Question
A 37yo man is presenting to your practice to establish primary care. He reports a history of controlled inflammatory bowel disease and sees a gastroenterologist every 6 months. Before you begin your physical examination:
Triangle of Calot
Other Known Aliases – none
Definition – anatomic space bordered by the cystic duct (inferiorly), common hepatic duct (medially) and cystic artery (superiorly)
Clinical Significance – this anatomic space is where you can see lymphadenopathy in patients with cholecystitis. This is often confused with the cystohepatic triangle (read more here).
History – Named after Jean-François Calot (1861-1944), who was a French surgeon and received his medical doctorate from Saine-Pe de Bigorre in 1880. He would go on to have a modest career in the field of orthopaedic surgery, and is known for describing the treatment of spinal deformities in Pott’s Disease. He would describe his eponymonic area in his doctoral thesis defense in 1891.
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Question
You are asked to evaluate a 23yo male prisoner for underlying psychiatric illness prior to standing trial for his third aggravated assault arrest in 12 months. During your discussion, he discloses that he doesn’t hold jobs down very well because “his bosses are idiots”, does not speak with his family, and prefers to not have friends because “everybody is stupid”. He was expelled from 3 different high schools and finally dropped out at 16. In reviewing his criminal record with his attorney, it is revealed he has been arrested 9 times starting at age 14 for theft, burglary, assault, and intoxication infractions.
Answer
Korsakoff Syndrome
Other Known Aliases – none
Definition – chronic, irreversible amnestic disorder caused by thiamine deficiency classically associated with longstanding alcohol use
Clinical Significance – there are seven major symptoms of Korsakoff syndrome that can be seen clinically:
This is classically taught as a continuation of Wernicke’s encephalopathy, though patients may not present in early stages.
History – Named after Sergei Sergeievich Korsakoff (1854-1900), who was a Russian neuropsychiatrist and received his medical doctorate from Moscow State University in 1875. He would go on to gain fame in fields of neurology and psychiatry culminating in his appointment as professor extraordinarius at a dedicated psychiatric hospital in Moscow and helping to found the Moscow Society of Neuropathologists and Psychiatrists. His eponymous condition was first described in 1887 in his graduate thesis entitled “Alcoholic Paralysis”
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Question
You are asked to evaluate a 23yo male prisoner for underlying psychiatric illness prior to standing trial for his third aggravated assault arrest in 12 months. During your discussion, he discloses that he doesn’t hold jobs down very well because “his bosses are idiots”, does not speak with his family, and prefers to not have friends because “everybody is stupid”. He was expelled from 3 different high schools and finally dropped out at 16. In reviewing his criminal record with his attorney, it is revealed he has been arrested 9 times starting at age 14 for theft, burglary, assault, and intoxication infractions.
Tourette Syndrome
Other Known Aliases – Brissaud’s Disease
Definition – neurodevelopmental disorder characterized by motor and vocal tic with onset during childhood
Clinical Significance – the exact cause is still largely unknown, but likely results from a disturbance in the cortico-striatal-thalamic-cortical (mesolimbic) circuit, which leads to disinhibition of the motor and limbic system. There are no specific tests to confirm and is a clinical diagnosis. The severity of the tics largely decreases, and in some instances disappears, in adolescence and adulthood.
History – Named after Georges Gilles de la Tourette (1857-1904), a French neurologist who recieved his medical doctorate from University of Poitiers at the age of 16. He subsequently moved to Paris to train at the famous Laennec Hospital and Salpêtrière Hospital under Jean Martin Charcot. Under the tutelage of Charcot, he made tremendous strides in the area of psychotherapy, hysteria, psychology, and neurology and described his eponymous condition in a nine patient case series in 1884. In a rather cruel twist of fate, he was shot in the neck by a patient he had treated with hypnotism in 1893, fell into a deep depression, committed to a psychiatric hospital due to tertiary neurosyphilis, and died there in 1904.
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Klumpke’s Palsy
Other Known Aliases – none
Definition – paralysis of the upper extremity from a lower trunk injury classically effecting C8-T1.
Clinical Significance – this brachial plexopathy can be infants as a result of birth trauma from pulling on an extending arm or in older children/adults from hanging from an outstretched arm. The classic manifestations are paralysis of the intrinsic hand muscles, fixed and flexed wrist and finger flexors, and sensory numbness of the C8/T1 dermatome leading to the textbook “claw hand” deformity.
History – Named after Augusta Déjerine-Klumpke (1859-1927), an American-born French physician who received her medical doctorate from the University of Paris in 1889 after becoming the first woman to be appointed interne des hôpitaux. She would immediately make a reputation for herself by being able to speak three languages and took an interest in neuroanatomy and physiology. She would meet fellow physician and future husband, Jules Dejerine, during her studies in medical school and the two would study and publish extensively together in the realm of neurology including the classic two-volume textbook on the anatomy of the nerve centers entitled “Anatomie des Centres Nerveux”. She would describe her eponymous condition in her 1885 case review of 18 patients taken from the available medical literature and would win her the Godard prize in 1886.
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Question
49yo man presents to his primary provider’s office with a 2-week history of bilateral leg weakness. He denies any pain associated with it and has never had any symptoms like this before. He denies any previous back problems and reports never remembers injuring his back. He thinks it first started in his feet when he noticed he was dragging is toes when walking, but now finds some difficulty lifting his legs when going up stairs. PMH is significant for hypertension (controlled on lisinopril) and osteoarthritis (controlled with exercise and celecoxib). He also reports having a pretty severe case of “food poisoning” a month ago when vacationing in the gulf, but is otherwise healthy.
Physical examination reveals 3/5 strength bilaterally with plantarflexion and dorsiflexion of the ankles and 4/5 strength bilaterally with hip and knee flexion. His ankle deep tendon reflex is absent and knee is diminished at 1+. Sensation and two-point discrimination of the feet are intact
Answer
Erb’s Palsy
Other Known Aliases – none
Definition – paralysis of the upper extremity from an upper trunk injury classically effecting C5-C6.
Clinical Significance – this brachial plexopathy is most commonly associated with birth trauma from a shoulder dystocia and depending on the severity of the injury, can resolve on its own or be permanent. The arm is classically internally rotated, with an extended and pronated forearm referred to as the “waiter’s tip” or “porter’s tip” sign.
History – Named after Wilhelm Heinrich Erb (1840-1921), a German neurologist who received his medical doctorate from the the University of Heidelberg in 1864. He would spend his early career assisting Nikolaus Friedreich and Ludwig von Buhl in Munich, before becoming chair of the pathology department at the University of Leipzig in 1880, and ultimately succeeding Friedreich in 1883. He is credited with popularizing the reflex hammer use in neurologic examinations and would be instrumental in identifying and describing myasthenia gravis, tabes dorsalis, and his eponymous point in the brachial plexus where this injury arises. Of note, he is also credited with the cardiac auscultation point where the S2 is best heard.
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