Recent technological and scientific advances have fuelled a neuroscientific revolution. Imaging techniques such as those shown above have given us an unprecedented view into the structure and function of our brain.
If you’re interested in neuroscience or psychology, I’d highly reccomend any book by Oliver Sacks! I get asked a lot about books to read so you can also check out this video I made with my top 7 and this masterpost which includes websites where you can learn more!
For centuries, physicians have been fascinated by the many manifestations of migraine, and especially by the visual hallucinations or auras- similar in some ways to those induced by hallucinogenic drugs or deliria–which often precede a migraine.
Dr. Sacks describes these hallucinatory constants, and what they reveal about the working of the brain.
Awakenings is the remarkable account of a group of patients who contracted sleeping-sickness during the great epidemic just after World War I. Frozen in a decades-long sleep, these men and women were given up as hopeless until 1969, when Dr. Sacks gave them the then-new drug L-DOPA, which had an astonishing, explosive, “awakening” effect. Dr. Sacks recounts the moving case histories of these individuals, the stories of their lives, and the extraordinary transformations they underwent with treatment.
3. The Island of The Color Blind
Oliver Sacks has always been fascinated by islands, and this book is an account of his work with an isolated community of islanders born totally colorblind. He listens to these achromatopic islanders describe their colorless world in rich terms of pattern and tone, luminance and shadow.
4. Uncle Tungsten
A book about Sacks’ childood;
his discovery of biology, his departure from his childhood love of chemistry and, at age 14, a new understanding that he would become a doctor.
5. An Anthropologist on Mars
This book talks about 7 seemingly paradoxical neurological conditions: including a surgeon consumed by the compulsive tics of Tourette’s Syndrome except when he is operating; an artist who loses all sense of color in a car accident, but finds a new sensibility and creative power in black and white; and an autistic professor who has great difficulty deciphering the simplest social exchange between humans, but has built a career out of her intuitive understanding of animal behavior.
6. Seeing Voices
A journey into the world of deaf culture, and the neurological and social underpinnings of the remarkable visual language of the congenitally deaf. Sacks writes “The existence of a visual language, Sign, and the visual intelligence that goes with its acquisition, shows us that the brain is rich in potentials we would scarcely have guessed of, shows us the almost unlimited resource of the human organism when it is faced with the new and must adapt.”
Phineas Gage is one of the most famous patients in the history of neuroscience. He was 25 years old when he experienced a serious accident at his work place, where a tamping iron was shot through his head - entering under his eye socket at exiting through the top of his head - after an explosive charge went off. The tamping iron was over a metre long, and after exiting Gage’s head landed 25m away.
Initially Gage collapsed and went into minor convlusions, but recovered quickly and was able to speak after a few minutes. He walked with little assistance to an ox-cart and was brought to a nearby physician. Initially the physician did not believe his story because he was in such good condition, but was convinced when:
Mr. G. got up and vomited; the effort of vomiting pressed out about half a teacupful of the brain, which fell upon the floor.
Gage exhibited a number of dramatic behavioural changes following the accident. Harlow, the physician who initially treated Gage, described this change “He is fitful, irreverent, indulging at times in the grossest profanity (which was not previously his custom), manifesting but little deference for his fellows, impatient of restraint or advice when it conflicts with his desires”. However the surgeon Henry Jacob Bigelow described his condition as improving over the course of recovery, stated he was “quite recovered in faculties of body and mind”. This may have been early evidence of neural plasticity. This recovery was also reported by a physician who knew Gage while he lived in Chile, who described his ability to hold on a full time job as a Concord coach driver, a job that required exceptional social skills.
Gage’s neurological deficits following his traumatic brain injury is thought to have been exaggerated and distorted over the course of history, to the point that he is often portrayed as a ‘psychopath’. Scientific analysis of the historical accounts of Gage’s life following his accident, namely by the psychologist Malcolm Macmillan, find that these distorted accounts are most likely untrue, and that Gage made a very good recovery.
Post-mortem analysis of the Gage case concluded that it was the left frontal lobe that was damaged in the accident, although further neurological damage may have resulted from infection. Combined examination of the Phineas Gage case with the other famous cases of Tan and H.M. have concluded that social behaviour, memory, and language are dependent on the co-ordination of a number of different brain areas rather than a single region.
This week, I learned a lesson about why medical school is so important. For 4 years, we cram everything into our heads, a little about every specialty. In the end, we all just can’t wait to specialize in our own fields and not have to remember the majority of other stuff we memorized. We can always just consult someone else if we need help right? Well… What if you didn’t recognize the underlying problem in the first place?
This week on neurology, we had a 27 year old woman who was admitted overnight for severe headache. They ended up doing a brain MRI, which showed several small diffusion weighted defects in the posterior brain consistent with strokes. We were asked to see her in the morning for evaluation of “strokes”. I was asked to read her chart and go see her. I thought it was a little odd that a healthy 27 year old had strokes, but you never know. I start reading up and see that her systolic blood pressure has been above 160 all night. They were allowing some degree of permissive hypertension for her strokes. Her creatinine was 1.4. They also assumed this was because of her elevated blood pressures. Finally, there was protein in her urine. I keep reading and notice she is 4 days postpartum. I haven’t even seen the patient yet and put the pieces together in my head. Elevated blood pressure, severe headache with visual scotomas, elevated creatinine, protein in the urine, postpartum… Holy shit, this person has preeclampsia with severe features and needs to be started on a magnesium drip immediately!
I want to go into Ob/Gyn, so naturally I was a little excited that I recognized this. I immediately went to my 70 year old attending and told him this. He looked surprised, and I could tell he probably hadn’t thought about this disease in decades since usually they are admitted to ob/gyn and not neurology. He asked me to call the ob/gyn that was on. Within a few hours, she was seen and started on a magnesium drip for preeclampsia with severe features. My attending and I went to radiology and had them re-read the scan. She had PRES not strokes. This woman could have gone home on aspirin, an anti-hypertensive, and a statin with neurology follow-up and had a seizure a day later from full blown eclampsia.
In the end, I learned about how one person going down the rabbit hole of one diagnosis can lead to a series of several providers going down it as well. It was a shining moment for me as a medical student, not going to lie. But it also showed me the importance of being well read and not shutting out my mind to other specialties. We all need to know a little about everything and when to realize our limits and consult someone else. And a lot of the time, medical school is the only immersive experience we will get in many of these specialties. It matters more than just learning for the sake of the shelves.
Photographs of William W. Keen’s successful operation to remove a brain tumor from a 26-year old patient, 1887. The patient was a carriage maker who exhibited symptoms of severe headaches, seizures, and partial blindness; he also had a history of a head injury and was prone to aphasia.
Owing to Keen’s demands at that proper antiseptic measures were taken for the operation (including removing the carpet and cleaning walls and ceiling), the tumor was removed after a two hour operation. Despite some complications with wound closure and cerebrospinal fluid leak, the patient lived for thirty years, even donating his brain to his surgeon for anatomical study.
Journal of the American Medical Association, 1918.
Typical complications of SCI include:
Autonomic Dysreflexia (AD)
Orthostatic Hypotension (OH)
Spasticity and Hypertonia
Deep Vein Thrombosis (DVT)
Osteoporosis and Risk of Fracture
Impaired Temperature Control
Bladder, Bowel and Sexual Impairments
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My favorite subject is anatomy, specifically neuroanatomy! I love learning about all the different components that go into making the body function as we know it. A follow-up favorite subject is physiology since it is the study of the function of these anatomical components.
Book: Anatomical Atlas (Maud Jepson)
Note: the diagrams are from this book (though I wish I could draw this well!)