Ep. 52 | A Dark Discovery
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One evening, a mother set a plate of chicken and rice on the table in front of her five-year-old daughter, and then she handed her some plastic silverware. The woman made a plate for herself, too, and then she sat down to eat. But before she could take a bite, she looked over and noticed that her daughter was struggling to use her fork. She kept poking empty spots on her plate like she didn't really understand how to use the fork, which she definitely did.

She asked her daughter, you know, "Hey, do you need help with that?" And the little girl's voice trembled as she said she just couldn't find her food. And then the mother watched in total shock and confusion as her daughter brought her fork down hard on the edge of her plate, not even touching her food, tipping it over and sending all her dinner flying across the table. The little girl burst out crying and the mother just stared at the mess, trying to understand what was wrong with her normally cheerful, happy daughter.

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Bank products are issued by Evolve Bank & Trust, member FDIC. From Ballin Studios and Wondery, I'm Mr. Ballin, and this is Mr. Ballin's Medical Mysteries, where every week we will explore a new baffling mystery originating from the one place we all can't escape, our own bodies.

If you liked today's story, please take the follow button to an amusement park and convince them to go on the biggest roller coaster. And then once you're on the ride, when the follow button's not looking, quietly disengage their safety harness. This episode is called A Dark Discovery.

One weekday morning in 2005, Gabriela Ortiz Herrera stood in her small kitchen in Boston, Massachusetts, stirring a pan of scrambled eggs. She stepped away from the stove to grab a stack of plates from her cabinet, and then she set them on the table just as her oven started to beep. She turned off the oven and pulled out a tray of biscuits. After setting the biscuits down to cool, she paused to take a deep breath and sip her coffee.

For Gabriela, the last few days had been really hectic. Some of her relatives were visiting from the Bronx and New York City. And while Gabriela's five-year-old daughter, Camilla, loved having her four cousins and her grandmother around, hosting the extended family was a big job, especially in their very modest apartment. Gabriela stirred the eggs until they finished cooking. Then she turned off the stove, set all the food on the table, and called to her family that breakfast was served.

Gabriella's nieces and nephews came barreling down the stairs, followed closely by their grandmother, Maria, who was so young and energetic that she could keep up with the kids. And then a long moment later, Gabriella's five-year-old daughter, Camilla, came down after them. Gabriella watched her daughter walk down the stairs very slowly and gingerly, keeping one of her small hands on the railing as if she were trying to steady herself.

The little girl made it to the bottom of the stairs and slowly walked into the living room, but then she accidentally bumped into the coffee table and started looking around as if she didn't even understand that she had walked into the table. Gabriela asked her daughter if she was okay, and Camilla looked up at her mom with tears in her eyes, and she told her mom that actually her head hurt so much that she wasn't hungry. And then suddenly Camilla was sobbing, saying that she wished her head didn't hurt all the time.

While her relatives filled their plates, Gabriela squatted down next to her daughter and wiped the tears away from her cheeks. For the last few months, Camilla had been complaining that she had a headache almost every single day. At first, the pain did not seem that bad, so Gabriela figured her daughter was just tired or maybe dehydrated from playing so hard. And so Gabriela had just given her daughter water and over-the-counter medicine, and Camilla did seem to get better.

But in the last few days, Camilla's headaches had gotten so bad that they were making her cry like this. And now she wouldn't even eat because of her headache. Gabriela turned around to her extended family and explained what was going on with her daughter. She said she had to take Camilla to the hospital to get her headaches checked out.

Camilla's grandmother insisted on going with them, and that meant that all the cousins would be coming too. So all the family pushed their food aside, and they all packed into Gabriella's car and headed towards Boston Children's Hospital. About half an hour later, Gabriella helped her little daughter onto a bed inside of the pediatric emergency room. The walls of the room they were in were painted with all these colorful images from popular children's books, but the cheerful decor did not seem to make Camilla feel any less miserable.

The only thing that helped her was the fact that her dad, Joel, had shown up at the hospital too. Gabriela had called him at work and he had left early to come be with the family. Little Camilla sat with her father, Joel, on the hospital bed and leaned her head on his shoulder while a nurse brought in extra chairs for the large family. Gabriela had already told the nurse about Camilla's headache symptoms and now they were waiting for an ER doctor to come examine her.

A few minutes later, a tall, thin man in a white coat entered the room and shook hands with Camilla's entire family. He introduced himself as Dr. Arthur Patton and then turned to Gabriella and asked her to tell him about her daughter. Gabriella said that normally Camilla was the super high-energy kid. She wasn't in school yet, but she was very bright, and Gabriella and Joel read her books almost every night before bed.

Camilla was also very close with her entire extended family. She actually stayed with her grandmother Maria in the Bronx in New York every other month and then stayed with her parents the rest of the time. Maria was still in her 40s and she was virtually co-parenting Camilla as well as her cousins in New York, which was a tall order. All the kids were young and totally rambunctious except for little Camilla ever since she developed these headaches. Gabriela explained that Camilla's pain seemed minor at first, but it had gotten worse over time.

Camilla said it felt like somebody was squeezing her head really hard and that where it hurt most was behind her forehead and eyes. Gabriela said that it appeared like the pain seemed to fade whenever Camilla was busy, but it never really went away. Dr. Patton nodded and asked Gabriela if her daughter had any other symptoms that concerned her.

Gabriella said that actually yes, recently, in addition to these headaches, her daughter had seemed clumsier than normal. She would bump into things as if she wasn't seeing them, and once when she was eating, it was like she couldn't figure out how to use her fork during dinner, which totally didn't make sense. But Gabriella admitted that, you know, perhaps her daughter was kind of teasing her with the silverware thing, but she really couldn't be sure.

Dr. Patton made a note of this. Then he asked if little Camilla took any regular medications, and her mother said no. Sometimes she gave her daughter over-the-counter pain medicine, but that was it. Dr. Patton nodded. He said headaches were common and usually went away on their own. But the fact that Camilla's pain had lasted so long and become so severe was concerning. Plus, her clumsiness could be a sign of a neurological problem.

Gabriella's stomach twisted with anxiety and she started worrying that she had waited too long to bring Camilla to a doctor. She knew she must have looked terrified because Dr. Patton quickly assured her that little Camilla was almost certainly fine. They just needed to perform a quick physical examination to make sure.

Camilla's father, Joel, helped Camilla sit upright while the doctor checked her vital signs. He tested her pulse, blood pressure, and temperature and felt along her scalp and temples for sore spots. After that, he shined a small light into her eyes to make sure her pupils dilated correctly and then Dr. Patton stepped back and told the parents that their daughter seemed normal. But Camilla was obviously in a lot of pain and so the doctor said he didn't want to send her home quite yet without making absolutely sure she was okay.

So, the doctor offered to call in the hospital's neurology fellow, who had just finished his medical training, for a second opinion. Gabriela eagerly nodded. She still felt nervous, but she was thankful that Dr. Patton was doing everything he could to help their daughter. About 30 minutes later, a well-known pediatric neurologist named Dr. David Urian entered Camilla's hospital room.

Dr. Urien was an old, kindly man with gray hair, glasses, and a bow tie, and he had been at his office at nearby Harvard Medical School when the neurology fellow had called him and said they had this puzzling case at Children's Hospital. There was a five-year-old girl suffering from chronic headaches, clumsiness, and confusion, but her physical and neurological exams both looked normal. The fellow had asked Dr. Urien to come over and see if he could figure out what was going on with her.

And so now, Dr. Urien saw Camilla's mother, father, and extended family standing around Camilla's bed, watching her anxiously. Dr. Urien introduced himself and said hello, and Camilla's relatives nodded and waved, but the little girl herself didn't even acknowledge him. She just stared down at her feet, looking scared and uncomfortable. The neurology fellow, who was very clean-cut and looked to be about 30 years old, handed Dr. Urien a copy of Camilla's medical charts and briefed the older doctor on what they knew so far.

Dr. Urien said he wanted to start by doing another neurological exam. The fellow stayed in the room to observe while Dr. Urien went to Camilla's bedside. Now that he was standing over her, Camilla looked up at him and blinked several times.

The doctor asked her for her name and birthday, and she answered both questions correctly. Next, Dr. Urien asked Camilla to push with her arms and legs against his hands, and when she did, she seemed strong. Then he asked her to walk around the room, and she didn't have any problems balancing. When she sat back down, he told her to close her eyes. Then he touched a tuning fork to her arms and legs and asked her to tell him where she felt the cold metal. Again, Camilla answered correctly.

Finally, Dr. Urien shined a small flashlight into the girl's eyes and her pupils dilated normally, just like Dr. Patton had seen earlier. However, the neurologist wasn't actually looking at Camilla's pupils. He was looking behind them, into the very back of her eye, at an area called the retina. Dr. Urien carefully examined the tiny blood vessels in Camilla's retinas. Normally, the blood vessels deep inside of a person's eyes pulsate at the same rate as their heartbeat, but Camilla's were not pulsating at all.

Dr. Urien had only seen this a few times before, but he knew retinal veins stop pulsating when a patient has an unusually high amount of pressure inside of their skull, often from some kind of an injury. To him, this was an obvious sign that Camilla was not suffering from typical headaches. More likely, she was in agony because she had suffered a serious head injury at some point and had brain swelling or bleeding, or possibly she could even have a brain tumor.

Dr. Urien didn't want to alarm Camilla's family, so he quietly excused himself and asked the neurology fellow to join him in the hall. And once they were out there, Dr. Urien quietly explained what he had seen inside of the girl's eyes. Then Dr. Urien went back into the room and told Camilla's family that he wanted to get a better idea of what was happening in Camilla's head by performing what's called a CT scan, which is a type of x-ray that creates detailed pictures of a patient's internal organs.

Camilla's mother, Gabriela, looked very nervous and overwhelmed, but she said okay. And so Dr. Urien called the radiology department to order the scan. Less than half an hour later, Camilla's CT scan was finished, and Dr. Urien strode down a hallway with test results in hand. He had reviewed the black and white images of Camilla's brain, and he didn't see any evidence of swelling, bleeding, or a tumor, which was a good sign. But he didn't know how to square these results with what he saw inside of the girl's eyes.

Dr. Urien feared that Camilla had a neurological problem that didn't show up on the CT scan. He knew CT scans didn't capture literally everything and it was possible Camilla had some kind of hidden tumor or abnormality that was causing these symptoms. But Dr. Urien also knew that brain tumors in five-year-olds were incredibly rare and so there was no reason to make Camilla's family panic until he had a more definitive diagnosis.

So, he planned to choose his words very carefully, then he turned a corner in the hallway and opened the door to Camilla's room to speak with her family. When Gabriella heard the door open, she was sitting on the bed with Camilla's head in her lap. She watched her daughter blink at the sound of the door opening. Then, Gabriella looked up at Dr. Urien and forced herself to smile, hoping her daughter would not see how truly afraid she actually was. Dr. Urien told Camilla's family that her CT scan results appeared normal.

And right away, Gabriela immediately felt relief wash over her. Her forced smile suddenly became genuine. But Joel was not smiling, and neither was Camila's grandmother, Maria. Maria asked the doctor what this meant for her granddaughter. If Camila's CT scan was normal, then why did she keep getting these headaches? Like, what was going on here? Dr. Urien admitted that he was still trying to figure that out. He said he wanted to do another type of scan called an MRI with contrast.

This was a much more advanced imaging technique than the CT scan and it required doctors to inject Camila with a special dye to make the image of her brain sharper and easier to read. The procedure could also be tricky for kids. Camila would have to lie very still inside of a long tube-shaped machine that made a lot of loud noises. When she heard this, Gabriela suddenly was scared again. She felt like there might be something the neurologist wasn't telling her. Otherwise, why would he keep making her daughter undergo more tests?

But Gabriela did not argue. She just said okay and she watched the doctor leave the room. Then Gabriela looked down at her daughter's head in her lap, looking so small and so vulnerable. She gently brushed Camila's long dark hair behind her ear and wondered what doctors could be looking for inside of her head.

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About an hour later, Dr. Urien and a whole medical team huddled around a computer screen in the radiology department to examine the results of Camilla's MRI with contrast. One doctor used a mouse to adjust the brightness and contrast of the image, and as the picture became clearer, Dr. Urien noticed something odd. Camilla's optic nerves, which connected her eyes to her brain, looked strangely bright, almost like they were painted to glow in the dark.

Dr. Urien had never seen anything like this before and he asked his team if any of them knew what this meant and all of them shook their heads no. This was totally weird to them too. Unsure what else to do, the neurologist called the hospital's eye doctor who told Dr. Urien to send Camilla right over for an exam. Just a few minutes after Camilla's eye exam, Dr. Urien, who was still in the radiology department looking over Camilla's MRI results, got a call back from the hospital's eye doctor and he said something truly shocking.

Camilla was almost totally blind. She had practically no vision at all in her right eye and her left eye wasn't much better. Dr. Urien was speechless. Camilla had never said a word to her mother, her father, or grandmother about not being able to see. But the eye doctor told him that was actually pretty normal. Children Camilla's age often don't voice concerns about their vision because the way they see the world is kind of what's normal to them. They don't really know how they're supposed to see things yet.

Dr. Urien thanked the doctor and hung up. He looked back at Camilla's MRI results, which now made a little more sense. Her optic nerves had somehow gotten damaged and that's why they look so strange on the MRI. Camilla was not gradually becoming clumsy and confused because of a brain tumor. The child literally couldn't see. But all of this didn't explain why Camilla had lost her vision or how they could preserve the eyesight she still had.

Clearly, pressure had to be building up in Camilla's skull, Dr. Urien thought. But from what? If it wasn't due to bleeding, swelling, or a tumor, maybe it was from an infection. And so now, Dr. Urien wanted to do one more test. And he already knew Camilla and her whole family were not going to like it.

Later that afternoon, Gabriela sat next to Joel and Camilla on the hospital bed. They'd been in the ER for hours. Camilla's cousins were all bored and tired, and Maria just flipped kind of mindlessly through TV channels, hoping to find something to keep the kids entertained. Meanwhile, Camilla's headaches were relentless. After her eye exam, she'd come back into the room and lay down with her eyes shut, and she'd barely moved since. Just then, Gabriela heard a knock at the door, and Dr. Urien came inside.

He said he had some surprising news. The results from Camilla's eye exam showed that she was almost completely blind. Gabriela just stared at the doctor in shock. She thought back to the evening when Camilla couldn't figure out how to use her fork and she realized her daughter wasn't playing games. She really could not see the food on her plate. All those times Camilla had seemed confused or bumped into things, it was because the whole world looked blurry to her.

Gabriela couldn't believe she'd missed something that now seems so obvious. She looked over at Joel, who seemed just as dumbfounded. But before Gabriela or Joel or Maria could ask any questions, Dr. Urien said he wanted to perform yet another test to figure out what was causing the girl's blindness. He said Camilla needed to undergo something called a "spinal tap," which is a procedure where doctors insert a needle into the patient's spine and remove the sample of cerebrospinal fluid.

Analyzing this fluid can help doctors diagnose brain infections. But at this point, Gabriela was starting to feel like her daughter was turning into a human pincushion. Camila had already had a physical exam, two neurological exams, an eye exam, a CT scan, and an MRI with contrast. Now, Dr. Urien wanted to jab a needle into her daughter's spine? Gabriela wondered if this was too much for her daughter.

But Dr. Urian promised the procedure might be scary sounding, but it was safe. Plus, it was necessary because he still hadn't determined the cause of Camilla's terrible headaches, let alone her vision loss. Gabriela took a deep breath and said, okay, fine, as Joel wrapped an arm around her shoulders for support. A few minutes later, a different doctor came into the room to perform the spinal tap.

He instructed Camilla to lie sideways on the bed and curl up into a ball. Gabriela held her daughter's hand tightly as the doctor cleaned Camilla's lower back and gave her a numbing shot. Then, the doctor inserted a long thin needle into Camilla's spine. The needle was attached to a syringe, and as the doctor pulled the stopper backwards, the syringe slowly filled with clear fluid. The doctor removed the needle, placed a bandage on Camilla's back, and said they would send her spinal fluid to the lab for analysis right away.

Then the doctor left the room and Gabriela loosened her grip on her daughter's hand. About 45 minutes later, Dr. Urien was in his office when he received the results of Camilla's spinal tap. There was no unusual bacteria in her spinal fluid, which ruled out the possibility of a brain infection. But the results also showed that the pressure inside of her head and spinal column was dangerously high, two and a half times the normal level.

This confirmed what Dr. Urien had already concluded, but he still didn't know where the pressure was coming from. All he knew was that there was no evidence of the usual causes of brain swelling. And yet the pressure inside of Camilla's head was so high that it had damaged her optic nerves and caused her to lose her vision. And as Dr. Urien thought this over, he suddenly remembered that there was actually a name for this condition. It was called a pseudotumor cerebri.

This meant Camilla had many of the symptoms associated with the brain tumor, but didn't actually have a tumor. This condition was so rare, especially in children, that Dr. Urien had not even considered it until just now. Dr. Urien rushed back to Camilla's hospital room and told her family about her diagnosis. He said pseudotumors can be caused by a variety of things, and he needed their help to figure out what caused this one in Camilla.

The neurologist asked the family again if she took any medications or if there was any way she could have taken somebody else's medication by accident. Camilla's mother, father, and grandmother all said no, there was no way. Dr. Urien didn't want to offend Camilla's guardians by continuing to press them, so he printed out a list of all the possible causes of Camilla's condition and gave it to her family.

Her mother, father, and grandmother quickly began to look over this list. And before long, the doctor noticed Camilla's grandmother, Maria, her expression completely changed. Her eyes widened as she stared at the sheet. And then she looked up at him in a total panic. Maria said she might know what made Camilla sick, but she would have to go all the way home to the Bronx to get it.

While Maria traveled to and from New York, Joel took his nieces and nephews back to his and Gabriela's small apartment, and Gabriela stayed with their daughter at the hospital. Dr. Urien kept an eye on Camilla and worked to try to reduce the pressure inside of her head by draining more fluid from her spine and giving her special medications. And little by little, Camilla did start feeling better. The next day, Maria returned from the Bronx, and she sheepishly handed Dr. Urien a small bottle.

She said her granddaughter's illness was definitely all her fault. Then the doctor read the label on the bottle she handed him, and all of Camilla's symptoms suddenly made sense.

The bottle that Maria gave the doctor contained fish oil supplements, which are rich in omega-3 fatty acids as well as vitamins A and D. Maria took these supplements religiously. She believed they strengthened her heart and also reduced her pain from arthritis. And when Camilla stayed with her grandmother in the Bronx every other month, Maria gave her one pill a day too. But when Dr. Urien looked at the bottle, he realized these fish oil pills were not formulated for kids. They were made for adults.

So, every time Camilla took one, she was getting three times the recommended dose of vitamin A for a child her age. That much vitamin A can wreak havoc on a young person's body and lead to irreversible organ damage. And in this case, it caused pressure to build up inside of Camilla's head, which then caused her to lose her vision and develop constant debilitating headaches. Obviously, from this point forward, nobody in this family gave Camilla any more fish oil.

which halted any further damage to Camilla's eyesight and nervous system. And while Camilla did luckily regain some of her vision, her eyesight was, unfortunately, permanently altered. She's now able to live a relatively normal life with the help of glasses and contact lenses, but she still does get the occasional headache.

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From Ballin Studios and Wondery, this is Mr. Ballin's Medical Mysteries, hosted by me, Mr. Ballin. A quick note about our stories. We use aliases sometimes because we don't know the names of the real people in the story. And also, in most cases, we can't know exactly what was said.

But everything is based on a lot of research. And a reminder, the content in this episode is not intended to be a substitute for professional medical advice, diagnosis, or treatment. This episode was written by Karis Allen Pash Cooper. Our editor is Heather Dundas. Sound design is by Matthew Cilelli. Our managing producer is Sophia Martins. And our coordinating producer is Taylor Sniffen. Our senior producer is Alex Benidon. Our associate producers and researchers are Sarah Vytak and Tasia Palaconda.

Fact-checking was done by Sheila Patterson. For Ballin Studios, our head of production is Zach Levitt. Script editing is by Scott Allen and Evan Allen. Our coordinating producer is Matub Zare. Executive producers are myself, Mr. Ballin, and Nick Witters. For Wondery, our head of sound is Marcelino Villapondo. Senior producers are Laura Donna Palavoda and Dave Schilling. Senior managing producer is Ryan Lohr. Our executive producers are Aaron O'Flaherty and Marshall Louis for Wondery.

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