TV Checkup: <i>HOUSE</i>: This Diagnosis Was Hard to Swallow

A young Ukrainian female experiences hallucinations, delusions, and seizures and is placed under Dr. House's care.

This week's wild goose chase included workplace toxicity, Creutzfeld-Jakob agent (the same prion felt responsible for mad cow disease), porphyria, Parkinson's Disease, and vasculitis.

[Hey! When did the medical terminology Jakob-Creutzfeld get reversed anyway? That's akin to introducing the classic comic team Hardy & Laurel. Was money involved?]

Eventually one of the competing fellowship applicants burps up the correct diagnosis: Ergot poisoning.

Now before I discuss ergot poisoning I have to take issue with House's writers (for a third consecutive episode) for misrepresenting the neurophysiology of vision. Early in the episode retinal vasculitis was considered - inflammation of the retinal vessels. The team's hypothesis was that the starving retina was transmitting visual hallucinations to the brain.

In order to test the retina's ability to communicate with the brain they performed some kind of Hollywood-improvised visual psychometric device that attempted to imitate a cross between VEP (visual evoked potentials) and an ERG (electroretinogram). Nice try, but the patient was not dark adapted, the exam room was illuminated and I saw no flashes of light. Three strikes and you're out! Color testing, pupillary light reflexes and a peek with an ophthalmoscope would have given them all the information they needed! I'm really starting to develop a complex about the recurring ophthalmic misrepresentation in this show.

Don't confuse Ergotism (patient's poisoning) with Egotism (House's poisoning).

Ergot refers to a psychoactive chemical that is naturally occurring in select fungal species. There are prescription medications that contain ergot derivatives. Battlefield chemical weapons rely on ergot poisoning to immobilize enemy forces. Ergot pops up in all kinds of plants, grains and mushrooms. Apparently this culturally attentive Eastern European consumed lots of dark moldy bread just like they did back home on the farm. Ergot poisoning causes a slow heart rate, vasoconstriction, tissue ischemia, hallucinations, tremors, seizures and tiny pupils (What did I tell you?!? Another inadequate eye exam on House!)

Fluids and supportive care works for mild cases. Atropine can be administered as an antidote. US troops carry injectable atropine with them if there is a risk of ergot exposure.

The woman was treated, she quickly recovered, and at discharge the hospital nutritionist switched her to Wonder Bread.

Nah, I made up that last part.

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