Can You Make the Diagnosis? (and a little Delirium Tremens)

July 31st, 2009

Filed under: Comics, Medicine

Time for another Comic Book Medicine Case Study. There’s a fair amount of discussion after the case study — not about the actual diagnosis — but about what the patient thinks it is.

Case Study #10: The patient is a male in his late thirties. Though generally healthy, he leads a sedentary lifestyle and has a high stress job. His face had a ruddy complexion and he admits to being a “social drinker.”

While out to dinner alone one night, he experiences the sudden onset of a severe weakness of the left arm. None of his other limbs are affected. There is no history of prior injury, and he denies any numbness, tingling, or pain in the involved extremity.

The correct diagnosis for this patient is:
A. A stroke
B. Caught up in a science experiment gone wrong
C. Multiple Sclerosis.
D. Victim of a magic spell.
E. Tetrodotoxin poisoning (i.e fugu, or puffer fish)

Click here for the ANSWER


The victim’s response to his predicament is interesting.

First he is concerned about paralysis — but his arm’s not actually paralyzed; it’s the wine glass that is immobile. Surely he can feel his hand grip as he tries to move the glass. He must have had more to drink than just a sip or two of wine.

Second he is concerned about the DTs — also known as “delirium tremens“. DTs are a very severe and potentially fatal type of alcohol withdrawal. They are typically seen in chronic alcoholics who haven’t had any alcohol for several days. Classically, patients with DTs experience hallucinations (the delirium part) and the shakes (the tremens). That’s an oversimplification of a complex condition, but it’s enough to show that nothing in this scene fits the diagnosis of delirium tremens. For starters, being unable to move the arm — or being suddenly incredibly weak — is not a symptom of the DTs. More importantly, the cause of DTs is lack of alcohol — which does not describe this gentleman at all.

Playing armchair psychologist for a minute, I suspect that all the patient knows about delirium tremens is that it is alcohol related and that it is very bad. I also suspect that he realizes that he drinks too much. Thus, when something bizarre and frightening like this occurs, he automatically assumes it is related to his drinking and must be bad — and therefore he latches onto the idea of DTs.

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9 Responses to “ Can You Make the Diagnosis? (and a little Delirium Tremens) ”

  1. Dean
    July 31st, 2009 at 2:01 am

    I believe that’s Zatara, not Zatanna.

  2. Carl
    July 31st, 2009 at 6:08 am

    Why is this guy drinking Romulan Ale? At least according to my monitor that wine is blue.

  3. Scott
    July 31st, 2009 at 9:21 am
    Official Comment


    Oops. Fixed it.

  4. Karl Withakay
    July 31st, 2009 at 9:44 am

    Is there any reason why he couldn’t just shout, “Don’t drink the wine, it’s poisoned!”, shatter the glass, or simply use his magic powers to neutralize the poison?

    Note to self, don’t drink blue wine, it’s may be poisoned.

  5. Mr. B
    July 31st, 2009 at 5:52 pm

    Just follow the advice from The Court Jester (1956 Danny Kaye) and you wont be poisoned. lol

  6. Sarah
    July 31st, 2009 at 7:54 pm

    Is there any reason why he couldn’t just shout, “Don’t drink the wine, it’s poisoned!”

    This way it’s more fun? Comic mischief and lifesaving don’t have to be mutually exclusive : )

  7. Jayunderscorezero
    July 31st, 2009 at 8:06 pm

    This may have been a deliberate trap on your part, but I assumed you were describing Homer Simpson and hence guessed E.

  8. Scott
    August 1st, 2009 at 12:01 am
    Official Comment

    The murderess (or attempted-murderess) was still in the restaurant, so Zatara didn’t call out a warning for fear of alerting her that her plan had failed.

    Of course, the fact that her victim lived to walk out of the restaurant should have told her something was wrong as the poison is later described as “instantly fatal.”

  9. Al
    August 2nd, 2009 at 8:03 am

    Hey Scott, House returns in September. Is now too early to start getting predictions in?

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