Association between aspirin dose and subarachnoid hemorrhage from saccular aneurysms: a case-control study. Neurology 2018; 91:e1175-e1181. Can A, Rudy RF, Castro VM, et al. Abstract OBJECTIVE: To determine the association between ruptured saccular aneurysms and aspirin use/aspirin dose. METHODS: Four thousand seven hundred one patients who were diagnosed at the Massachusetts General Hospital and Brigham […]
Alice’s Adventures in Wonderland is a fairy tale that is beyond comparison in its implausible scenarios and outlandish characters. It intrigues and fascinates in equal measure, and it has held generations of children and adults spellbound since its publication in 1865. The fantasy is as fanciful as Lewis Carroll, the pseudonym of the author Charles Lutwidge Dodgson.
As outrageous and as preposterous as it is, the book actually confirms the truism that most works of fiction are grounded in hard reality. In their excellent article, Alice in Wonderland Syndrome: A Historical and Medical Review, Osman Farooq and Edward Fine demonstrated that Alice’s adventures are not a figment of the author’s imagination, but the depiction of his real-life illusory experiences. Lewis Carroll suffered from migraine, and Alice was a perfect incarnation of the visual distortions that accompany this very common and debilitating disorder. Therefore, when lay people read that Alice’s body “had grown too tall or too small”, the stoney-eyed neuroscientists only see macropsia and micropsia, objects appearing larger or smaller than they actually are. When ordinary folks read that “parts of her body were changing shape, size, or relationship to the rest of her body”, the neurologist just sighs and yawns…migraine auras again! What spoilsports they are!
Large and small of course bring to mind another great work of fantastic fiction, Gulliver’s Travels by Jonathan Swift. His Lilliputian and Brobdingnagian hallucinations are in another scale altogether, but did Swift also suffer from migraine? He probably did because the list of artists with probable migraine is fairy long (please don’t miss the intended pun). Some neuroscientist will however pour cold water on the idea that migraineurs are blessed with any creative impulses. Indeed it is not universally accepted that Lewis Crroll suffered from migraine auras. And just when you thought your migraines were worth the suffering! You may read more about art-disease relationships in this excellent article titled Alice in Wonderland Syndrome: A Clinical and Pathophysiological Review.
But we mustn’t be distracted or derailed from the theme of today, Alice in Wonderland syndrome (AIWS). This fascinating disorder, and a disorder it is according to neurologists, puts us in a circular situation: fiction first mimicked fact to produce Alice, and fact then imitated fiction to produce a real ailment. I know, it all sounds absurd. But what did you expect with this theme!
What then is the cause of these illusory experiences that literally blow the mind? Yung-Ting Kuo and colleagues attribute it all to reduction in blood flow to the visual centers in the brain. And how many disorders may do this? Because this is neurology we are talking about…almost anything. The common culprits however are migraine, epilepsy, LSD, an assortment of intoxicants, and a menagerie of brain infections. The syndrome has also been reported in a host of psychiatric and organic brain disorders such as Cotard syndrome, Capgras syndrome, depression, and schizophrenia. More worrying however is the association of the syndrome with prescription medications. One such drug is Topiramate, a medicine neurologists prescribe to prevent, among other conditions, migraine! And another, Aripiprazole, is paradoxically an excellent treatment for…hallucinations!
As bizarre as Alice’s adventures are, Alice in Wonderland syndrome goes much farther: people with the syndrome experience a wider variety of even more grotesque illusory experiences than Lewis Carroll ever imagined. A recent paper in the journal, Neurology Clinical Practice, shows just how grotesque. Titled Clinical Characteristics of Alice in Wonderland Syndrome in a Cohort with Vestibular Migraine, the authors provide an almost endless list of unusual clinical manifestations of AIWS. The prize must however go the illusion that the brain is coming out of the head! There you go Lewis Carroll, you may eat your mad hat: fact will always be stranger than fiction!
Learning neurology is a very visual and hands-on affair. Neurological assessments are complex and steeped in ritual. Tomes have been written about the best way to take a neurological history. A lot of ink has been spilt in describing great eponymous neurological signs. But nothing comes close to learning from the masters. Observation and apprenticeship have been key to transmitting neurological skills since the time of Charcot.
There is no doubt that neurological disorders are mushrooming, and the skills required to master them are becoming more intricate. But this has flamed rather than dampened the desire of learners to acquire them…by all means possible. But only the privileged can witness the artistry on display at the grand rounds of Queen’s Square; the exhibition of finesse in the teaching halls of the Pitié-Salpêtrière; or the sublime virtuosity evident on the wards of The Brigham.
What then to do in the digital age? Online videos of course. These are now playing a major, perhaps unconventional, teaching role in neurology.
The Neurology Lounge has already reviewed the changing terrain of neurology, throwing a light on the increasing role of social media, online video sites, and online databases, all competing and complementing the classroom and the clinic. Our previous posts on this subject include:
Youtube remains the clear leader when it comes to videos. Buried among the cat and dog snippets, hiding behind the crazy stunts and funny clips, and camouflaged by the ubiquitous vlogs, are many enlightening neurological stuff. And of the many neurology videos on Youtube, some have attracted more attention than others. Is there a secret? There’s only one way to find out!
Here then are the top 10 most viewed neurology videos on Youtube:
If there is any lesson here, it’s all about the simple things. No complicated syndromes, no convoluted guidelines. In some cases, no master at all! Viewers just want to see the complex simplified!
PS. To widen the variety of video sources, I have restricted each source to one video.
It’s what we do every year… Plough through myriads of papers… Scrutinise methods and results… And hone in on the conclusions. We chart the hard work of neurologists… The mysteries they decipher… The riddles they solve… The conundrums they unravel. We extract only what is good enough… For inclusion in Neurochecklists. We disseminate the major breakthroughs… […]
With almost 25,000 visitors…
and almost 35,000 post views…
the highest since this blog launched…
It appears The Neurology Lounge has had a busy year.
But compared to the previous whirlwind years…
2018 was a relatively blog-quiet year.
Dominated by older posts…
And a sprinkling of new ones.
This is neither because of a flagging spirit…
nor a waning passion.
Neurochecklists, my other task-master…
Demanded more and more of my time.
Revising, refining, retuning…
Simplifying, clarifying, edifying…
In pursuit of the ideal neurology database.
As that task is now nearly done…
2019 beckons back to the blogging arena.
But just before looking forward…
In this season of looking backward…
Let’s spare some time to take account.
How did the old expositions fare?
How did the new compositions rank?
Here are your top 20 most viewed blog posts of 2018
Stay in touch with The Neurology Lounge in 2019
2018 started a 100 posts ago. A busy year for the blog. How time flies! A year of asking questions… And seeking answers… One blog post at a time. So which of our blog posts… Old or new… Attracted the most attention in 2018? Here are the 20 most popular neurochecklists blog posts […]
Effects of valproate on reproductive endocrine function in male patients with epilepsy: a systematic review and meta-analysis. Zhao S, Wang X, Wang Y, et al. Epilepsy Behav 2018; 85:120-128. Abstract BACKGROUND: Valproate (VPA) is a broad spectrum antiepileptic drug (AED) that is generally used as a first line agent for most idiopathic and symptomatic generalized epilepsies. Many […]