Right Brain: Past medical story

Abstract

L.M., a 71-year-old man presenting with gait disturbance, was my first Neurology patient upon entering the clinical clerkships. On my way to the Emergency Department, I learned from the chart that his past medical history (PMH) was significant for eastern equine encephalitis (EEE) 9 years earlier. I had never heard of EEE. In the elevator, I dutifully pulled out the tablet I carried in a fanny pack. To my amazement, I had to peruse several medical reference services before finding a short entry informing me that the often deadly eastern equine virus has a predilection for the basal ganglia. I was still holding my tablet when I reached L.M., more interested in his rare previous disease than in his current difficulty walking. “I understand you suffered from eastern equine encephalitis. Is this correct?” I asked, after introducing myself to a jolly obese gentleman appearing in no acute distress. L.M. affirmed the chart entry and provided details about sudden loss of consciousness, a 3-week coma followed by months of paraplegia, and eventual complete recovery. On examination, L.M. had masked facies, a mixed tremor, cogwheel rigidity, intact strength and sensation, and shuffling gait. He reported all symptoms to have begun in the last month, with abrupt onset. His family history was positive for essential tremor and Alzheimer disease (AD) in his father. The neurology resident presented L.M. the following day in morning report. EEE was brought up and I shyly raised my hand from the student section of the room. “EEE has a predilection for the basal ganglia. Could the damage done to L.M.'s basal ganglia have slowly progressed to …