He had spent the previous six months in a private treatment center receiving care for bipolar disorder and depression. Chloe had gotten better and was ready to move into transitional housing when she suddenly became combative and threatened to harm staff and kill herself. Police had taken her to the emergency room at Cedars-Sinai Marina del Rey Hospital before a planned transfer to a psychiatric hospital.
Chloe, Mitchell recalled, was “muttering about Rosa Parks” when they met. She managed to tell the doctor that she had not used drugs or alcohol, but that she was otherwise incoherent. “We get a lot of psychiatric patients, and they’re just waiting to be placed,” Mitchell said.
But something indefinable, Mitchell characterized as “perhaps a gut instinct” honed by nearly two decades of practice, prompted her to order a CT scan of Chloe’s head to better assess her condition. state of mind.
When he held up the image, Mitchell gasped. “I’ve never seen anything like it,” she said. He rounded up his colleagues and “had everyone in the ER come watch.”
“I was speechless,” he said. “All she could think was ‘How did no one notice this?’ ”
That question resonated more deeply after she spoke with Chloe’s mother. That’s when Mitchell learned of the shocking oversight that resulted in years of needless anguish for Chloe and her family.
For life coach Alison Houghton Kral, the initial plan to send her daughter to a closed ward was a devastating coda to the previous six years.
Chloe had left her parents’ home near Palos Verdes, California, in August 2015 to start college at the Fashion Institute of Technology in New York. Her first semester was difficult, not unusual for a college freshman. “I struggled a lot and was very homesick,” Chloe recalled. Over Thanksgiving break, she saw a therapist who prescribed antidepressants, which seemed to help.
“I couldn’t wait to go back” for sophomore year, her mother recalled. But in late October 2016, Alison was visiting her native Australia when she called Chloe. “She said, ‘Mom, I can’t do this. I want to go home. ”
Alison flew to New York to discover that Chloe had been bedridden for six weeks, skipping school, and seemed oddly unoccupied.
“She couldn’t understand things like, ‘Can you pack that box?’ She would have to say, ‘Take the books off the shelf, then put them in the box, then seal the box.’ She was completely beside herself,” said Alison, who attributed the behavior to severe depression.
Once home, Chloe went back to the therapist. “I felt very depressed,” she said, “but I don’t remember why I felt depressed.” Her memory of the years prior to her diagnosis is patchy.
She enrolled in community college but dropped out after forgetting to turn in assignments, a stark contrast to high school when she was focused and organized. And she got fired from jobs at a movie theater and at a local market because she couldn’t remember her instructions.
“It was very upsetting,” Chloe said.
Her mother, who practices yoga, thought it might improve her daughter’s mood. But she noticed that Chloe seemed to wobble, even in basic positions on her hands and knees on the floor. Her instability was the latest of the physical changes that she had begun in early adolescence. She tended to veer to the side when she walked, bumping into whoever was next to her. She sometimes tripped going up stairs. Although Chloe had been a good skier, around the age of 13 she fell more often and eventually gave up the sport.
“Throughout high school I struggled with not being able to walk in a straight line,” Chloe recalled. “It became kind of a joke.”
He also fainted periodically. In early 2018, she was taken by ambulance to the emergency room after fainting; no cause was found. When Alison followed up with the pediatrician, she said the doctor’s response was “Some people faint a lot.”
In late 2018, a therapist friend of Alison’s suggested that Chloe might have attention deficit hyperactivity disorder (ADHD). Testing revealed a mild case along with severe anxiety.
Despite therapy and various combinations of medications, Chloe seemed worse. In 2019 she experienced what seemed to be bipolar episodes. She didn’t sleep, she talked fast, and she was unusually aggressive. She once she disappeared for two days.
At other times, he would cling to his mother and follow her around the house for hours like a small child. Her psychiatrist, who had prescribed medication for bipolar depression, told Alison that her daughter was also showing signs of depression. derealization, a disorder sometimes associated with trauma, in which people think their surroundings are not real. Chloe expressed doubt that her father, a songwriter, and her mother were her parents.
“Nothing seemed to help,” Alison said.
Starting in the summer of 2020, Alison noticed that Chloe would sometimes drag her right foot when the couple went for a walk.
“There was so much going on,” Alison noted, “and I kept thinking that if I went to the doctor and she didn’t” drag her foot, then what was the point? She assumed it was another sign of worsening mental illness.
By fall, Chloe spent her days on the living room sofa, inert. She forgot to bathe or brush her teeth. She once urinated while she was riding in her mother’s car. Her parents consulted a second psychiatrist, who told them that she needed to be hospitalized. In September she was admitted to a center that provided intensive psychotherapy.
“I told them all about the foot drag, the urination, I gave them everything,” Alison recalled of the lengthy intake interview. “They told me that they noticed the strange way of walking her.” When Chloe wet her pants during an hour-long visit with her mother a few weeks after her admission, Alison told staff about her.
“They said ‘Oh, maybe she has a AND YOU,‘” Alison says she was told. But after Chloe tested negative for a urinary tract infection, that seemed to be the end of the matter.
His six-month stay cost his parents $180,000. “It was our savings plus some of her college fund,” Alison said. “She just stripped us naked, but what choice did we have? I remember thinking if this doesn’t work, I don’t know what we’re going to do.”
Mitchell’s first call to Alison from the ER was brief. Her daughter was being evaluated, the doctor said, before she was transferred to a psychiatric hospital an hour away.
Less than two hours later, he called again with explosive news. Chloe had a life-threatening condition that Mitchell characterized as “the most severe case of hydrocephalus I have ever seen.” She needed brain surgery as soon as she could be scheduled and they were going to send her to the neuro-ICU in Cedars-Sinai.
hydrocephaluspopularly known as “water on the brain”, is caused by the accumulation of cerebrospinal fluid in cavities known as ventricles. Cerebrospinal fluid, which protects the brain, is vitally important for a wide variety of brain functions. The excess fluid was compressing the brain. frontal lobe —responsible for memory, decision-making, and emotions— against the inside of Chloe’s skull because it couldn’t be reabsorbed. Without treatment, hydrocephalus, which can be present at birth or occur later in life, can cause brain damage, coma, or death.
Alison had never heard of hydrocephalus. And Chloe, she told Mitchell, had never undergone brain imaging.
Mitchell mentioned the diagnostic mnemonics he had learned in medical school; “wet, wobbly and crazy.” She was incredulous when Alison listed telltale symptoms of hydrocephalus, many of which date back years: poor balance, trouble walking, personality changes, confusion, fainting, memory lapses, and involuntary urination.
“I can’t believe no one has ever ordered a CT scan,” Mitchell said. “That’s what I thought was very strange.”
“There were things that we noticed and I certainly didn’t put them together and the medical staff didn’t put them together,” Alison said.
An MRI determined that Chloe’s hydrocephalus was caused by aqueductal stenosis, a narrowing between the ventricles that caused a blockage. The obstruction, which she was present at birth, was partial and her brain compensated until she couldn’t take it anymore, she said. neurosurgeon Ray M. Chuwho treated her at Cedars-Sinai.
If Chloe had developed headaches, double vision or nausea, which can also be symptoms of hydrocephalus, or if her symptoms had been going on for a few months, Chu thinks she might have been diagnosed earlier.
“If there’s something funny going on, it doesn’t hurt to get brain images,” Chu said, which would have revealed hydrocephalus. He called the delay of years “pretty unusual.”
“It’s a cautionary tale,” Chu observed. “People are pigeonholed” if they have a psychiatric diagnosis.
Chu made a endoscopic ventriculostomy of the third ventriculostomy, a minimally invasive procedure that creates a permanent pathway to relieve pressure and allow fluid to drain properly.
The day after her operation, Alison received a call from Chloe, who had been incoherent just 24 hours earlier. “She was like, ‘Oh hey mom, can you get some magazines or something? It’s really boring here. It was like a miracle.” Some patients are not so lucky; hydrocephalus can cause irreversible brain damage.
Chloe went home after a five day stay. Chu, who saw her in June, described her as “a totally different person.” She was driving again, working at Nordstrom and headed to college in San Francisco.
Chloe continues to take medication for her mental health. Doctors have said they cannot determine if all of her psychiatric symptoms were related to hydrocephalus. “I’m not angry, like ‘Why did this happen to me?’ I’m over that now,” she said. She recently completed a semester of college and is taking a break at home.
Alison, who says she is particularly grateful to Mitchell, is traumatized by the ordeal. She has repeatedly wondered what she should have done differently. And she regrets not taking Chloe to a doctor after she started dragging her foot, which could have been “a game changer.”
“I was completely overwhelmed,” Alison said. “I watched her life disappear and felt completely powerless to know what to do to help her. I have a lot of sadness for that and for the things that she has had to go through. And then of course how much it has cost us financially.”
Mitchell has pondered what Chloe’s future would have looked like without that CT scan. “I think she would have ended up in a closed psychiatric facility” until she had a seizure “and then I hope someone found out,” she said. “But I’m not sure.”
Sandra G. Boodman, a staff writer for the Washington Post for more than 30 years, created the Medical Mysteries column.
