|Diagnosis||Propylene glycol poisoning|
|First Appearance||Both Sides Now|
Scott is a patient who has had split brain surgery recently causing the right hemisphere of his brain to be a different person than his left. While at dinner with his wife his left hand throws rolls at someone. When the person confronts him his left hand spills its drink on him, then a tear of blood appears on his eye.
He was taken to Princeton-Plainsboro Teaching Hospital to be treated by House. As the two sides of Scott’s brain struggle for dominance, his warring personalities make it increasingly difficult for the team to figure out what is causing the unique problem. The team is forced to use some unusual methods to get him to cooperate with their necessary testing. His left hand hits his girlfriend and she leaves.
Later on, his girlfriend returns and explains that she thinks the deodorant caused it because when the left hand threw it he seemed angry. And she had brought him the deodorant causing him to hit her. Foreman notes that she is correct. Scott is told to say "I am going shopping" out loud before going shopping. He leaves Princeton-Plainsboro.
The patient suffered from frequent seizures and anti-seizure medication was ineffective. As a last resort, the patient had surgery to sever his corpus callosum, thereby eliminating any communication between the rational word-centered left hemisphere of the brain and the more creative and image centered right hemisphere. The surgery successfully ended his seizures, but had an unintended side effect - alien hand syndrome. As a result, the patient's left hand (which is controlled by his right brain) often engages in actions over which the patient has no conscious control. Otherwise, the patient showed no other neurological or cognitive impairment.
The patient was admitted after he collapsed during a tussle in a restaurant, the result of his left hand throwing rolls and water at another patient. he was bleeding from his left eye. Dr. Taub was consulted by Dr. Cameron, but he felt that the bleed was merely a minor hemmorhage and the loss of his sense of taste was another symptom of a common cold or similar malady. The patient described to Dr. Taub the problems he was having with his left hand. Dr. Hadley thought it might be an autoimmune disease, a nasal-lacrimal tumor, an infection or even a cold. Dr. House ordered an environmental scan.
Dr. Taub and Dr. Hadley performed the environmental scan. They found fungus.
Dr. Hadley noted the patient's alien hand throwing a deodorant container away with force. She gave the patient anti-fungal medication by putting an intravenous tube in his right arm. Suddenly, the patient's left hand struck his wife. When she left, the patient tried to follow her, but realized he could not walk.
The patient's inability to walk seemed to rule out a fungus. The patient's coordination seemed fine. Dr. House thought it might be a meningioma that had re-grown the link between the two hemispheres. Dr. Foreman went to run tests.
Dr. Foreman ran a test where only one part of the brain could see an image on one part of the screen at a time. The patient could not see words on his left side, but could draw pictures representing the word. This showed there was no communication between the two hemispheres. They double checked by seeing if the patient would confabulate why he stood up when they flashed the words 'stand up' to his right brain. Dr. House noted the patient was itching and had ammonia on his breath. This showed his liver was failing. Dr. House went to Dr. Cuddy to seek permission to do a liver biopsy. She agreed.
Dr. Hadley tried to perform an ultrasound, but the patient's alien hand kept knocking her away. Dr. Taub wondered how they were going to perform a biopsy if the alien hand was going to try to stop them. The patient suggested playing music, and the alien hand started playing along as if it were doing the fingering on a guitar. This allowed Dr. Taub to do the biopsy. However, Dr. Hadley noted the patient had splinter hemorrhages under his fingernails. Suddenly, the patient started vomiting blood. Dr. Hadley ordered a unit of B- type blood for a transfusion.
The patient's new symptoms ruled out sarcoidosis and pointed to a clotting problem. The patient was on heparin and an echocardiogram was performed, but it did not show that the heart was throwing clots. The patient's blood tests for clotting factor problems were all negative. Dr. Hadley mentioned the patient had a history of heavy sweating. Lymphoma and pancreatic cancer can both cause night sweating. Dr. House ordered a scan of the pancreas.
The patient tried to discharge himself. However, his alien hand kept trying to undress him.
As they performed an MRI, Dr. Wilson talked to the patient to attempt to have the patient reconcile his brain's two hemispheres. The scan showed no abnormalities. Dr. House still believed it was pancreatic cancer, but in the early stages. Dr. House suggested a procedure using surgery, scorpion venom and infrared paint that highlights cancerous cells. However, Dr. Foreman pointed out that this could cause dangerous clotting which could lead to a stroke. However, Dr. Taub noted that only one hemisphere would die in this case, and that the patient might accept that. The patient was informed and consented to the procedure.
Dr. Chase performed the surgery. There was no sign of cancer, but the patient's blood pressured dropped to 90/60. Suddenly Dr. House appeared and ordered an immediate transesophageal echocardiogram. He had realized that the patient's heart was only throwing clots due to an intermittent Arrhythmia, which is why the patient's blood pressure was dropping. The echo confirmed that the heart was throwing clots.
Dr. Hadley suggested rhabdo, but Dr. Taub pointed out that it also causes kidney problems. Dr. Taub suggested Grave's disease, but the thyroid function tests were normal. Dr. Hadley suggested cortisol overproduction. Dr. House agreed and ordered a dexamethasone suppression test.
The patient's girlfriend returned and noted that although the alien hand often threw things, the deodorant was the only thing that he threw in anger. The patient noted he used the deodorant several times a day because of his sweating. It was a special heavy duty deodorant. Dr. Taub and Dr. Hadley decided to check out the effects of the deodorant. The alien hand softly caressed the girlfriend.
The deodorant had a high proportion of propylene glycol, which can cause heart problems and seizures. The patient's deodorant may have been causing his seizures as well, which meant the split brain surgery was unnecessary.