Fun neurological cases
1–3–17, Adil
Okay homies, thought it might be fun to play doctor with some reeaaal basic neurology cases. When I first came across cases like these, I just remember thinking how the symptom patterns were so funky and interesting, so thought I’d share just a few.
- A girl has an episode where she blacks out (can’t remember anything from the past few seconds-minutes), but when she comes back to reality, she is overcome with the strong smell of burning wood or rubber.
Weird eh? This is actually a pretty common symptom of temporal lobe epilepsy; in particular, a seizure near the amygdala. I was actually shadowing a doc when we saw a common case like this. When patients describe these hallucinated smells — a phenomenon called “phantosmia” — it helps the doc make a this pretty pointed diagnosis.
2. A chick comes in after a minor car wreck with no apparently physical injuries. The accident was her fault: “I just didn’t see the car coming, doc, so I tried to switch lanes. I done goofed up.” In her history & physical exam workup, you discover she also is having irregular periods.
Well shoot, these seem like 2 pretty unrelated things. Wrong! In fact, this story again leads to a pretty specific diagnosis: a pituitary tumor. The chick has loss of her peripheral vision and hormonal problems. Neatly, the pituitary tumor controls hormone secretions (like those involved in menstruation), but it also happens to sit just above the optic nerves, which transmit information from your eyes to your brain.
If this little brain ballsack starts swelling up because of a tumor, it not only messes up hormones (here, overproducing prolactin), but also presses on these nerves and messes up visual signals to the brain. Easy diagnosis!
4. A little kid has bouts of paralysis on the left half of his body, called hemiplegia. This means there can be full loss of sensation and movement (including in the face), often with painful stiffening of the limbs. But wait… the hemiplegia suddenly switches sides to the right! Now the left is okay. These attacks can last anywhere from seconds to days.
This wild symptom is part of a rare disease called Alternating Hemiplegia of Childhood (AHC). Ya boi actually researched this disease for 2+ years at Duke. Often times, kids with AHC also develop epilepsy, have motor problems, social problems, and developmental problems… so it’s a real doozy, combining like 5 diseases into one. Hemiplegic episodes can be initiated by tons of different things — temperatures, smells, physical activities, meds, fatigue, and more. In one particularly sad case, a family we met had to stop celebrating birthdays because the excitement was too much for the kid to handle and he would have an attack. Same went for Christmas, which was even worse — excitement + festive lights invariably set him off. We’re still researching causes, but one leading contender is a mutation in the gene that codes for the very important sodium-potassium pump in some neurons. Pretty wild to think about how if part of one kind of cellular pump goes awry, it can have such a profound effect.
5. Dude has trouble talking. As part of the neuro exam when you ask him to stick his tongue out, his tongue deviates to one side.
This is maybe the single most specific lesion (general term for “some kind of problem”) in all of neurology. It is a lesion of cranial nerve 12, the hypoglossal nerve, which controls tongue movements and swallowing. Depending on some biological details I won’t bore you with, you can deduce if it is pointing toward or away from the side of the brain with the lesion. It’s pretty rare to have a singular problem with CN12; it’s more like an indicator of how bigger diseases are moving. For example, it could help you track spread of polio, ALS, or some cancer of the brain. A rare occasion when your body can point, literally and specifically, to where something is wrong.
6. A homie can’t form new memories lasting longer than 30 minutes. Ouch.
This is actually a famous case described by Oliver Sacks as “the most severe case of amnesia ever documented.”
Apparently this is what the bro’s journal entires look like:
Strangely, it’s not due to any sort of trauma, but actually herpes simplex encephalitis (HSE), a viral infection that attacks the central nervous system. Mhm, this virus creeps into your brain and silently robs you of your humanity. In less severe cases, HSE patients can present with confusion, personality changes, and seizures. And it’s tough to get a full recovery; one-third of treated people still die, and if you’re lucky enough to live, only 2.5% get full brain function back. Pretty brutal. 0/10 would not recommend contracting.
6. A little boy presents with unexplained limping. The next day he has a very wobbly walk. The next day, he can’t even get out of bed because he’s too tired. Soon, he loses the ability to move his upper extremities, and then his lungs stop working. He has to be intubated. This is a case of ascending paralysis — pretty freaky.
Differential/Diagnosis: What diseases cause the spooky sensation of migrating/expanding paralysis? Botulism is caused by 1 of 8 toxins secreted by the bacteria Clostridium botulinum, and typically results in descending paralysis. Yikes… but descending is not what we’re looking for. Guillain-Barré syndrome results from the immune system attacking the peripheral nervous system (an autoimmune disorder of unknown cause, really), and gets us closer — it typically results in ascending paralysis. Bingo! But wait…
We see a small lump on the kid’s scalp. A tick! Totally new diagnosis: Tick paralysis. Yep, if some particular species of these suckers bite you (and stay there for some days secreting toxins through saliva), then you can get royally screwed (e.g. will get killed if no interventions are made). Requires rul different treatment from Guillain-Barré syndrome though: just remove the tick, and you should get rapid resolution of symptoms.
Just a little foray into some wacky things that can happen in and around your brain and the weird repercussions. Obviously there are thousands of different/cool/sad things that can happen, but this was just a little sampling.
Sources:
http://nymag.com/scienceofus/2015/08/7-of-oliver-sacks-most-fascinating-case-studies.html
