Meredith feels the pain of being torn between her boyfriend who wants
her to kick out all her other roommates and her friends, who need a
place to live. Retaking the intern exam is George's pain. And nothing
says pain to Cristina like NOT being on the cardiothoracic surgery
rotation. But, none of these compare to Derek's patient, Phillip
Patmore's pain. He has been living with an intense unrelenting headache
for seven years!
When it was clear that a simple aspirin wasn't going to stop the
Phillip's pain, doctors prescribed narcotics, anti-seizure medications,
antidepressants, anti-psychotics. None of these worked. Phillip's tried
everything except having part of his brain surgically removed and that
is exactly what Dr. McDreamy, pain specialist and neurosurgeon
extraordinaire is about to do.
The procedure is called a bilateral cingulotomy. Derek opens into
Phillip's skull, targets part of his frontal lobe and removes two small
pieces of his brain. It's so radical that it is only done in cases of
extreme and unmanageable pain or OCD. The risks are serious: seizures,
cognitive defects and behavioral changes and no one knows exactly why
this technique works
But, right before the surgery, Lexie Grey, Meredith's younger sister
with a photographic memory, remembers an obscure condition of a pinched
sinus nerve which is described as the worst pain you'll ever know.
Lexie makes a connection. What if Phillip's headache is actually caused
by a pinched sinus nerve?
Inside the nasal passages there are turbinates, which regulate the flow
of air through the nose. They filter out harmful particles and add
moisture to the air and warm it before it travels to the lungs.
Sometimes a previous infection or a trauma causes a glitch and a nerve
in Phillip's case the ethmodial nerve gets trapped between one of these
turbinates and the nasal septum. It's called a "contact point" or
"trigger". Because this condition is so rare, the most difficult part
of the diagnosis is thinking of it. Usually sinus headaches involve
inflammation and swelling of the sinuses. But in Phillips case he had
no current sinus infection or swollen sinus tissue, so doctors had not
considered this as a possibility. Once it is suspected, there are two
easy ways to rule out or confirm the diagnosis. The first, while the
pain is in evidence, put anesthetic on it. If the headache goes away,
then a trapped ethmodial nerve is indeed the problem. The second way is
to push on the trigger and if the patient screams in pain. Either way a
simple surgery to clear out the blockage that is putting pressure on
the nerve will fix the problem permanently.
While Lexie is sometimes the cause of Mereidth's pain, for Phillip
Patmore, little Lexipedia saved the day!
