Neurology rotation


Neurology cycle finished today. I’ve seen a lot of interesting cases, but probably the esteemed neurologists and neurosurgeons are bored to death with the cases that I have seen during the past 2 weeks.

Unfortunately for the neuro patients, there’s a very good chance that their quality of lives will deteriorate by time. The main task for neurodoctors is to keep them alive.

My patient for example has  a secondary progressive subtype of multiple sclerosis (MS), a significant MS history for 30 years. He’s been talking inappropriate jokes (at first I couldn’t understand until teacher said it was inappropriate). Whatever.  MS has increased frequency proportional to increased distance from equator. Seriously. So might as well learn here becoz MS is not really frequent in Malaysia (honestly I don’t really know the frequency of MS in Malaysia).

My classmate’s patient is a hit-and-run-and-comeback victim of spinal trauma at level of L1-2 (apparently the drunk driver came back to pay for the surgery). It’s sad tho, he’s just 18 years old and he’s paraplegic. If the trauma could hit a little bit lower than L2, that dude could have a better prognosis. Whatever. God has His own plans.

There are also tumor patients; post-op pituitary adenoma with acromegaly. Nyeh nyeh I caught that acromegaly tho. Hehe. Not that the neuroguys cannot diagnose acromegaly for themselves but since the patient has been talking about cannot fit his feet into his socks (enlarged feet) and enlarged hands, I decided to check for the tongue. Macroglossia with teeth gapping. More test is needed of course, but those are positive signs of acromegaly though. Probably the neuroguys have called endocrinologist’s consult and starting on octreotide… I’m glad the patient has improved his vision after suffering homonymous hemianopsia for quite a while.

Then there’s one with post-op unilateral acoustic neuroma. Unfortunately he’s got Bell’s palsy because he couldn’t close his left eye plus some signs of left-sided facial paralysis. Since he couldn’t close his left eye, he gets infection and develops keratitis. At first, I was quite horrified to see this patient coz he’s got half-sided satan-like face and a big scar at the back of his head which totally looks like a hardcore skinhead! Right side of his face is the normal one, left side has a satan-like look with that keratitis and bulging eyeball… But a patient is a patient, right? He may look satanic, but what he has been thru from there is much more horrifying to him than to us!

Well, those are just some patients that I have seen and remembered to write here. If I write more, probably a neurologist who happens to drop by would say “Amateur kid bragging over acromegaly!” Hehe… Whatever. The tiring neuro cycle has finished, final neuro exam in June awaits. Coming next is medical genetics – studying with the same neurologist.

One thought on “Neurology rotation

  1. Well done on catching the likely diagnosis of acromegaly. The operation for a pituitary adenoma though did bring the options down to a non-functioning or one of eight different adenomas. Good work.

    If you can remember what somebody looks like with acromegaly (big bottom lip etc..) then let’s hope you can diagnose more!

    Trys

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