Neurologists and physicians writing on KevinMD about the brain: dementia and Alzheimer's disease and the biomarkers that now find it early, stroke and what recovery really allows, autism, Parkinson's disease, gait and balance as vital signs, and caring for a spouse or parent with a neurological illness. Three maintained records draw on this archive: Aging and dementia: what physicians say, in their own words, Heart disease: what physicians say, in their own words, and Mental health: what psychiatrists and physicians say, in their own words.

MKSAP: 52-year-old woman with a burning sensation on her forehead

Conditions and Diseases
November 21, 2015

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.

A 52-year-old woman had a burning sensation involving the right side of her forehead and the tip of her nose for 2 days, followed by increased redness and the development of lesions involving the tip of her nose. Medical history is significant for hypertension, and her only medication is ramipril.

On physical examination, vital signs are …

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MKSAP: 52-year-old woman with a burning sensation on her forehead

A physician puts his welfare in the hands of others

Physician
November 20, 2015

“I have always depended on the kindness of strangers.”
– Blanche DuBois, A Streetcar Named Desire, Tennessee Williams

It was near the end of 2008 that I developed symptoms that I recognized as sciatica.  The Internet is a wonderful source of information (and some misinformation).  I decided to educate myself.  In my reading, I encountered one study that indicated that patients who underwent surgery were better at one year, but about the …

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A physician puts his welfare in the hands of others

Embracing the sick role and not so sick: Ann Romney and multiple sclerosis

Conditions and Diseases
November 13, 2015

In her new book In This Together: My Story, the former First Lady of Massachusetts, Ann Romney, describes receiving in her mid-40s a diagnosis of multiple sclerosis (MS). She offers vignettes of a “life upended”: her abandonment of therapeutic swimming because it made her hair “look bad” and the need to revise plans for her Park City home to include an elevator.

In her case, MS is invisible, characterized by fatigue, …

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Embracing the sick role and not so sick: Ann Romney and multiple sclerosis

Should tackling be removed from youth football?

Conditions and Diseases
November 10, 2015

Tackling: in so many ways, it’s what football is all about.

Now, of course running, passing and scoring (and strategy) are important parts of football too. But it’s tackling that stops the opponent. Without tackling, you can’t play football.

Or can you?

A policy statement just released by the American Academy of Pediatrics (AAP) suggests that we need to do some thinking about tackling and its impact — literally — on …

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Should tackling be removed from youth football?

Test your medicine knowledge: 67-year-old woman with increasing forgetfulness

Conditions and Diseases
October 24, 2015

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.

A 67-year-old woman is evaluated for a 1-year history of increasing forgetfulness. She reports greater difficulty keeping track of upcoming appointments, recalling details of recent telephone conversations, and remembering names of new acquaintances. She has completed 16 years of formal education, currently works as a teacher’s assistant, and has noticed no change in her ability …

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Test your medicine knowledge: 67-year-old woman with increasing forgetfulness

Is the end of football coming? This doctor says it can’t come fast enough.

Conditions and Diseases
October 17, 2015

Evan Murray was a 17-year-old high school senior, honor student, and three-sport athlete who died recently as a direct result of injuries sustained playing quarterback for his school football team.  On the last play of his life, he got drilled by a defender with a clean hit to the midsection.  He gathered himself, rose, and walked off the field on his own.  Shortly thereafter, however, he collapsed on the sideline …

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Is the end of football coming? This doctor says it can’t come fast enough.

Medicine can suck the compassion out of you. But I still give it my best shot.

Physician
September 11, 2015

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Compassion.  Once upon a time, I had a lot of it. I guess I still do, or I wouldn’t be at this desk.

I think most medical students start out that way. We want to help the sick, heal the wounded, decrease suffering. All that stuff we once wrote in the “personal statement” section of the universal med school application. And believed.

A friend …

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Medicine can suck the compassion out of you. But I still give it my best shot.

Did the Ice Bucket Challenge really lead to ALS research breakthroughs?

Conditions and Diseases
September 7, 2015

Everyone, it seems, knows about the Ice Bucket Challenge, the viral phenomenon that raised record-breaking sums for the Amyotrophic Lateral Sclerosis (ALS) Association. This feel-good movement was critiqued by many, but no one can claim it was a bad thing: It raised lots of money, the Read more…

Did the Ice Bucket Challenge really lead to ALS research breakthroughs?

A neurosurgeon remembers the humanity in medicine

Physician
August 30, 2015

The vast majority of physicians enter medicine with an inborn sense of compassion. Junior residents, however, are the logistical workhorses of teaching hospitals — their north star is efficiency and they are measured largely on their capacity to “get things done.” The consequence is often a slide towards unwitting apathy. I, like all residents, have witnessed this reality first-hand. By reflecting on my experiences, I hope to discover insights we …

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A neurosurgeon remembers the humanity in medicine

How this neurologist used Twitter to help treat a stroke

Social Media in Medicine
August 7, 2015

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The most important factor in successful stroke treatment is time. When a stroke patient is encountered by EMS, or when they present to an emergency department, it is absolutely vital to determine the time “last known well” to make decisions about what treatments may be available and appropriate.

A 97-year-old woman arrived in our emergency department after suddenly becoming unable to speak, and …

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How this neurologist used Twitter to help treat a stroke

Alzheimer’s disease and the dawn of preventive neuroradiology

Conditions and Diseases
July 15, 2015

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In 1735, Benjamin Franklin wrote, “An ounce of prevention is worth a pound of cure.” Now 280 years later, this basic concept of human health has been refined and applied throughout medicine. Recently, the emphasis on prevention has been amplified by the passage of the Affordable Care Act that prioritizes such services. Radiology remains uniquely poised for this change with its …

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Alzheimer’s disease and the dawn of preventive neuroradiology

Test your medicine knowledge: 28-year-old man with recurrent headaches

Conditions and Diseases
June 13, 2015

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.

A 28-year-old man is evaluated for a 5-year history of recurrent headache that occurs several times per month and lasts 12 to 24 hours. He describes the headache as a bilateral frontal pressure associated with nasal congestion and sensitivity to light, sound, and …

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Test your medicine knowledge: 28-year-old man with recurrent headaches

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Defining the narrative of emergency care: The danger of Maureen Dowd

Physician
June 6, 2015

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If I’m to take fashion advice from Maureen Dowd’s March 3 column, “Stroke of Fate,” a take-down of emergency medicine disguised as a recovery narrative of her niece, then I should exchange my white coat for grease-stained overalls.

In her column, a Harvard neurology professor who specializes in stroke describes the brain as the Rolls-Royce of the human body. When it …

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Defining the narrative of emergency care: The danger of Maureen Dowd

An emergency physician defends the profession from the New York Times

Conditions and Diseases
May 11, 2015

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With the flurry of Twitter posts about Maureen Dowd’s article “Stroke of Fate” in the New York Times, it almost seems as if the subject is already stale.

Maureen Dowd is the Pulitzer Prize-winning op-ed columnist for the New York Times who tells a compelling story about a young patient who suffered from a stroke. The patient was …

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An emergency physician defends the profession from the New York Times

After an autism diagnosis: A new parental role

Conditions and Diseases
May 1, 2015

A variety of factors contributes to the challenge. First, even in this era, in which autism is a household word, it is not unusual for me to give the diagnosis to parents who have not considered the possibility that their child has autism. Statistically speaking, the children we see at Albert Einstein College of Medicine’s Children’s Evaluation and Rehabilitation Center for these initial evaluations are very young — on average, 24 months …

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After an autism diagnosis: A new parental role

How will I know that you’re not dead?

Patient
April 28, 2015

I never thought it would go on for so long — seeing Donald Wyatt, I mean. I certainly didn’t plan it this way.

More than six years ago, I retired at age sixty-six from my social work job at a mental-health agency. Donald had been my client there for about eight years.

As I was cleaning out my office, his mother called. She explained how Donald’s father had left when Donald was …

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How will I know that you’re not dead?

Break seizure break. I repeat it in my mind. Again. And again.

Physician
March 28, 2015

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The girl seizes.

Her body torques and twists and jerks about like a snake trapped on an electric fence. She flops back and forth on the gurney before us, her pale forehead glistening with sweat, her brown hair wetted black from the effort of muscle contractions that threaten to tear apart her tiny frame.

Trauma room two is silent save for the gluck-gluck-gluck of her …

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Break seizure break. I repeat it in my mind. Again. And again.

Exploding head syndrome: Is it really terrifying?

Conditions and Diseases
March 6, 2015

The medical condition provocatively called exploding head syndrome, or EHS, brings back the disturbingly graphic images of the 1981 sci-fi horror flick Scanners where the main character blew up people’s heads with the power of telekinesis. Fortunately, as ominous as exploding head syndrome sounds, no skulls have actually exploded, and the condition is reassuringly non-life threatening. For the people who experience the symptoms of EHS, however, the ordeal can be …

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Exploding head syndrome: Is it really terrifying?

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