Neurology of Not Knowing

By Gabriel Calleja, Regis ’12

Red, Table, Broadway. These three seemingly unrelated words can act as an indicator of how a stroke could have impaired the brain functions in a patient. Depending on the accuracy with which the patient is able to retrieve the information after being distracted, a neurologist can deduce the seriousness of the trauma affecting the brain.  Remember those three words; there will be a quiz at the end of this blog post.

Through diagnostic tests like this word game as well as a clinical vignette, the Seminar tackled the topic of strokes and related neurological abnormalities with the help of Dr. John Caronna, Regis ’57 and former Vice Chair of Neurology at Weill Cornell Medical Center.

Prior to Dr. Caronna’s visit, the Seminar students were presented with a case study of a stroke victim.  Through individual research and investigation, we were asked to attempt a diagnosis. This clinical vignette involved a 17-year old senior in high school brought to the Emergency Department after collapsing during a basketball game. The left side of his body appeared inhibited: he was immobile and uncoordinated on his left side and he suffered from a left hemianopsia, which is an inability to see objects presented in the left visual field. Dr. Carrona further explained how vision was affected distinguishing between the occipital lobe and optic radiation.

See video below to watch the “Seminarians” listen to Dr. Carrona as he relates how damage to the occipital lobe is different from damage to the area of optic radiation. (One with damage to the occipital lobe notices a clear problem with one’s vision--for example, blurred vision. Damage to the parietal lobe’s visual field  causes the patient to lose visual awareness and usually leaves the patient confused and unaware of the problem.  Such a problem is called an “agnosia.”)

After solving the supplemental questions, the “Seminarians” were able to localize the trauma to different parts of the brain as well as find the cause and diagnose the patient.  It seems that he strained one of his muscles, causing an artery to tear. The blood then redirected into the tear and created a new channel for the blood to flow. This dual channel, along with pieces of the artery that had dislodged, clogged the artery and caused an ischemic stroke.

This is why clinical vignettes are necessary and beneficial for diagnosis and treatment. These clinical examples provide a framework to formulate hypotheses about the location and nature of a patient’s problem.

What we all found most disturbing about this was that this kid was our age and had a typical medical history (i.e., negative for medical and neurological problems). But what do strokes have to do with us? We are all too young to suffer something so severe, or so we think. After all, this patient was our age. Are we not at risk as well?

Although everyone faces the risk of a stroke, Dr. Caronna explained that “clot-busters” already exist, and that a breakthrough to prevent strokes was underway.

Still, many of us are able to relate in some way to Dr. Caronna’s talk, whether learning that Padmé Amidala’s “broken heart” death has biological causes or knowing someone who has suffered a stroke.

Not being a Star Wars fanatic, I belong to the latter group. My grandfather suffered a stroke when I was little, so I was looking forward to Dr. Caronna’s visit. After his talk, I gave my grandfather a few mock tests at home and attempted to diagnose him to the best of my ability. One of the tests I administered was a memory test that is supposed to compare a vital youthful memory to that of a stroke patient. Did you remember the three words from before?

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