Hemichorea/hemiballism

The NEJM just published a short case of a patient who developed hemichorea/hemiballismus in the setting of diabetic ketoacidosis. A video shows the abnormal movements. His symtpoms resolved after short-term treatment with a dopamine-blocker and time.

Donald and Math

This is segment 1 of 3. The rest of the 1959 "Donald in Mathmagic Land" can be found on Youtube. The end of the video discusses the golden ratio, always of interest.

Gehrig's etiology

A paper being published in the Journal of Neuropathology and Experimental Neurology is reporting that in three autopsies of athletes with motor neuron disease, TDP-43 and tau deposits were found extending to the spinal cord. The athletes' motor neuron disease mimicked ALS but was distinct pathologically. The New York Times explored how this finding may alter our understanding of Lou Gehrig's disease, the disease whose name has become inseparable from its famous sufferer. Gehrig's sports career was accompanied by a number of head traumas and concussions, so his disease may not have been the same as the majority of other ALS patients. The situation is analogous to Muhammed Ali's relationship to Parkinson's disease. Ali suffers from dementia pugilistica, parkinsonism its most visible manifestation, secondary to his history of occupational head trauma. Even Michael J. Fox, whose Parkinson's disease began when he was young, doesn't represent the median PD patient. Nevertheless, any celebrity attracts attention and eventually money to a disease.

The recent finding underscores what has become increasingly clear about neurodegenerative diseases, specifically Alzheimer's, Parkinson's, and ALS: they are all complex diseases with complex etiologies. In some patients, e.g. athletes, head trauma may play a major role in their development, but not all athletes develop disease. In non-athletes, even minor head trauma may contribute to a lifetime of accumulating neuronal damage and loss. Regardless of its relative contribution to an individual's disease, the neurodegenerative consequences of head trauma, via inflammation or structural damage, deserve further study.

Best American Medical Writing 2009

Unlike the Best American Science and Nature Writing 2009, this volume focuses on the human aspects of medicine rather than the scientific. That isn't to say there isn't science, but there aren't the mind-blowing ideas of the other volume, such as how life may have started in ice.

The best pieces in the collection show how dysfunctional the medical system currently is (Tom McGrath, "My Daughter's $29,000 Appendectomy"; Harold Pollack, "Lessons from an Emergency Room Nightmare"). There are plenty of personal struggles, including two physicians' encounters with drug addiction. The first involves an anesthesiologist (Jason Zengerle, "Going Under"); the second follows the career arc of an AIDS physician. This latter article (David France, "Another AIDS Casualty") and the one before it provide the history and the current state of HIV/AIDS in this country. Both are eye-opening in different ways: it's hard to imagine that at the height of the AIDS crisis, not even two decades ago, a third of the beds in St. Vincent's in NYC contained dying AIDS patients; "Apartheid" reports on the evolution of the AIDS epidemic in this country and the brewing health crisis in the South.

Kevin Baker's "Mind Bomb" follows the journalist's struggle to find out his own Huntington's disease genetic status. The article makes it clear how important genetic counselors are and how fraught applying genomic advances will be. There were personal stories about struggles with cancer, and Sharon Begley's "We Fought Cancer...And Cancer Won", which details the inadequacies of decades of cancer research and treatment. "Contagious Cancer" about the Tasmanian Devil Facial Tumor Disease would have fit in well in the Science and Nature volume. Oliver Sack's almost obligatory piece catalogs and reviews insanity.

This is the first year I've read the science/medicine entries of the Best American series. I'll certainly be returning to them again next year.

End-of-life Medicine

Today the NYT magazine had an excellent article about how the medical system fails when patients approach death.

Iceland Volcano

Some stills of the erupting Icelandic volcano, the huge plumes of ash, and the melting glacier.

Lewy Body

Courtesy of pathguy.com, here is a Lewy body, the pathologic hallmark of Parkinson disease, in a substantia nigral neuron.

This picture has been incorporated into the header of this blog.