seizure

She was brought in by EMS after having a full tonic-clonic seizure at work. The seizure lasted about a minute. She was awake and a little befuddled as is often the case in someone that has just had a seizure. No history of seizures so that's a problem. Not that adults don't start having epilepsy, they do, but often new seizures mean something is going wrong in the brain. No medical history, says she has been feeling fine up until today but even today only a mild headache, nothing major.

Off to CT scan she goes. The scan shows a huge mass with multiple 'tentacles'. The mass had started on the right side of her brain but now has penetrated across the midline into the left hemisphere. It's a particularly malignant brain cancer known as Glioblastoma Multiforme, or GBM. The radiologist has never seen any thing like it, keeps asking what kind of symptoms the patient has been having and is disbelieving when we tell him that she has had none before.

We return to the ER where her anxious husband is now waiting. The ER attending is faced with giving them the news. The patient and her husband are bewildered and devastated, but she hasn't been sick? Are you sure? Maybe there is some mistake. How can you go to work normal in the morning and end the day with a death sentence?