9/20/2023 0 Comments Nytimes magazine![]() The biggest disappointment came from the Mayo Clinic, where the neuroimmunology lab looks for evidence of any of a dozen paraneoplastic syndromes. So were the other vitamin deficiencies he was tested for. They needed to give him time.Īs he waited for his patient to start to get better, Opolinsky kept his eye on the results that were still trickling in. Still, it often takes a week or two for any improvement following the IVIg. Unia had warned Opolinsky that the patient was eager to feel better but that his exam had not really changed since his arrival. Much better, the patient exclaimed, but then exploded into a paroxysm of coughing. The patient had just finished his last day of treatment when the hospitalist Dmitry Opolinsky took over his care. Treatment involves suppressing the wayward immune system - first with steroids and then, if needed, with intravenous immunoglobulin (IVIg), an infusion of antibodies that block the destructive ones of G.B.S. In the meantime, the neurologist decided to treat him even without this proof. Unia ordered the blood test that looks for this version of G.B.S. In the Miller Fisher variant of G.B.S., the disease attacks the nerves controlling the muscles of the head and neck as well as those of the feet and legs, causing double vision and difficulty swallowing. Antibodies created to fight the infection mistakenly attack the nerves that control movement, usually starting with the legs and ascending up the body. is also an autoimmune disorder, usually triggered by an infection. These paraneoplastic syndromes, as they are called, are a rare consequence of the immune system’s attacking cancer but can cause devastating injuries to the nervous system as well as other parts of the body.īut highest on Unia’s list of suspects was an unusual version of Guillain-Barré syndrome (G.B.S.) known as the Miller Fisher variant. Some of these autoimmune diseases are associated with cancers. These disorders occur when the immune system gears up to take on some kind of invader, and the antibodies generated to protect the body attack it instead. Something else that can affect the brain and nerves are autoimmune diseases. Vitamin B1 and E deficiencies, while less common, can also cause these kinds of neurological symptoms. And it’s common - seen in up to 15 percent of those over 60. ![]() Could it be a vitamin B12 deficiency? Loss of this key nutrient can cause a wide variety of neurological symptoms - usually difficulty walking and a loss of feeling in the hands and feet, sometimes double vision and trouble swallowing as well. Unia knew from the records from the first hospital visit that this wasn’t a brain tumor or stroke. The cough, she suspected, was his body’s last-ditch effort to keep food, liquids and his own saliva out of his lungs. Normally the epiglottis, a leaf-shaped flap located at the base of the throat, folds over the trachea as we swallow to prevent the food meant for the esophagus from going down the wrong tube. The esophagus (the swallowing tube) is right next to the trachea (the breathing tube). Unia suspected that his swallow was as uncoordinated as his walk. His tanned round face reddened as he surrendered to a violent cough. But nothing had laid him this low before. Of course, at 74, he had a bunch of medical problems - diabetes, high blood pressure, some heart disease, even gout. And that wasn’t the only thing: He was seeing double. Roople Unia, the neurologist on call that day. The uncertain and awkward way the patient moved made doctors at LincolnHealth worry that something - maybe a stroke, maybe a tumor - had injured that part of the brain. Virtually every movement the body makes requires several muscles working together - a collaboration that occurs in the cerebellum. doctors that the patient wasn’t weak but ataxic, lacking not strength but coordination. His legs moved awkwardly, as if they had somehow forgotten what to do.Īt the LincolnHealth-Miles Campus Hospital in nearby Damariscotta, it was clear to the E.R. He needed both hands on the railing to get down, grunting with each step. She eased the car right next to the porch. Then he needed help getting out of his big chair. But a few weeks earlier, she noticed that he was parking his tractor next to the back porch so he could get on it without pulling himself up. Her husband was stubborn, a seventh-generation Mainer, not given to complaining. “I’ll go to the hospital.” His wife of 46 years gave an inner sigh of relief. ![]() “OK, I give up,” said the 74-year-old man.
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