Reaching Down the Rabbit Hole: Extraordinary Journeys into the Human Brain

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Told in a breezy style through a series of real-life case studies, Ropper's book offers a fascinating glimpse of the ways in which our brain can go wrong. * Financial Times * Yes, good, good, fine," Vincent replied. He was sitting up in bed, watching television with a smile of bemused innocence. Vincent Talma was a picture of contentment. His room on the tenth floor of the hospital tower commanded an outstanding view of Fort Hill Park in Boston's Roxbury section, but Vincent took no notice. Along with twenty-nine of our other patients, he had been waiting for a visit from the neurology team on their morning speed rounds. A week earlier, Cindy Song, a sophomore at Boston College, had started acting a bit withdrawn. Her roommate was concerned enough to call Cindy's sister. The first phone call was not too worrisome. "Not a big deal," the sister said. "She gets that way. Just give her time. She'll be okay." The next call could not be taken so lightly.

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. 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. Hannah was in charge. Her service, the culmination of three years as a neurological resident, had started a week before I came on board. A "service" involves running the neurology inpatient ward, admitting and discharging the patients, and directing a team consisting of three junior residents, two medical students, and a physician's assistant—a cohort that could barely squeeze into Vincent's curtained-off half of the room. By Anthony Gross– http://media.iwm.org.uk/iwm/mediaLib//143/media-143796/large.jpgThis is photograph Art.IWM ART LD 43 from the collections of the Imperial War Museums., Public Domain, LinkVincent knew who he was. He was sharp enough to find himself amusing. Did his colonoscopy earlier in the week bring this on, or, more to the point, did the anesthesia bring it on? My guess is that it was just a coincidence. A straw poll of the team leaned toward a diagnosis of tumor, possibly stroke, maybe a seizure, but they were basing their guesses on Vincent's MRI. I had seen the scans and knew they did not hold the answer. On the other hand, Vincent's wife, who was sitting in an armchair at the foot of his bed, did.

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.We treat people with seemingly implausible ailments all of the time. Each day they show up in a predictable parade of signs, symptoms, and diseases: an embolus, a glioma, a hydrocephalus; a bleed, a seizure, a hemiplegia. That's how the residents refer to the cases, as in: "Let's go see the basilar thrombosis on 10 East." When viewed in terms of actual patients, however, no day is quite like any other. After the bedside visit, the thrombosis suddenly has a name, the glioma has a wife and children, the hydrocephalus writes a column for a well-known business journal. Our coed suffering from psychosis turned out to be a Rhodes Scholarship candidate, the case of multiple strokes became a charming woman who had competed in the Junior Olympics, and the man for whom a smile was a troubling symptom owned a personal empire of six Verizon wireless stores. Filled with patient histories and puzzling symptoms waiting to be understood, Reaching Down the Rabbit Hole is a detective novel, and despite his flapping white coat and squeaking Crocs, Ropper is Humphrey Bogart, cerebral yet tough and blessed with a terse wit. -- Christian Donlan * New Statesman * Holy cow!" I said. "It's an ovarian teratoma. You'd better send her over." It was a snap diagnosis, possibly wrong, but there was no harm in raising on a pair of aces. I had a pretty good idea what the other cards would be: memory deficits, gooseflesh, a high heart rate, and no family history of psychosis. The drooling alone was a tip-off.

This starts out strong, with an introduction into various complex and interesting neurology patients. We have hydrocephalus, subarachnoid haemorrhage, strokes and even ovarian teratomas. It's fascinating stuff, told in a way that feels accessible and not too weighed down by medical jargon. However, I did find the stories petered out somewhat towards the end, and I also really didn't like the way Allan Ropper describes some of his patients. Is 'blonde, very attractive, a little on the plump side, but very lovely' really appropriate? No, I think not. I liked Dr Ropper, he came across nicely and informally, but his ego can get a bit wearisome after a while. I am trying not to hold the whole ego thing against him, after all he is a neurologist and fair enough he does an amazing job that very few people can or would choose to do.When you no longer have a reason to get out of bed, that’s when you’re going to take a long look at the worth of your life.” Dr. Allan H. Ropper is a Professor at Harvard Medical School and the Raymond D. Adams Master Clinician at Brigham and Women's Hospital in Boston. He is credited with founding the field of neurological intensive care and counts Michael J. Fox among his patients. I've rounded up the book from a very precise 2.75 to a 3 because it wasn't a bad read, just not a very good one. If you do nothing, you will be auto-enrolled in our premium digital monthly subscription plan and retain complete access for 65 € per month. 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.

I wish I was smart enough to become a doctor because I think their work is so interesting particularly neurology. Dr. Ropper, Reaching Down The Rabbit Hole makes this point with his tales of the variety of illnesses, accidents, and medical conditions neurologists treat. He calls neurology the Queen of medicine because of its diversity. All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher. To become a good clinical neurologist, you have to be intensely interested by what the brain does, how it works, how it breaks down.”I kept reading hoping he would stop talking about himself and talk about something interesting, but alas, his reference to women neurologists using a reflex hammer to test brain reaction in unconscious patients by saying they, "tend to press harder than men, as if to insure that no one is getting out alive" was my final straw.