An Unusual Presentation

Several months ago I went to see a patient in my ED with the Chief Complaint: Altered Mental Status. Fairly common complaint in the ED.

On entering the room was a mid-60′s nice, polite lady and her two daughters, who were visibly nervous about being there.

What seems to be the problem?

“You have to understand that our mom is not a cookies-and-milk grandma. She’s not, she’s actually a piss-and-vinegar type. Usually she’s a little mean, but the last week or so she’s been the nicest little old lady in the world. Something is wrong with our mom.”

So, you think there’s something wrong with your mom because now she’s being nice?

“Very much so. This isn’t her usual self.”

After a pretty unremarkable rest of the history and exam (except for a remarkably nice and polite patient) I had to talk myself into doing a workup, but I did. I ordered blood and urine tests, and a CT scan of the head.

A CT which showed a marble-sized frontal lobe brain tumor with some surrounding edema. A tumor in the region of the brain having to do with personality. I found out why she was nice. Her daughters were actually relieved, not that mom had a tumor but that they hadn’t been wasting everyones’ time.

Amazing thing, being too nice. It took a brain tumor to make her that way.