A persistent and pernicious headache

still clutching his discharge instructions from a suburban Maryland emergency room, Brian Harms struggled to make sense of what the neurosurgeon was saying. The ER staff had told Harms, admitted hours earlier, that his diagnoses were headache and vertigo and that he should go home and rest. A CT scan had found a benign cyst in his brain, but the staff didn’t convey any urgency about treating it.

As the 29-year-old College Park resident was gathering his things, a neurosurgeon rushed in, telling Harms he would not be going home.

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“I need to get this information to you quickly,” Harms remembers the specialist telling him on the morning of Sept. 28, 2011. “You are in a lot of trouble, and you need surgery as soon as possible.” The neurosurgeon had been trying to arrange a transfer to Johns Hopkins Hospital in Baltimore, but doctors were worried that he might die en route. “I highly suggest you trust me and let me do this procedure here,” Harms remembers the surgeon telling him, but the decision was his.

For Harms, who had seen several doctors for headaches and other symptoms during the previous 18 months, the news was beyond shocking. “It felt like the floor dropped out beneath me,” he recalled. “I was scared witless.”

Only later would Harms, a University of Maryland doctoral candidate in geochemistry, learn how lucky he was to have survived both a series of misdiagnoses and a test, performed hours before his emergency surgery, that could have killed him.

In November 2010, Harms began feeling as if he had a low-grade flu. His weight, a problem since childhood, seemed harder to control, and he began packing extra pounds onto his 6-foot, 280-pound frame, even though he wasn’t eating more than usual.

Harms consulted an endocrinologist. Tests showed that his thyroid seemed sluggish and his liver enzymes were elevated, a finding that can result from multiple medical problems, including obesity. The endocrinologist referred him to a gastroenterologist, who decided that his liver enzymes were high because Harms was “too fat.” Come back when you’ve lost 30 pounds, Harms said the specialist told him, and we’ll retest your liver.

In January 2011, Harms felt so exhausted that he went to a Montgomery County emergency room. His blood pressure was alarmingly high, and he had intermittent spots in his vision. The ER doctor found nothing: An eye exam didn’t reveal anything amiss, while a test for mononucleosis, a viral infection that can cause prolonged fatigue, was negative and other blood tests were normal. Harms was discharged with a diagnosis of fatigue.

For the next few months, the fatigue and headaches seemed to come and go, but Harms’s weight kept creeping up, despite his efforts to control it. He was working out five days a week at a gym and playing basketball, in addition to curbing his calories.

Harms soldiered on, trying to ignore his physical ailments and concentrate on his studies.

By August 2011, his headaches, which seemed concentrated on alternating sides, were at their worst when he woke up in the morning or when he changed position. At times, he felt so dizzy he had to hold on to something to keep his balance.