If it was any of the organs systems that seem to scare me as a general practitioner, it is probably neurology. It is something that can be so subjective, and non specific in general, with sometimes no notable significant neurological signs. In particular, dizziness is one of my pet hates. But when there are actual demonstrable neurological signs, that’s when things get interesting.
A couple of weeks back, I had the fortune of seeing such a gentleman with significant pathology. He had spent the weekend at a location about 8 hours drive from where I work, doing a bit of crane driving for a mining project.
His daughter accompanied him in to the practice.
“Doctor, I’m concerned about my father. Today is the first day I’ve seen him back after his weekend job, but he is not himself. He can’t even walk properly. Something is seriously wrong.”
Unfortunately, it was the first time I had seen this gentleman, so I had no baseline to compare his current self with. What I did notice, was an unsteady gait however.
On exploring his history, he had apparently been involved in a truck rollover accident, for which he went to a tertiary hospital and had head scans which did not reveal any significant bleed. He was not on any anticoagulants or blood thinners, and had no significant past medical history.
Examination revealed 3-4/5 weakness of the left upper and left lower limb regions in power, with cranial nerves intact. PEARL
Thinking this could potentially be a stroke, a CT brain was ordered. The radiologist phones me up.
“The CT brain scan has some significant findings with bilateral subdural haemorrhage and a 5mm midline shift. ”
That was all the information I needed for an urgent referral to the Emergency Department.
A few weeks later, I see the man again, and he is walking normally.
“Doc, they cut my head open and drained out all the blood. I’ve just come in to see you to determine if my staples are ready to come out yet.”
A neurological examination was completely normal. Here was a man who a few weeks ago, had trouble walking and seemed vague at times, and now he was walking normally with everything back to normal.
It was at that point that I marvelled at the wonders of modern medicine and how much of a difference could be made to the patient.
The patient later revealed that apparently, the hospital were not certain if there was a small bleed in his brain 6 weeks ago after his truck accident, and had advised him to return for regular check up with information advising him of this. He didn’t read that information, so didn’t think much of it. This may have lead to a continuous ongoing bleed, up till the time of presentation when there was too much blood present.
The Placebo Effect (and Medicine) 