My experience told me that Arwen Cleary's echocardiogram had missed something, not just once, but twice. I turned to Hannah after we had left the room, and asked her this crucial question: "Can you put your finger on what's different in this case?" She replied that it was the angiogram, which showed the alarming number of constricted blood vessels and cutoffs in the cerebral arteries. But this book tells real stories, some of them awe inspiring both from the point of view of the dedicated hospital staff and the courageous patients. Some are simply heartbreaking. Some patients present with bizarre symptoms as the brain struggles to function normally. Through it all Dr Ropper talks about how vital it is that doctors listen to their patients. Having gone through such a situation with a close family member I would say that this is what patients want most, to be really heard in an atmosphere where they don’t feel hurried or pressured. It was good to hear this doctor’s words on that particular aspect of consultation. It is a series of clinical accounts by Boston neurologist Dr Allan Ropper over his many years working at Brigham and Women’s Hospital. Gilbert, the medical student who had made the initial exam, recorded this as "orientation times one."

She was in rough shape, virtually blind in her right field of vision, and now aphasic. What worried me was that she didn't have any reserve left, and any little chip-shot stroke was going to be a disaster. The next one, I was convinced, could wipe her out. Arwen Cleary had been a professional figure skater as a teenager, had retired from the Ice Capades upon its dissolution in 1995, had then raised three children, gotten divorced, and moved with her two younger children to a ranch house in Leominster, a distant suburb, where she worked part-time at a local health club. Her medical history was unremarkable: once a smoker, she had quit ten years earlier. Her travels had taken her no place more exotic than Bermuda and no more distant than Orlando. Her only hospitalizations to that point had been in maternity wards. She was remarkably fit and in seemingly good cardiovascular health, if judged only by her appearance and vital signs. But shortly after a visit to a chiropractor, she had suffered a vertebral artery dissection, a form of stroke. Time and again, characters with boilerplate descriptions – “Lucinda H is a Latina female in her late teens … with short-cropped and spiky hair” – announce themselves with bizarre symptoms that arrive, often without warning, in the most mundane situations. You have to." She spoke with an unnatural monotone, somewhat like a deaf person, without accenting any of her words. That was the aphasia. She struggled with all but the simplest responses, and settled for tropes.That's because you're missing the right side of the world. You might not be aware of it, but your vision on the right is diminished because of one of the very early strokes. Are you a different person now?" I just ran into your Mr. Talma in the elevator lobby." Elliott, a colleague who seems to keep closer tabs on my patients than I do, had buttonholed me in the corridor outside of the ward. "When I gave him a shout-out," he said, "you'd think I'd asked him to put up bail for the Unabomber. The guy comes in here a pussycat, and when you finish with him he's Mr. What's-It-To-You-Pal. No more smiles, no more jokes. What did you do to him?" An interesting discussion about brain death and the philosophy behind that and the difficult position it puts neurologists in. The case discussed in detail was a known local paedophile and how this may affect your decision about preserving life (or not). Carrying a donor card and does this ultimately make you a good guy in death? You get the feeling he rather thinks it does – or at least not all bad – perhaps no one is all bad? If you have forgotten your basic neurology this will remind you about what functions come from the different areas of the brain.

Apropos of nothing really, but this reminds me of British game shows. It is very alien to the British to applaud oneself or one's accomplishments, whereas Americans jump up and down and shout out how proud they are of themselves, this makes British people cringe. However, it makes much more exciting television, so the producers now have got the British to run around arms in the air shouting out and generally looking awkard and embarrassed. Everyone feels the same inside, it's just a difference in expression and probably the one people prefer is the one of the culture they were brought up in. All went well for two years, until she returned to the hospital with sudden right facial drooping and difficulty finding words, sure signs of another stroke, but this time a stroke of a very different kind. A portion of one of the language centers of her brain had been deprived of its blood supply. Her speech was now noticeably impaired. Within a few days, she showed signs of improvement, and was again discharged on a blood thinner. Your co-authors must send a completed Publishing Agreement Form to Neurology Staff (not necessary for the lead/corresponding author as the form below will suffice) before you upload your comment.She called their primary care physician, who told her to get him to the emergency room immediately. While Lewis Carroll's Alice's Adventures in Wonderland is the source of the title, the theme of implausible reality in neurologic practice comes from the White Queen of Through the Looking-Glass. Neurology is queen of the medical specialties, says Ropper. Like Wells, a queen among Gothic cathedrals, she is neither the biggest nor necessarily the best but few exceed her for finesse and elegance. Nevertheless, there are some wonderful accounts of rare cases, such as the young Asian Korean woman who was fuming like she has rabies. That definitely requires an experienced eye to make an accurate and prompt diagnosis, and to prevent further damage to the patient's physical functioning and quality of life.