Oct 03, 2023
Oct 03, 2023
In neurology some diseases are easily diagnosed as the patient enters the doctor's office. The scraping toe and spastic gait of the hemiplegic is unmistakable. Lesions in the cerebral cortex or sub-cortical region on one side cause a flexed upper limb bringing the hand nearer to the mouth and a stiffly extended lower limb with the foot flexed downward at the ankle towards the ground (on the opposite side as the brain lesion). The knee is extended and stiff and the above two defects makes the paralyzed leg longer than the normal one. The patient cannot walk normally and has to swing the paralyzed longer leg outwards (called circumduction) and the plantar flexed foot touches the ground first on the medial or inner side with scraping of the toe portion of the sole of the shoe. It wears out preferentially and the gait is called a spastic circumducting gait.
On the other hand a person with spastic paraplegia (both legs affected with a spastic paraparesis) swing one leg outwards and bring it in (circumduct) and then do the same with the other leg. This is called the scissors gait and is equally unmistakable. A patient with bilateral flaccid foot drop due to a peripheral neuropathy has distal leg weakness with relative sparing of the proximal thigh muscles and to avoid stumbling due to the foot drop has a high steppage floppy gait. A patient with Parkinson's disease has a simian posture (Trunk slightly bent forward), tremors of hands that look like he is rolling pills or using a rosary or worry beads and an expressionless poker face.
Chorea is a disease in which patients have spontaneous involuntary rapid jerky movements which may seem semi-purposive, together with grimacing of the face. Chorea occurs in many diseases but an inherited autosomal dominant form is Huntington's (Guthrie the American folk singer). When rheumatic fever from streptococcal infection was highly prevalent in the pre-antibiotic era, a childhood form called Sydenham's was common. Sydenham an astute British physician with good writing skills said, 'A child with chorea is thrice punished unfairly by the elders, for not sitting still, making faces at grandma and breaking dishes by throwing them.
So I got to thinking about the common affliction affecting Bernanke, Summers and a host of male money managers haunting the television channels. My latent paranoia first hit on the idea that they were all a cabal of conspirators bribed by Obama. When my mood became charitable, I ascribed their parroting to having sought shelter under the same TARP, roof or TALF. Then I put on my clinical neurologist's hat and the Eureka moment came. Fortunately I had finished my bath and was fully dressed when I ran out of my house and their was no cause for embarrassment for me or criticism from my neighbors.
They are not closely related though many are economists and someone wisecracked if you took all of them and put them end to end you would still be unable to come to a conclusion. Their favorite speech is 'On the one hand ------- but on the other hand------ .' Some US president (Truman) got so annoyed that he told his chief of staff to find him a one-handed economist. None of them had recently gone to Mexico and if they had swine flu then surely all house and senate members would have shown signs of the disease. It was thus not an acquired or infectious disease that altered their judgment. By reductio absurdum, then there could be a genetic problem. A perception disease that made them see green shoots. I googled the human genome project and scanned genetics texts and concluded that they all suffered from red green color blindness a common X chromosome linked recessive genetic disorder that affected males only. In this condition men will mistake red thorns for green shoots. Problem solved . Q.E.D.
More by : Gaurang Bhatt, MD