The Case of the Confused Grandfather

For months, the 78-year-old* had been behaving strangely. Fearing the worst, his family consulted UCSF neurologist Georges Naasan, MD.

Four panel cartoon illustration. Top panel, left. Text reads: The Case of the Confused Grandfather. For months For months, the 78-year-old* had been behaving strangely. Fearing the worst, his family consulted UCSF neurologist Georges Naasan, MD. As told to Ariel Bleicher. Illustrated by Eleanor Davis. Below text: large cartoon illustration of Dr. Naasan with four thought bubbles coming out of his head. First thought bubble reads: The patient was severely paranoid: He thought the hospital staff was out to get him. Most doctors would have diagnosed dementia, but I knew this wasn’t your typical case. On right: cartoon of Dr. Hassan holding a clipboard, with an elderly male patient and two women next to him with concerned looks on their faces. Text above elderly patient’s head reads: involuntary spasm and a thought bubble reads: Food tastes bad. My bones hurt. You’re not a real doctor! Thought bubbles above women’s head read: Dad is normally so sweet. He tore up the intake form and ate it! Second panel, left: Cartoon illustration of Dr. Nassan. Text to the left reads: George Naasan, MD, UCSF Memory and Aging Center. Thought bubble to right of him reads: Testing was hard. Everything was a negotiation. To right: cartoon illustration of Dr. Naasan holding up a syringe and elderly patient with his hands up. Thought bubbles read: We need to draw some blood. I’ll only give you three tubes. How about five? Third panel, left: cartoon showing silhouette of a large head, with the brain visible, in color, and three indicators, one pointing to a neuron, one pointing to a killer immune cell, and one pointing to a tumor antibody. Thought bubble from Dr. Naasan reads: The MRI and spinal tap results were unremarkable. At right: cartoon of Dr. Nassan studying brain scans. Four different pathogens are crossed out, indicating that he eliminated them as a cause. Fourth panel, left: cartoon silhouette of brain described above. To right: cartoon of woman looking sad and elderly patient next to her looking confused. Thought bubble reads: If it really is dementia, we’ll take him back to Ohio to care for him – and say goodbye. Fifth panel: Two thought bubbles from Dr. Naasan read: Finally, after two weeks of searching, we found a molecule in his blood – an antibody – that suggested his immune system was attacking his brain. This is very rare, but it can sometimes be triggered by cancer. We scanned the patient and found colon cancer. Cartoon to right: Dr. Naasan holding a clipboard and speaking with the woman, who is crying and holding her hands to her chest. Thought bubble from Dr. Naasan reads: If we treat your father’s cancer, his cognitive problem may go away. Thought bubble from woman reads: Thank you for not giving up. Thought bubble from Dr. Naasan reads: Thank you for trusting me.

* Identifying information about the patient and his family has been changed to protect their privacy. The rest of the story is true according to Naasan’s memory and case notes.