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I'm STUMPED!!!

Discussion in 'General Residency Issues' started by Abby Knows, Apr 12, 2007.

  1. Abby Knows

    Abby Knows

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    Apr 11, 2007
    Came across someone with these Sx: tingling sensation under the skin, starting in the lower body, front and back, traveling upward to the head and under the scalp, and then going into the head between the bones, now has severe headaches off and on. person demands it's protozoa.
    Does anyone have any idea what this could be?
     
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  3. Tired

    Tired Fading away 7+ Year Member

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    Dec 12, 2006
    This isn't the Psych forum.
     
  4. San_Juan_Sun

    San_Juan_Sun Professor of Life 7+ Year Member

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    Aug 9, 2002
    Malingering.
     
  5. USAF MD '05

    USAF MD '05 Just another dumb ER doc. 7+ Year Member

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    Dec 7, 2004
    across the pond
    Morgellons Disease
     
  6. sophiejane

    sophiejane Exhausted Moderator Emeritus 7+ Year Member

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    Sep 18, 2003
    Waco, TX
    I think the severe headaches deserve some investigation. I wouldn't write this person off just because they also have some bizarre complaints. Migraines can cause sensory auras with tingling sensations.

    Do they have diabetes? Have they travelled recently? Are they from Mexico? Pork eater?

    I would go after the headaches before trying to put the pieces of the tingling sensation together. It may well be malingering, but you cannot write people off just like that and call it a psych case--it's not good medicine.
     
  7. McDoctor

    McDoctor Over One Billion Cured 5+ Year Member

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    Feb 13, 2006
    McHospital
    I agree. You have to work up the headache, and make sure there isn't an intracranial lesion. This can be done with a good neuro exam.

    An elevated eosinophil count could point to a parasite. This is probably not the case based on what you described.

    Connective Tissue Disorders can cause some of these symptoms. I wouldn't necessarily order an ANA, but would specifically ask questions to rule in or rule out things like SLE.

    I like to order sed rates on patients like this when I'm not sure if there is a significant psychiatric component. A normal sed rate pretty much excludes an overwhelming infectious or autoimmune process.

    Definitely psych is in the differential, like delusional parasitosis or cocaine dependence.

    I called in sick today. Thanks for making me feel like I'm at morning report, anyway.:thumbdown:
     
  8. Faebinder

    Faebinder Slow Wave Smurf 10+ Year Member

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    May 24, 2006
    Pennsylvania
    OOOOOhh... I know... this is half-Nematode half-Amoeboflagellate cross-breed :eek:

    You know.. one of those unique prehistoric monsters... capable of multiplying outside the body and still able to penetrate the skin and get into your nervous system..


    (It could be good old schizophrenia or he could be a politician... But I would never insult a patient by calling him a politician. He's better off being schizophrenic, at least it's treatable.).:cool:
     
  9. razorback58

    razorback58 Resident 2+ Year Member

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    Mar 17, 2007
    What other health issues? How old? What does neuro exam reveal? History of patient? Could check for teritiary syphilis? Some things don't present classically.
     
  10. LADoc00

    LADoc00 There is no substitute for victory. 10+ Year Member

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    That or acute napthalene toxicity from termite exposure. Saw that one on House.
     
  11. Whodathunkit

    Whodathunkit Senior Member 7+ Year Member

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    Nov 6, 2003
  12. SexPanther

    SexPanther This could be a problem 10+ Year Member

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    Feb 5, 2006
    If we're throwing in Zebras, how about Anterior Thalamic Syndrome (its got some fancy name like Dijiridou etc)
     
  13. TUCOMSam

    TUCOMSam Junior Member 5+ Year Member

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    Jul 31, 2006
    SoCal
    The OP probably is the one experiencing these Sx and so is trying to get an online Dx from all of us suckers on here. Maybe??? Or not... whichever. Clever approach and curious sx either way.
     

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