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When we don't feel well, we can go to the doctor, who might ask, "Tell me where it hurts."
Our answers can offer crucial information and clues about what's wrong — and help lead the doctor to an accurate diagnosis.
But what happens if the very part of us that's hurt is the organ that produces awareness, sensation and generates speech?
What happens when the source of what's wrong is the brain? It poses a huge challenge and sets up a complex riddle for doctors, or more specifically, for neurologists, who have to search more or less in the dark for clues about what's wrong.
Dr. Allan H. Ropper, clinical neurologist at Brigham and Women's Hospital and professor at Harvard Medical School. Co-author of "Reaching Down the Rabbit Hole: A Renowned Neurologist Explains the Mystery and Drama of Brain Disease."
Brian David Burrell, teaches mathematics and statistics at UMass Amherst and co-author of "Reaching Down the Rabbit Hole: A Renowned Neurologist Explains the Mystery and Drama of Brain Disease." He's also author of "Postcards from the Brain Museum."
On how neurology is similar to the story of "Alice in Wonderland":
Dr. Allan Ropper: "When the brain becomes diseased, the essential features of being human are altered in a big way, and to get at that you've got to go after things that are bizarre and unusual, almost like Alice falling down the rabbit hole and being in a world that has mirrors and kaleidoscopic visions. In order to get at that, the craft of neurology involves a number of peculiar tricks and ways of having one brain talk to another when the bad brain can't give you the information you need...And individual whose language, for example, is altered — who has aphasia — is not able to relate what's wrong, how they're feeling and their comprehension is similarly off. So, having a conversation with them is a little bit like Alice talking to the red queen."
On the importance of listening to patients in neurology:
AR: "The way in which the personality and affect goes wrong is exactly where the diagnosis is. So, to sort out who an individual is to begin with, hear from their family, see how that gets derailed, is the diagnostic process itself. You can't ask a liver that, or a stomach. But the brain, you can ask."
On a dramatic example of quick decision-making:
AR: "There was a woman who had been in and out of the hospital numerous times with bad headaches, difficulty walking, sleepiness, all symptoms of...hydrocephalus, and the cause was not clear. There was some kind of inflammation at the base of her brain that prevented the fluid from draining properly, and we had seen her in the morning and everybody was looking at her scans but nobody had really examined her carefully and noticed the subtle signs that the pressure inside her skull was increasing. And the next thing we heard....there was an arrest — cardiac arrest — called. And I knew immediately it was her...We were able to run in and see her heart had stopped and the so-called code team was in there banging on her chest in the graphic way that is shown on television, and because of experience with similar situations, I knew it was not her heart or lungs that were at fault, it was the increased pressure in her head. And the only solution to getting her heart to start again would be to drain that pressure. So, we had a wonderful young neurosurgical resident [who] dutifully pulled out the little kit and put a tube in the brain and the water spurted right over my shoulder onto the wall and her heart started again."
On the connection between neurology and psychiatry:
AR: "The distinction between what we call mental disease in the modern era and brain, or neurological, disease is an artifice, right? It's all one brain that's got to be doing this, and diseases that affect nerve cells produce mental disorders, produce paralysis, produce difficulty with speech — it's one package. And neurology and psychiatry were once a unified specialty. We were split apart by psychoanalysis and psychodynamics, and are now reemerging as one entity."
On what we don't know about confusion:
AR: "It raises the question of, what is it to be coherent? What's not confusion? What is it that we are every day and why are we the same in the morning when we wake up as we were when we went to sleep before? We don't miss a beat. Our memories are there, our continuity of thoughts and ideas are there. It's very easy to disrupt the flow of that internal conversation, and when that's disrupted the patient behaves in a confused manner. There are a lot of ways to produce that confusion. So, medications, sleep deprivation, trauma and a large number of brain diseases, but what it actually entails is tough to get your arms around, and we struggle with that in neurology because it's a manifestation of an opening shot of so many disorders."
- "I once had a patient, a salesman who drove from Philadelphia to Boston unwittingly and made it as far as Leverett Circle, the rotary near Massachusetts General Hospital, where he got stuck driving around and around for almost an hour."
- "When someone develops a serious brain problem, Ropper says, it can be like falling down a rabbit hole and entering an Alice in Wonderland world — where nothing looks or works the way it's supposed to. A neurologist's job is to find a way to understand the odd landscape of a damaged brain, he says."
This article was originally published on December 01, 2014.
This segment aired on December 1, 2014.
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