. So, it’s actually my job to “decode” aphasia, although we do this in a controlled laboratory setting, as opposed to analyzing spontaneous communications (which is indeed quite difficult, often impossible, but not necessarily “ludicrous”). I was thrilled to see a House episode about aphasia, especially since House’s following quote is almost a direct reference to our work: “A fluent aphasic retrieves words that are stored somewhere close to the one he wants. They can be filed by sounds or by meaning. So if he wants to say table, he could say… label, or he could say chair. Or he could just say Jabberwocky, there’s no way to tell.” Actually, analysis of speech errors, and these observations in particular, has been around for a long time, perhaps most notably by Freud. Our research group has gone some way to provide a scientific explanation of how these errors arise from neurological dysfunction. (Here is a great slideshow/lecture by my collaborator and highly influential language researcher, Gary Dell, from University of Illinois – http://www.hstalks.com/review/HST105/2504.htm)
Regarding this particular case, as with most of House’s cases, if this presentation exists at all, it is quite rare. As has been mentioned already, this type of fluent jargon production, particularly in the context of being unaware of one’s own errors, typically is accompanied by comprehension deficits. Language is an extremely complex integration of cognitive processes occurring in a parallel, interactive fashion. Many of the processes can be independently damaged, while sparing others, resulting in characteristic patterns of language performance. These patterns of performance have been classified by clinicians, and the most commonly recognized forms include Wernicke’s, Broca’s, Conduction, Anomic, Transcortical Sensory, Transcortical Motor, and Global aphasia. Wernicke’s and Broca’s aphasia, named for the neurologists who described the characteristic symptoms, were the first of these terms developed, and because of the stark contrast between them, these are the ones you may learn about in a Psych 101 class. In the real world however, the contrasts between diagnoses may not be quite so obvious.
These terms were developed about 100 years before clinical imaging (i.e. PET, CT, MRI) was available, using post-mortem dissection. The idea was to infer the location of brain damage from behavioral symptoms (e.g. Broca’s = anterior, Wernicke’s = posterior, Conduction = disconnection of anterior and posterior), and for the most part, these inferences work. The important thing to remember though is that these are syndromes, representing quite a bit of variability of symptom types and severity. For comparison, consider a patient with autism. This patient may fall anywhere along a spectrum of disorder, but the term itself carries a lot of useful stereotypical information. Many researchers in my field believe we should abandon the clinical terms for aphasia altogether, because they are often too imprecise for our purposes (e.g. localizing a single cognitive process). I disagree, because these terms provide a concise description for clinical purposes; nevertheless, one should be careful not to “pigeonhole” patients based on their diagnosis, especially since symptoms can vary over time through spontaneous recovery, or even over the course of a single day.
Overall, I thought it was a great episode, and I was happy to find such an interesting discussion about this topic.
May 16th, 2010 at 9:34 pm
No one mentioned this before and I know it is late but, Foreman says close to the end that “If someone along the line had bothered to look at the sample instead of running tests they would have seen the parasites.” I thought pathologists were trained to look at the sample at a macro-level, record its colouring that sort of thing. Of course being that the doctors were doing all the work themselves would explain it but I think the comment was unnecessary and fairly derogatory towards pathology staff.
January 28th, 2011 at 2:14 am
I liked the episode although there were a couple of mistakes as in every episode. First I thought about a brain abcess (hence the cyclic fever) when they mentioned he probably was on drugs since HIV is a riskfactor for a toxoplasmosis infection. You should’ve seen that on the MRI though. PML also crossed my mind but the fever didn’t really fit.
The biggest mistake was that the MRI didn’t show any signs of infarction or hemorrhage. In cerebral malaria there’s occlusion of the small vessels causing microbleeds (as in vasculitis) and multiple infarctions. In the episode they only checked the T2 series, while they should’ve made DWI series and SWI.
On DWI, in respect to a clinical aphasia, there HAVE to be hyperintense lesions in the corresponding areas. On SWI you’d clearly see the microbleeds. When you’re thinking about recent infarction only T2 is obviously not enough.
As people mentioned before, the aphasia was of a strange type.
It was a typical wortsalat like in Wernicke, but the comprehension was completely intact.
February 11th, 2011 at 3:53 am
This has been bothering me for five years: No one living in greater Princeton would fly to Baltimore. The train takes less than two hours.
April 21st, 2011 at 7:11 pm
Hey,
love your reviews by the way, keep them coming untill house goes of.
i dont know how long its bin since you posted this review, but i recon its about 5 years ago?
i know its a long time ago but i wanted to correct you on something, or if i’m wrong, you correct me on my correction of your correction of house (Im getting a headache)
you said that the decode the aphasia thing was “ludicrous”
So i looked it up
cause i figured that its not to much of a long shot that this was possible
so i googled, used about 40 minuts and i came over this
http://books.google.no/books?id=0asXiTckqp0C&pg=PA71&lpg=PA71&dq=aphasia+nife+instead+of+spoon&source=bl&ots=DZJqehvVPl&sig=9yM2Ws54Om-LFfqweVurQfYMFJM&hl=no&ei=rMOwTaDpL5WW4gaIoIijDA&sa=X&oi=book_result&ct=result&resnum=1&ved=0CBgQ6AEwAA#v=onepage&q&f=false
read the part that starts : When paitients says words that ryhmes with the correct……
i hope the link work, if not email me
i wanned to find out wether or not it is possible for a person with a serton type of aphesia to choose a word close in meaning as the word they wont like “spoon” instead of “Knife”
or by ryme like, as house use as an exaple “lable” instead of “table”
so my correction or your review is
it should in theory be possible to “decode the aphasia”
My email: Sigurdbergsvela@gmail.com
please Give me an answer, i would be delightet to hear wether i’m right or not
(I’m from norway and have dyslexia, please ignore the spilling errors)
January 12th, 2012 at 12:19 pm
I’m not certain how the malaria caused the aphasia — a stroke maybe?
Forgive me if I’m wrong here, the way I understood it was that the aphasia was caused because he hit his head quite nastily.
Also, I’m not a writer either but this episode pricked my interest and I did some research. I found that polyglots who suffer aphasia sometimes forget their mother tongue and start speaking in a language they learnt later. This would have been an interesting twist and a chance for House to show off since he is himself a polyglot if the patient had been multilingual as well. It would have made sense of the decoding part as well.
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