Neuro Wards!

Wow...neurology has been something else! While in the US adult neurology usually consists of stroke patients with the occasional MS, here stroke patients are managed mostly in the ER (otherwise known as the casualty service, it's more like a ward where patients can stay up to 3 days) or on the medicine wards. So the neurology service at CMC treats mostly demylinating disorders like MS or transverse myelitis. We also have patients in the service being worked up for Guillan-barre syndrome, motor neuron diseases, Creutzfeldt-Jakob disease, and Hanson's disease (more commonly known to us as Leprosy.) Oh, and i forgot the patient with neurotuberculosis and another with a possible mitochondrial myopathy (remember MELAS? well we might have it here...)

It's true that a lot of these patients may not get better, especially the patients with possible MELAS and CJD. But, still it's exciting to see all those things we learned in medical school become applicable in treating these diseases. And the neuro docs are really good, especially about using all that neuroscience we learned back in the day to clinically localize a lesion and narrow down a diagnosis. But technology is definitely not lacking. MRI's, EEG's and EMG's are routinely ordered, and its neat to see the doctors' satisfaction in being correct when the scans arrive later. I've also noticed that while presenting the neurological exam, some docs present by area of the brain... for example "testing of frontal lobe function shows... parietal lobe shows... etc"

I was told that there is actually a child neurologist who sees the kids, but she's away completing her training. So, until she gets back, the adult service sees the kids and does a great job. I love kids and brains!

Some interesting things I've learned: 1. the most common cause for adult-onset seizures here is neurocystercercosis and Tb. 2. Phenobarbitol is super cheap, and as a result lower-income patients with seizures are often on this med for years despite its horrible side effects. I saw a patient who was on it for 5 years and looked so cognitively impaired, it broke my heart. I also saw a pregnant patient who was still taking phenytoin. Ahhhhhh. Anyone up for starting a massive movement to improve seizure management and patient education in developing countries?

Oooh and I learned about Hiramaya's disease. It's when the dura in the cervical region is thicker and shorter posteriorly, so that everytime the patient flexes his neck forward it pinches the spinal cord. This eventually leads to a muscular atrophy of the upper limbs, you can totally see the wasting of this man's interosseous and thenar muscles. The radiologists diagnosed this in a 30 year old man, and we were confirming it. Treatment is to have him wear a C-collar that extends his neck back for a few years so that he doesn't bend his head forward as much. (This must be tricky-- I always have to look down here to see where I'm stepping!)

That's all for now! Hmmm... and here's a question to ponder. Say you have a restaurant with incredibly delicious indian food. And then say you have two mice running around and an ant that landed inside your friend's tea. Do you still eat there? Maybe with close-toed shoes...