"Paternity" is the second episode of the medical drama ''

House A house is a single-unit residential building. It may range in complexity from a rudimentary hut to a complex structure of wood, masonry, concrete or other material, outfitted with plumbing, electrical, and heating, ventilation, and air condi ...

'', which was first broadcast on November 23, 2004. A teenage boy is struck on the head in a

lacrosse Lacrosse is a team sport played with a lacrosse stick and a lacrosse ball. It is the oldest organized sport in North America, with its origins with the indigenous people of North America as early as the 12th century. The game was extensively ...

game and is found to have hallucinations and night terrors that are not due to concussion.

Plot

When a clinic patient claims to have an appointment with the diagnostic department, House is skeptical of the letter which he himself supposedly wrote to the family. House realizes that it was written by Cameron, but listens when he hears that one of the symptoms is

night terrors Night terror, also called sleep terror, is a sleep disorder causing feelings of panic or dread and typically occurring during the first hours of stage 3–4 non-rapid eye movement (NREM) sleep and lasting for 1 to 10 minutes. It can last long ...

. The patient, Dan (

Scott Mechlowicz Scott David Mechlowicz (born January 17, 1981) is an American actor. He is known for appearing in the films ''Mean Creek'' (2004), ''EuroTrip'' (2004) and ''Peaceful Warrior'' (2006). Early life and education Mechlowicz was born in New York City, ...

), is a 16-year-old

player who has been recently hit in the head in a game. House suggests that the night terrors were a result in post-traumatic stress disorder from sexual abuse and his double vision was caused by a concussion and/or eye strain. Then he notices Dan's foot twitch with a

myoclonic Myoclonus is a brief, involuntary, irregular (lacking rhythm) twitching of a muscle or a group of muscles, different from clonus, which is rhythmic or regular. Myoclonus (myo "muscle", clonic "jerk") describes a medical sign and, generally, i ...

jerk which normally only occurs when falling asleep. He immediately admits Dan and starts diagnosis with his team. House claims that Dan's father is not his true biological father and makes a bet with

Foreman __NOTOC__ A foreman, forewoman or foreperson is a supervisor, often in a manual trade or industry. Foreman may specifically refer to: *Construction foreman, the worker or tradesman who is in charge of a construction crew * Jury foreman, a head j ...

. None of the tests show why the night terrors occurred, but House finds a large blockage in one of Dan's brain ventricles. House and his team relieve the pressure, but they find that the blockage is not causing the other symptoms. During the night, Dan is found missing from his bed. Cameron,

Chase Chase or CHASE may refer to: Businesses * Chase Bank, a national bank based in New York City, New York * Chase Aircraft (1943–1954), a defunct American aircraft manufacturing company * Chase Coaches, a defunct bus operator in England * Chase Co ...

, and Foreman soon locate him on the roof, where he is hallucinating that he is on the lacrosse field. House is excited by this new development — it rules out his previous diagnosis of

multiple sclerosis Multiple (cerebral) sclerosis (MS), also known as encephalomyelitis disseminata or disseminated sclerosis, is the most common demyelinating disease, in which the insulating covers of nerve cells in the brain and spinal cord are damaged. This d ...

. The new diagnosis provided by Cameron is

neurosyphilis Neurosyphilis refers to infection of the central nervous system in a patient with syphilis. In the era of modern antibiotics the majority of neurosyphilis cases have been reported in HIV-infected patients. Meningitis is the most common neurologic ...

. To treat this, they inject

penicillin Penicillins (P, PCN or PEN) are a group of β-lactam antibiotics originally obtained from ''Penicillium'' moulds, principally '' P. chrysogenum'' and '' P. rubens''. Most penicillins in clinical use are synthesised by P. chrysogenum using ...

through a

lumbar puncture Lumbar puncture (LP), also known as a spinal tap, is a medical procedure in which a needle is inserted into the spinal canal, most commonly to collect cerebrospinal fluid (CSF) for diagnostic testing. The main reason for a lumbar puncture is to ...

, but during the injection Dan suffers an

auditory hallucination An auditory hallucination, or paracusia, is a form of hallucination that involves perceiving sounds without auditory stimulus. While experiencing an auditory hallucination, the affected person would hear a sound or sounds which did not come from t ...

, which rules out this diagnosis. House is stumped by this new development, and admits his problems to Wilson. Dan's parents are angered to discover House having coffee with Wilson while their son is dying. After House quickly elaborates in great detail exactly what Dan's condition is it at the time, he tells them to go and support Dan, after which he takes their coffee cups to run DNA tests. The tests show that ''neither'' parent is biologically related to Dan. House remembers a baby he treated earlier whose mother did not want to vaccinate the child and hypothesizes that infant Dan may have caught the

measles Measles is a highly contagious infectious disease caused by measles virus. Symptoms usually develop 10–12 days after exposure to an infected person and last 7–10 days. Initial symptoms typically include fever, often greater than , cough, ...

virus, which remained latent for 16 years. Avoiding a dangerous procedure to confirm this unusual case, they biopsy Dan's retina to find the virus, confirming House's diagnosis of

subacute sclerosing panencephalitis Subacute sclerosing panencephalitis (SSPE)—also known as Dawson disease—is a rare form of chronic, progressive brain inflammation caused by slow infection with certain defective strains of hypermutated measles virus. The condition primarily ...

. Dan recovers fully after brain surgery and reveals that he already knew he was adopted, but that he does not care.

Medical aspects

The sequence of tentative diagnoses in this case was: #

Sexual abuse Sexual abuse or sex abuse, also referred to as molestation, is abusive sexual behavior by one person upon another. It is often perpetrated using force or by taking advantage of another. Molestation often refers to an instance of sexual assa ...

Concussion A concussion, also known as a mild traumatic brain injury (mTBI), is a head injury that temporarily affects brain functioning. Symptoms may include loss of consciousness (LOC); memory loss; headaches; difficulty with thinking, concentration, ...

Degenerative disease Degenerative disease is the result of a continuous process based on degenerative cell changes, affecting tissues or organs, which will increasingly deteriorate over time. In neurodegenerative diseases, cells of the central nervous system stop wor ...

Hydrocephalus Hydrocephalus is a condition in which an accumulation of cerebrospinal fluid (CSF) occurs within the brain. This typically causes increased intracranial pressure, pressure inside the skull. Older people may have headaches, double vision, poor ...

Multiple sclerosis Multiple (cerebral) sclerosis (MS), also known as encephalomyelitis disseminata or disseminated sclerosis, is the most common demyelinating disease, in which the insulating covers of nerve cells in the brain and spinal cord are damaged. This d ...

Neurosyphilis Neurosyphilis refers to infection of the central nervous system in a patient with syphilis. In the era of modern antibiotics the majority of neurosyphilis cases have been reported in HIV-infected patients. Meningitis is the most common neurologic ...

Subacute sclerosing panencephalitis Subacute sclerosing panencephalitis (SSPE)—also known as Dawson disease—is a rare form of chronic, progressive brain inflammation caused by slow infection with certain defective strains of hypermutated measles virus. The condition primarily ...

The treatment for the final diagnosis was to inject

interferon Interferons (IFNs, ) are a group of signaling proteins made and released by host cells in response to the presence of several viruses. In a typical scenario, a virus-infected cell will release interferons causing nearby cells to heighten the ...

into the brain. The story exaggerates the difficulty of explaining this treatment for dramatic effect but the problem of obtaining

informed consent Informed consent is a principle in medical ethics and medical law, that a patient must have sufficient information and understanding before making decisions about their medical care. Pertinent information may include risks and benefits of treatme ...

in complex cases is a real one. The medical advisor for this episode was

Lisa Sanders Lisa Sanders (born July 24, 1956) is an American physician, medical author and journalist, and associate professor of internal medicine and education at Yale School of Medicine. In 2002, she began writing a column for ''The New York Times'' called ...

Recurring themes

The theme that "everybody lies" appears here in the question of the patient's paternity. The parents had lied to him in not telling him that he was adopted and do not admit this to House either.

Reception

Robert Bianco, writing in ''USA Today'', recommended the episode as "first-rate".

References

External links

"Paternity"
at

Fox.com The Fox Broadcasting Company, commonly known simply as Fox and stylized in all caps as FOX, is an American commercial broadcast television network owned by Fox Corporation and headquartered in New York City, with master control operations and ...

* {{House (TV series) House (season 1) episodes 2004 American television episodes Measles in fiction Medical diagnosis it:Episodi di Dr. House - Medical Division (prima stagione)#Problemi di adozione