In the following pages students in the 1998 Introduction to Neurology class share their summaries of selected popular case reports or personal accounts of the effects of neurological injuries, disorders, or diseases.


Motor Problems
    Parkinsonlike Disease reviewed by Rachel Fazio
    Lou Gehrig's Disease reviewed by Jescica Lage
    Dystonia, Ben Hogan's Downfall by Holly Barberra
    Myasthenia Gravis in a NFL Player by Teresa Parks         
    Bobbsey Twins Take Neuro(MS) by Craig Schaul
Epilepsy
    The Wandering Man with Epilepsy by Jaime Rogers
    Four Cases of Epilepsy by Elizabeth Williams
    Reminiscence reviewed by David Sivesind
Amnesia
   Korsakoff's Syndrome reviewed by Jennifer Michur
   Memory loss following brain tumor by Melissa Staker
Tourette's Syndrome
   Tourette's Syndrome reviewed by Jeff Wooton
   Those Two Rays reviewed by Jeffrey A. Hulne
   A Case of  Tourette Syndrome by Sara Nelson
Stroke
   Symptoms of Stroke reviewed by Chuck Bortscheller
   Transient Cortical Blindness by Jennifer A. Willey
   CVAs in Two Individuals by Janelle K. Chaney
Sensory Alterations
   The Man Who Fell Out of Bed by Magen Swarbrick
   Phantom Limbs reviewed by Courtney Determan
   The Colorblind Painter reviewed by Sheila Parks
Encephalitis Lethargica
   The Case of Rose R. reviewed by Michelle Laird
   Rolando P. reviewed by Jennifer Jewell
Temple Grandin, Autistic Ph.D. by Leslie Jorgensen

The Bobbsey Twins Take Neurology (multiple sclerosis)
Craig R. Schaul
Source: Klawans, Harold (1990). The Bobbsey Twins Take Neurology Newton's Madness, 115-123.
Patient Background: Mary Rickert was a medical student who had decided to become a neurologist along with her husband at the time. She was devastated when, in 1972, she developed retrobulbar neuritis in her right eye, which is an inflammation of the retrobulbar optic nerve. The inflammation is the known precursor of Multiple Sclerosis, which she was later diagnosed with. She was then put on steroids, which was the only available treatment for controlling Multiple Sclerosis in 1972, The diagnosis of MS caused the breakup of her and her husband's marriage. She decided to become a dermatologist instead of a neurologist. In 1976 she was remarried, and had a child by 1980. Behavior Change: Mary's first symptom was retrobulbar neuritis, a complication in which 1/3 of it's sufferers develop MS. Characteristics of this inflammation are blurry vision, with what seemed like a "black hole" in front of her eye. This "hole" is actually behind the eye in the optic nerve. Mary also showed other early symptoms characteristic of MS before the actual diagnosis was made. These included her right leg and foot ceased to work properly for about 2 weeks. These two symptoms were separated by "time and space", a distinction crucial to make the diagnosis of MS. This means that the two lesions causing the symptoms had to be in completely different locations within the brain to be classified as separated. Mary possessed the needed separate lesions, which determined the diagnosis of Multiple Sclerosis.
Nervous System Changes: Mary also had another symptom characteristic of MS, increased reflexes in her right leg. Mary had three serious attacks in the next two years, all three involved the brainstem, the symptoms of the attacks were the same, slurred speech, drunken gait, and inability to control her urine. Physician and Family Reflection: Mary's mentor in medical school was the neurologist who made the diagnosis. He has maintained friendship with her since she was diagnosed with MS. He has supported her throughout the ordeal. Mary's husband at the time of both of their admission into medical school couldn't deal with her disorder and he left her between her first and second attacks.
My Reaction to the Case: My reaction to this article comes from experience. My dad was diagnosed with Multiple Sclerosis in 1984. I can understand her husband's reaction, but to walk away when your loved one needs you the most isn't the answer. There has been many times that I wanted to escape from my dad's situation, but I have stuck it out and have given him as much support as I can. Right now, this is the time in which he needs it most.

The Wandering Man with Epilepsy
Jaime Rogers
Source: Klawans, Harold. (1990). The man about town. Newton's Madness, 73-79.
Patient Background: William (Willey) Miranda was fifty-six years old when first admitted to the E.R. around 10:30 am. The police admitted him after observing him sitting in his car, staring straight ahead in an apparent daze, for about two hours. Mr. Miranda did not know where he was or how he'd gotten there. Nor did Mrs. Miranda whom was used to such incidences. Mr. Miranda was now retired. However, in his early twenties he received a medical discharge from the armed forces after sustaining a cerebral concussion. Behavioral Change: According to Mrs. Miranda, Willie's first episode had taken place some thirty or more years earlier. During his shorter episodes, which she usually observed, he seemed to be indifferent to what was going on around him. He would neither speak nor answer questions. Instead, he would repeatedly perform meaningless tasks: opening and shutting a window, washing his hands over and over again, or taking off his shoes and putting them back on. If Mrs. Miranda spoke to him, he would often reply but always with one- or two- word answers. Never any more. Willie's trips were all similar in that he never remembered any detail of his travels. The didn't occur often, only once every few years. They usually lasted well over a day. He apparently drove reasonably well: he had no accidents or tickets. And he never ran out of gas, always remembering to refill the tank as he drove around. Once he even changed a tire. Or at least they thought he did, since when he got home, the spare had replaced the left rear wheel, which was now in the trunk and in need of repair.
Nervous System Changes: Mr. Miranda's neurologic exam was normal, as was his psychiatric assessment. His CAT scan showed no abnormal shapes of brain tissue or ventricles, and also no gross abnormalities (tumors, hematoma, compression of tissue etc.). However, an EEG showed a seizure like activity from the left temporal lobe. Damage to the left temporal lobe may have occured after sustaining a cerebral concussion.
Family or Physician Reflections: Mrs. Miranda was ready to take Willie home after his last "Little Trip". Apparently, she had always linked Willie's little trips to stress as she had done in this case. Willie's brother had just died in an automobile accident. Thus, she linked Willie's little trip to his "shock" over his brother's death. Once Willie had had his first three or four episodes and always came back alive and well, the Mirandas stopped worrying about him. They had become just Willie's little trips to relieve stress and forget about everything. Other people had worse problems so they didn't make a big deal out of it. They even made a game out of his longer journeys. As the neurology resident on call examined Mr. Miranda, he was not so certain. He thought Willie might well have just had a seizure and that his entire trip might have been a part of that seizure. He felt strongly that medications that help to control seizures might help him. He was aware that such trips had been described before in other patients with "epilepsy" and that in such patients they had nothing to do with any psychiatric problems. Mr. Miranda was put on anticonvulsants and, as far as the resident knew, he had not taken another little trip since.
Your Reaction to the Case: I thoroughly enjoyed the chapter, "The Man about Town". It contained just the right amount of information and was not the least bit sterile. I have always been interested in epilepsy because my brother's good friend has it. Mr. Miranda provided a lot of valuable and interesting information on the subject of epilepsy.

Tourette's Syndrome
Jeff Wooton
Source: Sacks, Oliver (1995). An Anthropologist on Mars, New York.
Online resource: Karch, Joshua P. (1997) An Encounter with Tourette's Syndrome. Http://cec.wustl.edu/~ jpkl1/tourettes.html.
Behavioral Changes: Dr. Carl Bennett is a skilled surgeon and general practioner living and working in Branford, British Columbia. His symptoms of Tourette's Syndrome began at the age of seven, but he was not clinically diagnosed until age thirty-seven. He was an adopted child, therefore his family history is unknown. When the disease first manifested in his youth the symptoms were modest, but they soon became progressively more elaborate and consuming of his daily life. He maintains an active interest in hiking, mountain climbing, cross-country skiing and piloting a single-engine jet plane. The author focused on his multi-day visit with Dr. Bennett, therefore much of his early repurcussions of the disease were undocumented. Dr. Bennett has experienced what could be called a full-fledged alteration of personality as a result of his infliction of Tourette's Syndrome. "Funny disease, I don't think of it as a disease but as just me," said Dr. Bennett on the topic of his lifelong neurological disorder. Tourette's involves many attributes of obsessive-compulsive disorder. His biggest obsessions are touching his glasses to make sure they are on perfectly straight and rubbing his mustache so that it is groomed perfectly, down to each individual hair. His touching of objects or people must be done symetrically. He will constantly re-adjust his legs in relation to the steering wheel (car or plane) until his knees are symetrical with the wheel. They must be exactly centered at all times. He also has a rapid walk with a skip on each fifth step. Another plaguing action is his sudden reachings to the ground as if to pick up something. No documentation of screaming obsenities was given, but he instead has several catch-phrases he will illicit in a high-pitched vocalization. His current favorite is "hideous." He is attracted to the word by its sound. He also enjoys "Hooty-hoo," "Hi, there" and "whoo, whoo." He obsesses on one or two words for about three months at a time. When one is released from his current vocabulary it is immediately replaced with a new word or phrase. He is attracted to the "melody" of a word and than implants into his mind for future repetitive usage. In refrence to his "Tourette Vocabulary" he said "Tourette's is a disease of inhibition. It releases primitive behaviors." His children adore him and even offer him lists of potentially new vocabulary words. His wife says that she wouldn't want him any other way, she loves him just the way he is. Unfortunately, the disease also strikes him with sudden rage. He is capable of supressing this instict until he is at home where he will fling inanimate objects across the room, making sure no one is in the pathway. If his motor and cognitive functioning is simultaneously activated, his symptoms are kept to a minimum, often seemingly disease free.
Nervous System Changes: Tourette's Syndrome is a hereditary neurological disorder which affects mostly males, it usually strikes during childhood or adolescence. It alters the individual's motor functions and produces involuntary movements (tics). The cause of the disorder is still unknown. The current research is speculating that an overabundance of the neurotransmitter Dopamine produces the tics. Tourette's is characterized by compulsive tics, involuntary mimicry or repetition of others' words or actions and by involuntary or compulsive utterances of obscenities. Tourette's is semi-controllable by medications known as Neuroleptics. These medications work at reducing the release of Dopamine, which in turn is to reduce the tics of the patient. It's results and side-effects vary from patient to patient.
Physician's Reflections: Oliver Sacks, author of Bennett's account, offered much reflection the daily life of Dr. Bennett. He was struck by how Tourette's Syndrome has a highly creative aspect as well as its negative attributes. He was often impressed by Dr. Bennett's observations of situations and scenery. What seemed like drab scenery came to life when described by Dr. Bennett. He also sees him as a deep thinker with a restless and questioning mind. Before this meeting he believed many professions would be necessarily closed to people with Tourette's. He thought this especially true of the "intricate, precise and steady work of a surgeon." When he was invited to attend a surgery, his position changed. For when he operates, he is indeed Tourette free, as long as he is void of interruption. He contended that Dr.Bennett was such a good surgeon as a result of the disease. His compulsive nature would not allow him to overlook any aspect of the operation, and would require multiple checks on the work completed. No detail could possibly be overlooked. This observation also made him relaxed enough to be flown by Bennett to Calgary via his plane. As he observed his rechecking of every pre-flight detail, he knew the plane would be in top-notch condition. He was also impressed, perhaps shocked, when a patient came in with a grotesque skin growth disorder that covered large portions of his body for examination and removal that there were no shrills of "hideous." These are just a handful of the many observations that Sacks made. He did have a tendency to question every aspect of Bennett's life and wondered if it was a result of Tourette's Syndrome or not. Once you go past the obvious it is difficult to tell. It's nearly impossible to draw the line between normal personality and symptoms of Tourette's poking through. This is under the assumption that there is a line to be drawn.
Personal Reflections: I would be lying if I didn't admit I was hoping for some humerous operating room tales of obscenity rants and raves. In fact, Dr. Bennett apparently does not suffer from this typical trait of Tourette's Syndrome. Sad but true. Before this report, I was highly ignorant of the disease. All I knew, in regard to the syptoms, was the uninhibited usage of profanity. In fact, I thought my elderly life would be enhanced by the onset of Tourette's Syndrome. I will have to find a new hobby for my retirement as I learned it is genetic (no family background here) and onsets by adolescence. With more knowledge of the disease I no longer believe it would be a fun experience. It is dysfunctional to one's lifestyle, but not disabling. Not only are the thoughts uninhibited, but so are unneccesary motor activity. So instead of jealousy towards victims of Tourette's Syndrome, I now carry compassion, empathy- but most of all an understanding. Your Title: Rolando P. Your Name: Jennifer Jewell Source: Sack, Oliver. Awakenings. New York: HarperCollins Publishing, 1990. 116-128. Patient Background: Rolando P.'s infancy and early childhood was very normal. He showed no signs of any dysfunctions or incapabilities. In fact, Rolando P. was excelling in motor and speech. At 30 months of age he suffered from encephali- tis lethargica. This illness lasted for about 18 week and forever changed Rolando's life. Behavioral Change: After Mr. P's bout with encephalitis lethargica, he suffered from severe motor dys- function, the inability to communicate through speech or facial expressions, as well as excessive salivating. Many felt his mental ability had also been diminished, but his mother argued that he was still as bright as he was before he became ill, now he just couldn't express it to others. In early childhood, Rolando attended classes for the mentally challenged, but this became too difficult for Mr. P because of his inability to sustain his balance. He was helpless without the support of someone else. From then he was at home with his parent through his adolescent years. His parents then admitted him to a hospital where Mr. P's limb became more rigid and his speech was more inaudible. The rigidity was slightly decreased in a left-sided chemopallidectomy operation. Even after the opera- tion, Mr. P's speech remained predominately inaudible and the rigidity in the right side of the body persisted. Mr. P was started on L-DOPA in an effort to reduce some of these symptoms. By the first week, the results were evident. His motor capability increased, he was now able to walk with very little assistance. The rigidity in his limbs, trunk, and neck were almost non-existent, the drooling had stopped, and he was able to communicate audibly. Mr. P also developed sexual urges. These positive results were short lived. By the second week on the medica- tion, there was an onset of akathisia. Thus his L-DOPA dosage was reduced. His akathisia was now specific which affected his right leg and a forced chewing movement. His libido continued to be strongly present. Mr. P increasingly became more hostile, irritable, and anxious. He found his eye to become fixed by moving object and he could not stop staring at the object until it was removed from his field of vision. Once again his L-DOPA was reduced. The excitomotor syndrome continued and haloperidal was added to his medication list. Mr. P's Parkinson's symptoms began to overshadow his excitomotor states. He continued to fall into sleepy states whether L-DOPA was increased or decreased. These states were only suppressed when in the presence of his family and while he was away from the facility. When he was returned to the facility the sleepy/depressed states resumed. Nervous System Changes: Mr. P's nervous system was very unstable. All of his behavior had an oscillatory, all-or-none quality that the doctors could not correct with medication. They tried to correct his inability to be mobile and communicate with an operation and the use of L-DOPA. L-DOPA did help these symptoms to a certain extent only to onset excitomotor syndrome. Family or Physician Reflection: Mr. P's mother played a very important role in his life. From the beginning she stood by him, not labeling him an invalid. She visited him weekly while she was well and it was during these visits when Rolando showed better mental and physical signs. When his mother passed away, Rolando became very depressed, having no one there to nurture and love him. To fill the shoes of his mother was a physiotherapist. She took Rolando under her wing and gave him the nurturance that he needed. It was only after she was dismissed from her position at the hospital and was no longer able to see Rolando that he gave up the will to live. He gave up all hope, knowing that there was no one left to care about him and love him the way his mother and the physiotherapist could. Your Reaction to the Case: With Rolando's situation, it is sad to see how easy it would be to give up on someone because of their lack of ability to communicate. Rolando was lucky enough to have a loving and caring family and doctor that never gave up on him. Despite some of the side effects of the L-DOPA, it did make dramatic changes in his life. It allowed him to be mobile and allowed his speech to be audible. Medicine can only do so much for a person, the power of love can be the cure for all. In the presence of his family, Rolando's symptoms seemed to prac- tically disappear. Feeling loved gave him the will to go on and con- tinue fighting for his life. When those people that cared for him were gone was when Rolando gave up hope. I believe that without hope there was little that science could do for Rolando.

Symptoms of Stroke
Chuck Bortscheller

 Source: May, Sarton. After the Stroke. W.W. Norton and Company, New York and London. (1988)

 Patient Background: Mary Sarton was an author and a poet before she had her stroke. She had authored over a dozen poetry books, eighteen novels, nine nonfiction works, and two children's books. On the 20^th of February, at the age of 73, she awoke in the middle of the night complaining of numbness in her left arm. She called for an ambulance and was admitted to the hospital that night. After six days of tests, a CAT scan showed a small hemorrhage of the brain. Two months earlier she had been diagnosed with congestive heart failure.

 BEHAVIORAL CHANGE: Most of her psychological changes came about due to the fact that her left side was weakened and she could not perform all of the tasks she was used to doing. She would become depressed very easily due to the fact that light household chores exhausted her. She would at times cry due to this. At this point, she also felt not whole for she had no poetry lines flowing through her as she had been accustomed to all her life. Added to everything else that she was going through, was the fact that her heart medication made her feel ill and uncomfortable. Ms. Sarton had many people that supported her throughout this time in her life, which helped to keep her from becoming overly depressed.

 NERVOUS SYSTEM CHANGES: The case report that I am using is the patient's own story, and does not go into detail about the actual physiological changes that took place. All that is really revealed is that she suffered from a minor hemorrhage on the right side of the brain. There did not seem to be any major damage for Ms. Sarton was able to use her left arm and leg again after recuperating from the stroke.

 FAMILY OR PHYSICIAN REFLECTIONS: Once again, this study is actually a journal kept by the patient, so it does not include any thoughts by the physicians that treated her. It does talk about the kindness of her friends that helped her with her recovery by doing simple household chores and supplying meals at times. Besides May's own feelings about what happened to her though, there are no other reflections in this book.

 MY REACTION TO THE CASE: While this case lacked in neurological and physiological information, it more than made up for it with the personal feelings of the patient. This journal allows us to see more than just "what happened" to her. It allows us to understand the emotions and feelings of someone who has gone through something that many people go through, yet can be hard for someone else to comprehend the effects of. This will allow us to be able to better understand and treat patients who suffer from mild strokes, for we will be more familiar with some of the emotional symptoms that can be associated with this disorder. I feel this is a great example of a woman who never gives up and uses the tragedies that she encounters to make her stronger.

Encephalitis Lethargica
Michelle Laird
Source: Sacks, Oliver. (1995). Rose R. Awakenings. Patient Background: Rose R. was born in New York City in 1905. She was the youngest child in a large, wealthy and talented family. Rose was full of spirit and had an intense love and affection for her family. She did not experience any neurotic problems or identity crisis while growing up. However, one night, at the age of 21, Rose became trapped inside her own body, never to fully return.
Behavioral Changes: The night the change occurred, rose was plagued with nightmares of being trapped. The next morning her family had trouble waking her and once they did, she showed little response. For the rest of her life, Rose's symptoms were variable. At first, Rose was only able to speak short sentences and make sudden movements before she would freeze up again. She seemed alert to what was going on about her and always kept her affection for her family. After three or four years, Rose became rigid on her left side and developed many other signs of Parkinsonism. She had more and more trouble with balance and walking. Rose would sit for hours on end without expression on her face. She drooled and sweat profusely, and her skin became very oily. Rose could only whisper a little and became unable to move her tongue much. Her legs became hypertonic with the left foot bent inward. Tremors would sometimes develop in her right arm, head, lips, and tongue. Rose was most likely to talk in times of severe crisis where she would cry out, "Help me...I'm in terrible pain...I'm frightened...I'm going to die!" At the age of 64 she began to be treated with L-dopa. This drug would help for a few weeks, but in a short time, the disadvantages and reactions it caused outweighed the benefits. During times of lucidity she had an outstanding memory of the year of encephalitis onset and would often pretend she was still living in that time period, although she knew how much time had actually gone by. Rose didn't age much. At 64 she still looked 30 years younger. In the end, she could only be roused out of her trance-like state by external stimuli. For the most part, she reported that usually there was absolutely nothing going on in her head.
Nervous System Changes: At the time, there were no brain scans performed on Rose. However, it is obvious that some of the motor pathways were interrupted through her tremors, rigidity, hypertension, etc.. Her memory did not seem to be affected.
Physician Response: The physician pointed out that during her last years, Rose was best when visited by her family. When one would see her at these times, he/she could see that Rose was really a normal, charming person who was imprisoned by the disease. She didn't actually live most of her life. In fact, he reports that in conversation with Rose, she remarked that she still felt like she was 21 years old because she had never experienced anything else. My Reactions: This was a very scary story to read. I can't imagine what torture Rose must have gone through. Although for the most part she thought absolutely nothing, it is apparent that during some of the bad times she was aware that she was pretty much trapped inside of her own body and could not express herself. She missed out on the majority of her life and could do nothing to help herself.

Rolando P.
Jennifer Jewell
Source: Sack, Oliver. Awakenings. New York: HarperCollins Publishing, 1990. 116-128.
Patient Background: Rolando P.'s infancy and early childhood was very normal. He showed no signs of any dysfunctions or incapabilities. In fact, Rolando P. was excelling in motor and speech. At 30 months of age he suffered from encephali- tis lethargica. This illness lasted for about 18 week and forever changed Rolando's life.
Behavioral Change: After Mr. P's bout with encephalitis lethargica, he suffered from severe motor dys- function, the inability to communicate through speech or facial expressions, as well as excessive salivating. Many felt his mental ability had also been diminished, but his mother argued that he was still as bright as he was before he became ill, now he just couldn't express it to others. In early childhood, Rolando attended classes for the mentally challenged, but this became too difficult for Mr. P because of his inability to sustain his balance. He was helpless without the support of someone else. From then he was at home with his parent through his adolescent years. His parents then admitted him to a hospital where Mr. P's limb became more rigid and his speech was more inaudible. The rigidity was slightly decreased in a left-sided chemopallidectomy operation. Even after the opera- tion, Mr. P's speech remained predominately inaudible and the rigidity in the right side of the body persisted. Mr. P was started on L-DOPA in an effort to reduce some of these symptoms. By the first week, the results were evident. His motor capability increased, he was now able to walk with very little assistance. The rigidity in his limbs, trunk, and neck were almost non-existent, the drooling had stopped, and he was able to communicate audibly. Mr. P also developed sexual urges. These positive results were short lived. By the second week on the medica- tion, there was an onset of akathisia. Thus his L-DOPA dosage was reduced. His akathisia was now specific which affected his right leg and a forced chewing movement. His libido continued to be strongly present. Mr. P increasingly became more hostile, irritable, and anxious. He found his eye to become fixed by moving object and he could not stop staring at the object until it was removed from his field of vision. Once again his L-DOPA was reduced. The excitomotor syndrome continued and haloperidal was added to his medication list. Mr. P's Parkinson's symptoms began to overshadow his excitomotor states. He continued to fall into sleepy states whether L-DOPA was increased or decreased. These states were only suppressed when in the presence of his family and while he was away from the facility. When he was returned to the facility the sleepy/depressed states resumed.
Nervous System Changes: Mr. P's nervous system was very unstable. All of his behavior had an oscillatory, all-or-none quality that the doctors could not correct with medication. They tried to correct his inability to be mobile and communicate with an operation and the use of L-DOPA. L-DOPA did help these symptoms to a certain extent only to onset excitomotor syndrome.
Family or Physician Reflection: Mr. P's mother played a very important role in his life. From the beginning she stood by him, not labeling him an invalid. She visited him weekly while she was well and it was during these visits when Rolando showed better mental and physical signs. When his mother passed away, Rolando became very depressed, having no one there to nurture and love him. To fill the shoes of his mother was a physiotherapist. She took Rolando under her wing and gave him the nurturance that he needed. It was only after she was dismissed from her position at the hospital and was no longer able to see Rolando that he gave up the will to live. He gave up all hope, knowing that there was no one left to care about him and love him the way his mother and the physiotherapist could. Your Reaction to the Case: With Rolando's situation, it is sad to see how easy it would be to give up on someone because of their lack of ability to communicate. Rolando was lucky enough to have a loving and caring family and doctor that never gave up on him. Despite some of the side effects of the L-DOPA, it did make dramatic changes in his life. It allowed him to be mobile and allowed his speech to be audible. Medicine can only do so much for a person, the power of love can be the cure for all. In the presence of his family, Rolando's symptoms seemed to prac- tically disappear. Feeling loved gave him the will to go on and con- tinue fighting for his life. When those people that cared for him were gone was when Rolando gave up hope. I believe that without hope there was little that science could do for Rolando.

Reminiscence
David Sivesind
Source: Sacks, Oliver (1995). The Man Who Mistook His Wife For a Hat. 125-142. Patient Background: Mrs. O'C, besides some deafness, was a relatively healthy woman in her eighties living in an old people's home. One night she had been dreaming of her childhood in Ireland. When she woke, she continued hearing the Irish music, although no radio was playing. She thought the music might be collecting like radio signals in her dental fillings. This was not the case. She consulted a nurse, an otologist, and a psychiatrist, none of whom could find an explanation. Finally, the author, a neurologist, was consulted in the case. Mrs. O'M, also a woman in her eighties at the same home, later came to the author with similar concerns. The woman complained of hearing several songs. Sometimes, she heard several songs at once. Her songs began one day when she was grating parsnips in the kitchen. She heard several church hymns in rapid succession. Mrs. O'M expressed considerably greater distress from hearing the music than Mrs. O'C.
Behavioral Change: Continuing from the night described above, Mrs. O'C continued to experience an "ocean of sound" both during sleep and waking hours. The songs were all Irish songs from her childhood. As the days progressed, the music continued to become louder and more prominent. Tests showed that she was not experiencing any deafness or loss of hearing. She was bright and alert, but was described as appearing remote and self absorbed. All indications were that Mrs. O'C was a completely normal 88 year old woman the day before she began hearing the music. After four months, the songs were gone. Mrs. O'C was relieved that the songs were gone, but expressed missing the songs. She felt that the experience had brought back a piece of her childhood that was lost before the incident. She felt that the experience, although unnerving, had been a sort of healing process for her. Mrs. O'M was a similar case with slight differences. She had heard sound in her head for four years before telling anyone of her symptoms. She was somewhat deaf. She heard music in her head, sometimes with ringing, hissing or rumbling sounds. She sometimes heard distant voices, occasionally many at once. Mrs. O'M's experience was significantly more rattling. The songs she heard did not hold any special meaning for her. Thinking of the songs would bring them into her mind. Avoidance of thinking of the songs would bring them into her mind. She came to hate the songs. She could hear several songs or sounds at the same time. Her condition progressed and worsened over the next year. At times, the music became so loud that she was unable to hear conversation. Mrs. O'M was finally treated successfully by the use of anticonvulsants. She did not miss the songs. Nervous System Changes: The concern expressed by both patients was dubbed a sort of 'Musical Epilepsy'. It is believed that the epileptic seizures occurred in the "reminiscence" portion of the brain. EEG's confirmed that both patients had experienced temporal lobe seizures during the time that they experienced the music in their heads. The songs experienced by both women did appear to have some psychological significance to them. While it is obvious that Mrs. O'C was experiencing songs she had recalled from a pleasant childhood, it was only late in treatment that Mrs. O'M revealed that she was apt to hum the songs she later heard in her head before she began to hear them in her head. Mrs. O'C's symptoms disappeared without physiological treatment. Her experience appears to have had the effect of a psychological healing, what the author dubbed "nostalgia". Mrs. O'M was successfully treated by anticonvulsants which halted her temporal lobe seizures.
Family or Physician Reflections: There was no mention of reactions from the families of either of the women. However, the author/neurologist expressed personal insights into the cases. He commented that the cases could be considered at the same time both from a physiological and psychoanalytic framework. He saw both women's experiences as "reminiscence". That is, an experience that was both meaningful physically and nostalgically, the workings of experiential memory.
Reaction to Case: It is very interesting that very similar neurological cases can be experienced so differently by individual patients. While the neurologist was able to determine the physiological cause of the songs experienced by both women, it is intriguing that the psychological importance of the songs was directly related to how the women experienced their symptoms.

The Man who Fell out of Bed
Magen Swarbrick
Sources: Sack, Oliver (1985). The Man who Mistook His Wife For a Hat. P.53-55. Kolb, B. & Whishaw, Ian Q. (1990). Fundamentals of Human Neuropsychology. p.424-427.
Patient Background: Patient C was admitted to the hospital for tests. This young man had no complaints, but the neurologists, feeling that he has a "lazy" left leg should come in for some tests.
Behavioral Change: All day Patient C felt fine, no complaints. He seemed very nice and normal until he awoke from a nap in the evening. Immediately after awakening he felt fine until he moved in his bed. Recalling that there was another leg in bed with him, a severed human leg. As he went to throw the leg out of his bed, he came with it. He now lay on the floor refusing to get back into bed. In confusion, he could not recognize that it was his own leg that he had felt in bed nor could he not understand where his left leg had gone.
Nervous System Changes: Patient C is suffering from sensory neglect. According to Kolb's & Whishaw's text and Dr. Walsh, further testing on Patient C would indicate that he is suffering from a lesion on his right parietal lobe. Patient C is portraying a classic symptom of contralateral neglect. This involves the neglect of part of the body or space contralateral to the lesion. Family or Physician Reflections: My case report comes out of a book written by Oliver Sack. There is no information included about the patient's family, where he lives, or any other personal background information.
Reaction to the Case: There was very little information given about this patient and no diagnosis, which made it difficult to understand the case. However, looking to other sources I was able to come up with a prognosis, and realizing that this would be a difficult injury/disease to live with. A follow-up of Patient C and coping with this disorder would definitely make for and interesting read.

Embolitic and Thrombolitic Cerebrovascular Accidents in Two Individuals
Janelle K. Chaney
Source: Klawans, Harold (1990). My Mother's Best Friend. Newton's Madness, 7-18.
Patient Background: Patient e was discovered by his wife lying on the bathroom floor unable to speak or move his right side. At the age of 72, he had suffered a cerebrovascular accident (CVA), commonly referred to as a stroke. This resulted due to a thrombosis on the left side of his brain. Patient B had a history of rheumatic heart disease with abnormal heart rhythms. Upon waking in the morning, her left leg had "given out" when trying to stand. An embolus caused by a blood clot in the heart had induced a CVA in B as well.
Behavioral Change: Patient E experienced partial paralysis of his right side (hemiparesis) and the inability to speak or understand language(aphasia). His eyes tended to look to the left as well. The cerebral thrombosis had blocked an artery in the brain causing the stroke resulting in these symptoms. Only three days after the stroke, E was speaking well enough to be understood and was walking with a cane. Patient B's symptoms were more severe. B suffered from a total left hemiplegia with no muscle tone. Although B's speech and memory were unaffected, she did exhibit severe agnosia involving all forms of sensation including touch, pressure and vision. Agnosia means "without knowledge" and more specifically being unaware of her body parts. When asked to identify her hand, B was unable to recognize it. B also exhibited neglect, meaning that the left half of the world did not exist for her. Patient B's condition never improved significantly. She was unable to walk, dress herself, or even read because of her unawareness of the left side of herself and other objects. Nervous System Changes: Patient E's CAT scan did not reveal a large stroke and only the neurons in the center of the stroke were unable to recover. As the other cells regained their function, E's condition improved. Patient B's CAT scan showed that she had experienced a moderate-sized stroke involving the motor strip and much of the parietal lobe. Although the stroke was not massive in size, it was massive by location.
Family and Physician Reflections: In this case there is a close personal relationship between Patient B and the physician. Behavioral changes in B were much easier to see because of this relationship prior to the stroke. Although it was hard to accept the severity of this stroke, the physician knew that little could be done to help B's condition. Since Patient B was the focus of this case, little extra attention was given to Patient E.
My Reaction: This case illustrates two different types of CVA's and the very different consequences that arise. Working with stroke victims is a large part of what I do in physical therapy. I felt that this case did a good job of presenting both the physical and emotional aspects associated with strokes.

Dystonia, Ben Hogan's Downfall
Holly S. Barberra
Source: Klawans, H. L. (1996). The bantam: Ben Hogan. In Why Michael couldn't hit; and other tales of the neurology of sports. (pp. 83-108). New York: Freeman.
Paitent Background: Ben Hogan was the greatest golfer in the history of golf. He was recognized as one of the people who put the sport of golf "on the map". At the age of 37, Mr. Hogan and his wife were victims of a car crash that left Mr. Hogan with a fractured pelvis, collarbone, ankle and several broken ribs. He was able to recover remarkably well, and was back on the tour by 1950. Though the accident was not the cause of his dystonia, his will to overcome any impairment took its toll on his nervous system. His constant, seeminly never-ending drive to perfect his posture and to control his movement taxed his extrapyramidal system. His first symptoms were seen at the U. S. Open in Rochester, his finger pulled away from the club, disrupting his controlled posture, causing him to miss the putt and lose the open. This loss of control has been termed the "yips" and has been associated with "oldtimers" in the game. Mr. Hogan's yips, like many others, does have a neurological basis.
Behavioral Changes: Mr. Hogan's golf game deteriorated from that point forward. His spasams increased until he was no longerable to play golf. Mr. Hogan's memory and cognitive abilities were not affected. He was suffering from a severe case of the yips. His ability to hold and maintain his posture and fine movement continued to occur after he had been playing for some time usually resulting in blowing the winning shot. As a result, he gave up golf. Nervous System Changes: The body is controlled by three systems. The pyramidal system which directs movement, the cerebellar system which provides synergy and coordination, and the extrapyramidal system which creates and maintains postures. It was this third system that failed for Ben Hogan. He lost the ability to control his posture in order to make the swing. His extrapyramidal system short circuts when he needs it most. There were no tests to be run on Mr. Hogan to make a medical diagnosis at that time. The yips have been viewed as a natural occurance in aging golfers. Dr. Klawans research discovered the connection and breakdown of the systems years after Mr. Hogan had retired.
Family or Physician Reflections: There are no reports about Mr. Hogan's family or his physicians reflections regarding his condition. The author shares his own views about Mr. Hogan's conditions as more of an annoyance than a disease. Dystonia musculorum deformans is the most severe form and can result in disability and death. Mr. Hogan's occupational dystonia only interfered with the types of movement and postures associated with his occupation, golf. Reaction to the Case: Mr. Hogan's disorder, dystonia is a common problem for many athletes. I believe that Dr. Klawans findings will help put these athletes minds at ease. They do suffer from a real problem. They aren't just getting old, or losing it. Their nervous systems have been worked hard and are reacting to their years of hard work. Although for many people, dystonia is only an annoyance, it can have a major impact on their psychological and emotional well being. Losing ones career is no small inconvience. Professional athletes like Mr. Hogan have a great deal to lose. As for the amateur, struggling to make the putt will not mean the difference between feeding their family or not this month, it can mean ridicule and loss of self-esteem. Golf, like any sport is competitive. But golf is a competition for the individual. He or she strives to be better against him/herself, not just the other players.

Four Cases of Epilepsy
Elizabeth D. Williams
Source: Martin, Russell (1986). Fire At Brief Moments. Matters Gray & White, 39-61. Wendy Stetham:
Patient Background: Wendy is a twenty year old woman. She is 33 weeks pregnant with her first child and unwed. She has a long seizure history extending back to her childhood. Prior to her pregnancy, her seizures were controlled with Dilantin, but the drug has recently caused a severe rash and her seizures are becoming frequent.
Behavioral Change: During her seizures, Wendy's eyes grow white and stare blankly, saliva pours from her mouth, and her arms and legs shake wildly. Each of the most recent seizures have brought about contractions, but each time they have ended shortly after the seizure. The child is still growing and the heartbeat appears strong.
Nervous System Change: Wendy is suffering from grand mal seizures. They start in a small, localized area but quickly move throughout the cortex.
Physician Reflections: Her physician, Ferrier, is quite worried about the child and is considering inducing labor. While he does believe that there is a physiological reason for her epilepsy, Ferrier thinks that some of Wendy's seizures are "pseudoseizures" caused by a psychological disorder.
Elliot:
Patient Background: Elliot is a four year old boy recently diagnosed with epilepsy. There is no family history of epilepsy and no major head traumas. He had two grand mal seizures, but since beginning treatment with Phenobarbital he has been relatively seizure free.
Behavioral Change: His first seizure occurred while riding home from a baseball game. He became drowsy and he slumped back in his seat. His eyes rolled back, he became pale, and his body quivered. All the time he held an ice cream cone upright. Upon regaining consciousness, he was drowsy and had slurred speech.
Nervous System Changes: Elliot's EEG showed normal activity until he fell asleep, then there was unusual activity in the right frontal region. He also showed weak ankle reflexes and had difficulty jumping off his left foot.
Family Reflection: His parents were extremely worried over his diagnosis and frightened by his seizures. They felt that Elliot was taking it quite well. In fact, he would even tell his baby-sitters what to do if he had a seizure.
Melanie Brubaker:
Patient Background: Melanie has been on medication since childhood for absence seizures. She also has been diagnosed with tension seizures, which she has had since childhood also. These tension seizures typically occurred when someone would get upset with her or when her parents fought.
Behavioral Changes: During the absence seizures, Melanie would go into a sort of trace. She would stare vacantly and would sometimes undergo a sudden loss of consciousness but would just as suddenly return to normal functioning. As a child her tension seizures consisted of her rocking back and forth screaming. In adulthood, she gets lightheaded and feels ready to faint but she can control when (or if) she does faint. She also has petit mal seizures that last 15-45 minutes. Her vision becomes blurry, she has a metallic taste in her mouth, she gets weak and feels queasy, and she feels hazy and unfocused.
Nervous System Changes: There was no discussion of CAT scan or EEG results for Melanie. It was noted that the petit mal seizures were located in the temporal lobe. The tension seizures are a psychological manifestation of stress. Physician Reflection: Melanie was placed on Phenurone, Diamox, and Tegretol. Ferrier also advised her to avoid stress, lack of sleep. and alcohol.
Sandra Fischer:
Patient Background: Nineteen year old female college student. No history of seizures. Her friends recognized that she had been having staring spells for the previous week.
Behavioral Changes: Sandra started with absence seizures, but was brought into the hospital when they had progressed. She started to loose focus and her left leg would quiver. Each episode lasted for about 15 seconds but they were appearing every 5 minutes. Nervous System Change: Sandra had a normal CAT scan but had unusual EEG activity in her temporal lobes.
Physician Reflections: Ferrier started her on Tegretol. There was a statement made about the unusual occurrence of absence seizures in an adult. Absence seizures usually only occur in young children, but there was no mention as to why Sandra may be having this type of seizure.
My Reactions: I felt this chapter was extremely informative. I would have enjoyed a little more detail about the patients with perhaps less accounts so that I could get more background and treatment information. The most interesting though was some of the history and research of seizures that was discussed.

Memory loss following brain tumor
Melissa L. Staker
Source: Sacks, Oliver (1995). Amnesia in a young man following a brain tumor. An Anthropologist on Mars, 42-77.
Patient Background: Patient F was an intelligent boy, especially in the area of music. However, he quickly tired of school and dropped out; turning to rock-n-roll, and drug use, which quickly became an immense problem. Now tiring of life, he decided to join the International Society for Krishna Consciousness in a Brooklyn temple. He was thought to be gifted, so he was sent to New Orleans. While in New Orleans, patient F began complaining of impaired vision; the temple ignored his problem, stating it was because he was merely connecting with life at another level. When his parents visited him at the temple, they sent him to the doctor; concerned about his apparent altered state of consciousness. It was at this point that the brain tumor was discovered.
Behavioral Changes: Patient F’s mid-line tumor left him with severe memory problems, not only with present day memory but also with past memories. If told a story and asked to repeat it five minutes later, the story he would tell would have no correlation with that which he was told. His vision has become totally lost, however, he does not seem to realize he is blind; but his attitude would suggest that he believes everyone sees the world as he does. He is happy when his parents come to visit him, but does not seem upset if they do not come for a number of days. Many years later, his father passes away. Upon being told the news, he appears to be very upset, but after a time forgets that his father is dead. He did not seem to mourn until after he had a nightmare, complaining that he lost something very important to him. While left alone he is placid, but becomes quite lively while in other's company. He has problems remembering information about people, so he has to break one person into two separate people. He has problems identifying with time, yet can remember geometric truths and procedural memory. He is slow with familiarization, but will retain it. He has problems transferring information into his long-term memory. He still posses a love for music and still has the ability to play instruments and remember the lyrics to his favorite songs, but has problems remembering new songs.
Nervous System Changes: Brain imaging showed an enormous mid-line tumor, destroying the pituitary gland, optic chiasm, and both sides of the frontal lobe. The tumor reached backwards toward the temporal lobe and downward toward the diencephalon. An EEG shows an incoherent pattern; however, it is calm and even becomes almost rhythmic while he is listening to music.
Family or Physician Reflections: His physician feels that most of the brain damage could have been prevented if only he had seen a doctor as soon as he started having vision problems. His parents saw him almost daily, yet they did not have many comments. His father does give the impression that he is not upset about his son’s condition, mainly because his son seems to enjoy their company.
My Reaction: I felt that there was a few things thrown in that had nothing to do with the patient directly. This leads to the article being choppy. There was an abundance of facts, but it did touch on some of Patient F’s interests.

An Anthropologist On Mars, Temple Grandin, Autistic Ph.D.
Leslie Jorgensen
Source: Sacks, Oliver (1995), An Anthropologist On Mars: Seven Paradoxical Tales.
Patient Background: Temple Grandin Ph.D. a now successful assistant professor in the Animal Science Department at Colorado State University, engineer, and successful author suffers from Asperger's type autism.
Behavioral Changes: At age six months Temple started to stiffen in her mother's arms, and at age ten months she started to claw "like a trapped animal", which made normal contact with her almost impossible. Temple suffered from heightened sensations sometimes at an excruciating degree, she said "her ears were like microphones transmitting everything at full volume. At age three she became destructive and violent and was taken to a neurologist where her diagnosis of autism was made. Temple's family was then told that in would be in her best interest to be institutionalized and that she may never speak. With help from special therapists Temple not only learned to speak, she went on to junior high and high school, and even graduated college with a Ph. D. Miss Grandin is now an assistant professor at Colorado State University, and with her powerful visualization skills is the designer of the Grandin Livestock Handling Systems Inc. Although, Temple has little interaction socially with other people due to her autistic condition she has dedicated most of her life to her work developing and improving cattle slaughtering and processing plants. Miss Grandin also travels the U.S. giving lectures about autism, and her autobiography about her life as an autistic Ph.D.
Nervous System Changes: Temple has a slightly clumsy or uncouth gait attributed to a simple ataxia associated with impaired development of her vestibular system and part of her cerebellum associated with autism. She also sometimes has episodes of short spasms or fixed posture in her arms.
Family Or Physician Reflections: The paradoxical tale I read from was written from the author's perspective and not much was mentioned about Temple Grandin's family or physicians. The author was amazed with Temple's ability to understand feelings even though she has little feelings (such as live, joy, wonder, etc.)herself. Temple also used jokes and metaphors, which is something autistic people do not comprehend. The author was also intrigued with the idea that on the surface Temple did not seem autistic at all, and found her accomplishments overwhelming.
My Reaction To The Case; In conclusion I thought this was an exceptional article. Not only did the article include information about autism, it described how one person, Temple Grandin, overcame it to become a very successful person. This was a very informative as well as interesting article and I am glad I was able to read and broaden my knowledge of autism.

Korsakoff's Syndrome
Jennifer Michur
Source: Sacks, Oliver. (1985). The Lost Mariner. The Man Who Mistook his Wife for a Hat, 22-41.
Patient Background: Jimmie was a friendly 49 year-old man born in Connecticut who finds himself in an office with a nuerologist. The problem is that Jimmie does not remember going there or why he is even there. Earlier, Jimmie found himself forgetting things, especially recent events. Jimmie graduated from high school in 1943 and then was drafted into the navy. In the navy he was an assistant radio operator on a submarine. He remained in the navy until 1965. In 1970 Jimmie began to drink more heavily. Around Christmas he exploded and was taken to the Bellevue hospital. A letter from 1971 was found from the hospital saying that he was disoriented with a advanced organic brain-syndrome caused from alcohol. A month later he calmed down, but still had some memory loss. He was later admitted to a home for the aged near New York City in 1975.
Behavioral Change: When Jimmie was admitted to the home for the aged, he talked about high school and the navy believing that the year was 1945 when it was really 1975. During his conversation with the nuerologist he talked in the present tense like his experiences were recent. The doctor did a test on him by getting up and leaving the room for a few minutes. When the doctor returned Jimie did not recall ever meeting him before. The doctor then did some ecaminations of Jimmie and on the intelligence testing he did very well. He was able to solve complex problems quickly without any difficulty. Although, if the tests took too long he would forget what he was doing. His recent memory was at great loss because he could not even remember anything that was said or done a few seconds before. He sometimes would remember what he had done, like playing a game with the doctor, but could not remember if it happened a few minutes ago or months ago. When he found out that the game was played with the doctor he became amused, which is very characteristic of Korsakoff's Syndrome. Jimmie was very good at math and science, just like a bright student who had graduated from high school. In other words, he acted like he was in the past through his feelings and by his words.
Nervous System changes: Korsakov's Syndrome is described as nueron distruction produced by alcohol in the tiny mammillary bodies with the rest of the brain perfectly viewed. All of the tests taken on Jimmie indicated that there was not any massive brain damage. He was able to remember and recognize the nurse, but thinks that he knows her from high school. His brother is the only person that he truely knows, but cannot understand why he looks so old. Jimmie was encouraged to keep notes everyday, but it was hard for him to remember to take notes. Later, instead of keeping notes, he got involved in recreation programs. By playing the games he was able to get involved and not be so bored. Soon he perfected everything and had nothing left to do. He liked to type so the home found him an easy typing job. He found it challenging and to his satisfaction. Jimmie also found continuity and unity spiritually at church, in nature, through art, and listening to music.
Physcian Reflections: Korsakov's Syndrome is due to a alcoholic degeneration of the mammillary bodies. Jimmie is a man without a past or a future, and is stuck in a period of time. He was lost and how would he ever establish roots? Jimmie always looked sad even though he never expressed any sadness. He really did not feel anything. It was also thought that Jimmie might of had hysterical or fugal amnesia because he only remembered up to the year of 1945 and not to 1970.
My Reaction to the Case: I found this case to be very interesting because I have never truely experienced what really happens to a person with amnesia. Alcohol is used so often and by so many people that more people need to realize how destructive it can be. Especially with the effects that it can have on the nervous system like in Korsakov's Syndrome. It makes me think that having a drink is not worth destroying my neurons which could destroy my life.

Phantom Limbs
Courtney Determan
Source: Lacroix, R., Melzack, R., Smith, D., and Mitchell, N. (1992). Multiple phantom limbs in a child. Cortex, 28, 503-507.
Patient Background: Patient K.G. was born in 1975 with a shortened leg. The right leg was 10 cm shorter than the left leg. The foot of the right leg was normal in size and had five toes, but the fourth was held in flexion overlying the third toe. When K.G. was 6 years old, went to the Shriners Hospital for a consultation. At this point, she was wearing a knee brace that provided a 4 cm elevation to the right foot. She was diagnosed with having a right congenital fibular hemimelia and a Symes amputation was performed. After the amputation at age 11, K.G. was provided with a prosthetic foot.
Behavioral Change: Patient K.G. was interviewed at 16. She was attending high school and living with her parents and her two brothers. She was very active at school and made use of her prosthetic leg. K.G. mentioned that shortly after her leg had been amputated, she had felt a phantom foot where her amputated foot had once been. This phantom foot extended forward like her original foot and it had five toes. This was phantom #1. Shortly after K.G. noticed phantom #1, she noticed another set of phantom toes which appeared at the top of the stump. This was referred to as phantom #2. About three months after the amputation, K.G. developed a third phantom foot. This phantom included a calf which extended from the stump and lead to a foot with a set of five toes that was coordinate with the prosthetic limb. This phantom was referred to as phantom #3. Each phantom was very distinct in size, length, and position in relation to the others. K.G. related also that the phantom foot (#3) seemed to be stuck in a flattened position which was quite unpleasant for her. K.G. experienced a wide range of sensations such as tickling, heat, formication, and fatigue. When interviewed, K.G.'s memories of her amputated foot were inaccurate. She recalled that her foot was normal with five toes, when in fact she had had a right flatfoot deformity and the foot was locked into an equinovalgus position with no active or passive movement. This suggests that she experienced somatosensory memories of the actual deformities without having conscious recall of them.
Nervous System Changes: Patient K.G.'s experiences with her phantoms had persisted for ten years after her lower leg was amputated. It is proposed that phantom limbs are generated by a widespread network of neurons (neuromatrix) which consists of loops that are integrated in the somatosensory thalamus and cortex, the limbic system and the association cortex. It is assumed that this neural network is genetically determined and is responsible for these experiences in K.G.'s body. Also, Changes in innervation due to neuroplasticity may conceivably play a role in the multiple phantoms that K.G. experienced, and may contributed to the fragmentation, fading and telescoping that are observed in the natural changes of the phantom limb in adults and children. Family or Physician Reflections: This case report was taken from a professional journal so it does not reflect the emotions of K.G. or her family. It does report on K.G.'s sensory experiences and the unpleasantness of the feeling in phantom #3 which seemed to be flat and stuck in a forward position. This report also contains a picture of a clay figure that K.G. made which depicts her three phantoms.
Reaction to the Case: This case is remarkable because it was the first case of a child who had a limb amputated at a young age and developed multiple phantoms. Although there was much detail of K.G.'s physical experiences with her phantoms, it was difficult to empathize with her situation because there was not much account of her daily life and how she coped with her disorder in her disorder in her everyday activities. From the vague detail that was given, however, it appears that K.G. copes fairly well. She has been active with her prosthetic foot, done well in school, and is a very serious intelligent girl.

Lou Gehrig's Disease
Jescica Lage
Source: Klawans, Harold L.. Why Michael Couldn't Hit: And Other Tales of the Neurology of Sports. New York: W.H. Freeman, 1996,(pgs.245-261). Patient Background: Lou Gehrig was the greatest first baseman in the history of major league baseball and the most famous person during his time to develop amyotrophic lateral sclerosis, a slowly progressive neurological disease. In 1938, at the age of 35, his performance began to decline and he began experiencing weakness in his lower limbs (especially) followed by atrophy of the muscles of his hands. In 1939, he permanately removed himself from the Yankee lineup, was evaluated at the Mayo Clinic and diagnosed with amyotrophic lateral sclerosis. Twenty-five months later, on June 2, 1942, Lou Gehrig died at the age of 38.
Behavioral Changes: My case report focused mainly on Lou Gehrig's career and performance as a professional baseball player and how his performance changed based on the symptoms of amyotrophic lateral sclerosis. It also focused on defining the disease and its effects. Lou's behavioral changes due to ALS were looked at in terms of changes in his performance and his batting statistics on a weekly basis during the final four years of his career. It wasn't until the 1938 season that his performance declined and continued to deteriorate from there. His batting average declined and the predominant weakness early in his illness was in his legs which altered his speed. He began using his hands to push down on his legs in order to straighten his hip joints when standing from a seated position. This is known as Gower's sign and showed evidence of weakness in his thigh muscles. Another factor which altered his batting performance was atrophy of his hand muscles.
Nervous System Changes: The neurological damage of ALS on Lou Gehrig could be seen by the progressive weakness and degeneration of his muscles as well changes in his motor funcion (voluntary motor function). Microscopic examinations attempted to correlate sclerosis of the lateral columns of his spinal cord and changes in his motor function, especially that of his lower limbs. ALS prevents the command messages for voluntary movements from getting from the upper motor neurons of the cerebreal cortex to the lower motor neurons that innervate the skeletal muscles and cause them to contract. Therefore these lower motor neurons die which causes atrophy (shrinking) of the muscles and a lack of voluntary movement-paralysis.
Family or Physician Reflections: Lou Gehrig was an inspiration to others not only as an incredible baseball player, but as an individual facing an incurable disease that wouldn't let it get him down. My case report did not give much detailed information about the people close to him, but it does illustrate how much he meant to his teamates and his fans-especially by holding a day for him in 1939 after he permanately left the Yankees, where thousands of fans flocked to Yankee Stadium to honor him and all of his hard work.
My Reaction to the Case: Case reports are especially important when trying to understand both the physical and psychological effects of disorders and diseases. In order to make a proper diagnosis, it is important to understand both aspects of the human being. I enjoyed reading this case report because it was not as dry and impersonal, and filled with medical jargon I couldn't understand as many case reports are. I could actually understand the definition of the disease, the symptoms and its effects, which made it that much more interesting.

The Colorblind Painter
Sheila Parks
Source: Sacks, Oliver. (1995). An anthropologist on mars: Seven paradoxical tales. New York: Alfred A. Knoff, Inc.
Patient Background: Jonathan I., Mr. I., was a successful artist. A painter whose colors play a major role in life. At the prime age of sixty-five, he was involved in a car accident and suffered a concussion. Through an eye examination, Mr. I could not distinguish letter or colors. The letters appeared to him in Greek although they were written in English. Within days he could distinguish letters, but he could not see any colors only black, white, and shades of gray. He also suffered transient amnesia. He completely forgot he was in an accident.
Behavioral Changes: Mr. I. changed socially, emotionally, and behaviorally. He could no longer stand social or sexual encounters. People were no longer flesh-colored but rat colored. He also could not distinguish the colors in traffic lights and ran right through them while driving. He closed his eyes to eat foods, because they seemed abnormal. He would stare at an orange wanting to force it to show its color. Finally, his diet only included naturally black and white foods like black olives, white rice, yogurt, and black coffee. He could no longer dress himself. His wife would set out his clothes for the following day, but he became annoyed. Finally, they categorized his belts, ties, and other articles of clothing with labels. Since he was a successful painter, he was hurting emotionally. His way of life was forever changed. He knew the exactness of color, but could no longer imagine the sight of colors. His visual imagery was colorless. His colorful paintings of flowers were now black, white, and shades of gray. He even dreamed in black and white. He longed to see color anyway he could. He tried pressing on his eyeballs, like staring into the light, to see any blotches of color. His career took a downfall. He tried painting again with color, because he knew the exactness of mixing paint. But only when he was shown a black and white photograph of his new paintings, could he see the confusion others seen. It completely frustrated him. His was depressed when he visited galleries. His favorite paintings seemed washed out. He created his own room in black, white, and grays to portray to others what he was experiencing. It included a elaborate dinner with tables and chairs. However, people could never understand the degree to which Mr. I. was living. His world wasn't like a black and white television although he wishes it was that simple. It was a different tonal and contrast scale, and completely three dimensional. He was forced to construct a new life. He began painting in black and white almost eighteen hours a day. He started to become a "night person" later in life. At night, it seemed normal for things to be dark. He could also do more than others at night like read a license plate from far distances.
Nervous System Changes: The doctors revealed he suffered cerebral achromatopsia, colorless vision that was uncontaminated by additional defects of perception of form, motion, or depth. He was administered many tests like the MRI and Cat scans, but technology in 1986 did not show any dysfunctions. They tested him for color anomia, failure to recall the colors of familiar object like a banana is yellow, but the results were negative. Mr. I. was also a smoker which can cause dimming in vision and sometimes achromatopsia, but that was due to effects on the cells of the retina. Mr. I's problem was cerebral from the concussion or a small stroke before or after the accident. Intriguingly, mechanisms of neural construction of how the brain transforms atoms into colors has been researched. Neurologist believe the damage was around the V4 area of the secondary visual cortex. It may have been reductions of oxygen to this area or carbon monoxide poisoning to this area which are known for changes in color that caused his deficit. However, because of his loss of memory, imagery of color, and dreaming in color, other places in the brain must play a role. The hippocampus plays a role in memories, so some damage may have occurred there.
Family and Physician Reflections: The Physicians in charge of this case were intrigued by its magnitude. Achromatopsia occurring to anyone can be devastating. Moreover, their client was a painter whose life revolved around many shades of color. Some cases of acquired cerebral achromatopsia improve although this was not the case for Mr. I. His wife was not really included in the discussion. However, Mr. I. commented how others could never experience the wholeness and strength achromatopsia affected his life.
My Reaction to the Case: I can not imagine how devastating life would be without color. I am affected enough when the sun doesn't shine for a week, and the winter grays set in. As the title of the book explains, it is a paradoxical tale.

Myasthenia Gravis in a NFL player
Teresa Parks
Source: Klawans, Harold L. (1996) Why Michael Couldn't Hit: And Other Tales of the Neurology of Sports. Washington D.C.: First Printing.
Patient Background: Dwight Jameson (not his real name) is a six foot, one inch, 195 pound NFL football player. In his senior year the onset of myasthenia gravis began with the droopy eyes.
Behavioral Background: Myasthenia gravis had many behavioral effects on Dwight Jameson. One effect was the weakening of his eye muscles. This weakness caused him to have two problems. One problem being ptosis, drooping eyes caused by the weakening of the muscle that lifts up the upper eyelid. This made Dwight Jameson look sleepy. The second problem with his eye muscle caused to have double vision (diplopia). So when he went out for the long touchdown pass he saw two footballs, so he couldn't catch it. This inability to see the long bomb had detrimental effects on his playing ability. This in turn, caused him to play only on the special teams, although he referred to himself as being a safety. Another behavioral change the doctor noticed was that he slurred his words after exercising.
Nervous System Changes: Myasthenia gravis means "grave weakness of the muscles". It is a disease of the neuromuscular junction. The neurotransmitter, acetylcholine (ACh) which initiates the muscles to contract and has a "growth stimulating function". Acetylcholinesterase is an enzyme that destroys ACh. Acetylcholinesterase inhibitors prolong the action of ACh to reverse the weakness. One such inhibitor is Tensilon. When the physician had Dwight Jameson exercise he became fatigued and began to get droopy eyes. When the doctor gave him Tensilon the symptoms disappeared. However, too much ACh can have the same effects as too little. Myasthenia gravis is also an auto immune disease. The patient produces antibodies in the thymus gland that reacts with the acetylcholine receptor. The doctor measured Dwight Jameson's level of acetylcholine receptor antibodies and found that it was above normal. Likewise, through a MRI scan they found the thymus gland was enlarged, which is common in patients with myasthenia gravis. A chest surgeon removed his thymus gland. Dwight was also put on immunosuppressant therapy to decrease the auto immune response. After having treatment, Dwight returned to being a free safety and he no longer was called "First Half Jameson".
Peer Reflections: Dwight Jameson had a reputation of letting the "big play" slip through his fingers in the fourth quarter. He acquired a nickname "First Half Jameson" because he played terrific in the first half, but not in the second. In college, his nickname was "sleepy Jameson" because his eyes were droopy.
My reaction to the case: I found this case on myasthenia gravis to be very interesting. It explained this auto immune disease very well. "First-Half Jameson" is an excellent example of a person with this disease. His nickname even gives a clue to how myasthenia gravis affects a person. Being a football fan, I understood this more on a personal level. I could see the impact of this disease clearer, compared to the basic text in a neurology book.

Parkinsonlike Disease
Rachel Fazio
Source: Klawans, Harold (1992). Such is Fame. Life, Death & In-Between, 12, 121-131.
Patient Background: Roberta Rose Richards lived in Muncie, Indiana and often had to travel to the Mayo Clinic in Rochester, Minnesota for treatments for what physicians there had diagnosed as Parkinson's disease. Fifteen years earlier, she had a thyroid gland removed due to a hyperthyroid condition. When she was being treated for Parkinson's disease at the Mayo Clinic, she had taken three grams of levodopa (transforms into dopamine) a day for four months and had no improvement or side effects. After having received medical care at the Mayo Clinic for fifteen years, Roberta decided it was becoming too difficult for her to commute that far, so she was referred to a doctor in Chicago. The doctor in Chicago had her go to an endocrinologist to rule out other possible causes of her symptoms; the results showed no signs of hypothyroidism. She began to take increased doses of levodopa (up to twelve grams a day) and still showed no improvements and her symptoms were getting worse. Her doctor took her off levodopa and put her on an experimental drug, bromocriptine (acts as a dopamine replacement). Her dosage started at two and a half milligrams a day, and slowly increased to one hundred sixty milligrams a day, and still she showed no improvements or side effects. Roberta was taken off bromocriptine and given another experimental drug, lergotrile (a second cousin of bromocriptine). She showed no response to lergotrile and her symptoms were still worsening. Roberta was taken off her medications and had more tests run including another examination by an endocrinologist, blood tests, and skull X-rays. They all came back normal. A spinal tap was performed on her and the results indicated her HVA level was 164-168,which was within the normal range and helped rule out Parkinson's disease because Parkinson's patients' HVA levels are well below normal. The doctor was able to diagnose Roberta with hypoparathyroidism after he ran a CAT scan (the CAT scanner had just been invented at the time). Roberta was given treatment for hypoparathyroidism which slowed the progression of the disease, but could not fix what had been damaged.
Behavioral Change: Roberta had Parkinsonlike symptoms, which included slow and slurred speech, a shuffling walk, tremors, unbalanced posture, and an expressionless face. As her symptoms worsened, she tried to use a cane to aid in walking, but it did not help, so she began to use a walker instead. Roberta was no longer able to do many self-care or daily activities on her own. For instance, she was unable to get out of an easy chair herself,she needed assistance with getting dressed, and it took her more than ten minutes to cut her own meat. She felt she no longer had a sense of well-being. She missed her sense of well-being and very much wanted to try everything possible, such as having tests run or trying new medications, to try to get it back.
Nervous System Changes: Roberta's HVA level was 164-168,which was within the normal range of 60-180, unlike that of Parkinson's patients whose HVA level is usually well below 40. The normal HVA level indicated that her dopamine level was also normal. Results from a CAT scan showed massive calcium deposits within each half of her brain around the area of each striatum (a major motor area that is acted upon by dopamine). Her striatum had been invaded by calcified tissue which had destroyed the dopamine receptors. Since her striatum could no longer respond to dopamine, she had developed Parkinsonlike symptoms. The striatum disorder was diagnosed as hypoparathyroidism, which possibly developed due to a complication from her thyroid surgery.
Family or Physician Reflections: The chapter that this case report is based on does not discuss any reflections from Roberta's family or friends. The author of the chapter was her doctor in Chicago and reflects his viewpoint very well. He was very determined to find a treatment that would help Roberta's condition and when nothing was working he did everything possible until he found the true diagnosis.
Your Reaction to the Case: This case presentation gave a well defined description of the steps taken and the determination that was involved by both Roberta and her doctor as they worked to find the true diagnosis for Roberta that would allow her to receive more affective treatment. This case also reflects the importance of the CAT scan. The CAT scan allowed Roberta's doctor to confidently diagnose her with hypoparathyroidism.