NeuroMutics

Neuro Physical Exam training today was awesome. Let me explain...

First why it wasn't awesome:
It wasn't awesome because I was always wrong. When asked if proprioceptive neurons were large or small, I said large. And was corrected quickly, "Right, small" by the precptor. Next question, is graphesthesia cortical or primary brain function. My reply: primary. "Yes, its cortical," was the retort. And then, vibration tests posterior or dorsal column function? Honestly, I didn't realize those were two different columns! (Posterior was the answer).

What was awesome was seeing the resiliency of the human body for recovery and how profound a difference good medicine can have.

Unbelievably, we saw a patient with Parkinson's Dx who had been mute for the past few years on account of his disease progression. The patient was wheelchair-bound with a half-full down drain urine bag hanging nonchalantly from the leg stirrups of his chair. His eyes stared blankly from behind his glasses, and the skin on his face was somewhat drooping downward. As I was looked I noticed a tear slowly trail from his unblinking right eye down his cheek and rest at the top of his lip. His eyes tracked our motions as we found our place in the room, albeit slowly. He had no visible Parkinsonian tremors (and later on physical examination he had a positive glabellar sign but did not have Cog-Wheeling or a palmar-mental reflex. It turns out he has been doing quite well with his new medications all but eliminating his tremor and other signs. Although his rigidity and bradykinesia are still apparent.)

Then when the preceptor greeted him, saying, "How are you doing today?" The patient mumbled with clear effort a flat and dampened: "Good." Really this was the first time I saw a preceptor break the guise of professionalism in teaching and truly celebrate. He looked at us and at the patient's wife with a big smile. "Did you hear that! Good, he said 'Good' He hasn't spoken in years!"

The Medications, therapy, and a neurosurgery ablative procedure successfully eliminated his tremor and other signs, as well as gave him higher functionality, some responsiveness, and his voice back! He didn't say much more during the exam. He said "yes" "Birthday" and perhaps a few other words, but what a great success to see. It was his and his wife's 59th year anniversary on Monday and it was transparent how delighted his wife was to hear his voice again. It was truly awesome.