Y'learn something new every day, I guess. I've seen seizures that manifest as the good, old-fashioned generalized tonic-clonic (shaking, grunting, scary, traumatic for everybody) sort; I've seen seizures that manifest as anxiety attacks or giggling fits or simply staring off into space for a bit.
I had never seen a somebody seize where the only symptom was that they were looking for something they couldn't find.
It took us a while to figure out what was going on. There weren't any acute neurological changes that I could see in the patient during these episodes--he stayed alert, oriented, aware. There weren't any acute changes that we could see in MRIs or repeated CT scans. We figured it was some weird anxiety thing going on--until the video EEG showed seizure activity concurrent with the patient's desire to find his wallet.
The residents and I were looking over the video record and saw the first telltale signs of a complex partial seizure corresponding to the patient's asking where his wallet was.
Well, I will be damned. Okay, then. Load 'em up on Keppra.
Short, sharp. Shocked.
Another nurse's patient had complained for the last hour or so of shooting, stabbing pain in one particular area of his shoulder. Given that he'd had a lumbar laminectomy, we couldn't figure out why his left shoulder would feel as though something was stinging it. Was it a problem with positioning during the surgery? Was it some unrelated problem in his cervical spine? Was it just one of those weird things that would go away on its own?
We rolled him and checked the shoulder. Nothing. We did range-of-motion. Nothing. Xrays showed nothing. Still that sharp pain. It wasn't consistent, and it tended to happen when he lifted his left arm up to grab something off the table.
Finally, we rolled him one last time. His nurse straightened the collar of his schwanky new, just-out-of-the-wrapping pajamas, and jerked, winced, and cursed softly. She'd stuck herself on a pin.
A pin. In the collar of the new, schwanky peejays. We found the source of the stabbing pain--but who puts pins in pajamas? It's like starching baby clothes.
You mean this opera involves handcuffs?
Word salad is the strangest, funniest, sometimes most charming part of a brain injury. It's the inability of the brain to make your mouth come out with the right word at the right time, so things tend to get a little skewed. Patients will ask when their sweater is due, rather than their medications, or tell you that you're the flossiest sausage they've ever seen.
Each person tends to substitute words in a particular way, so after a day or so you can figure out what they mean. I'm still scratching my head, though, over the guy who looked at me solemnly and said "You're handcuff and chocolate, Nurse."
It might be the best compliment I've ever gotten.
The trouble with normal
Looking around, I see that I have a collection of medical books and magazines from the 1920's through the 1940's. Most of 'em have subjects like "Clinical Syphillology" (1938), or "Your Health: HOW TO AVOID A NERVE CRACK-UP" (1943), and all but one were found for my by my Beloved Sister.
I'm thinking it might be fun to excerpt some of the articles--especially ones from the popular press--just to see how "normal" has changed in the last 60-odd years. F'rinstance, didja know that some folks thought it was harmful for people over 35 to exercise at all? I wonder what Attilla the Cheerleader would think of that.
(For those who are interested, titles come, in order, from: