By Dr. Anthony Policastro

We tend to think of the nervous system as related to muscles and sensation. However, just like any area of the body, symptoms can sometimes be bizarre.

When I was a medical student in Brooklyn, we had a young boy come in with acute paralysis in his arms. The immediate thought was that he had some kind of neurologic disease as the underlying process.

However, in Brooklyn we had some disorders that were more common than others. One of those was tuberculosis. It turned out that the boy had TB of the spine in his neck. The result was an impact on the nerves associated with muscle movement.

One might think that this was a far fetched diagnosis. However, TB of the spine actually has its own name. It is called Pott’s disease. It is more common than people think.

I used to teach the interns and residents that whenever you came across a strange set of symptoms, you always had to include TB as a possible cause.

A few years later, I was a pediatric resident in Boston. I got called down to the Emergency Room to see a patient with head trauma.

The patient was an adolescent female. She had hit her head and passed out. When she woke up, she became acutely paranoid. She would not let anybody near her. She was throwing things at people. She used the wired TV remote as a weapon. She grabbed it by the cord and was swinging it around by the cord.

She had to be restrained and sedated. The nurses called me to see her at 2 a.m. She had woken up from the sedation. She had no clue that she was in the hospital. She did not remember getting there. She did not remember the paranoid episode. Everything was perfectly fine. She was completely back to normal.

I had never seen anything like that before and to this day have not seen anything like that again. This can occur with traumatic brain injury but lasts for more than a few hours. The episode that I saw was distinctly odd.

I later was an attending physician at Andrews AFB. We admitted an adolescent female. Her boyfriend broke up with her earlier that day. Her brother came home and found her non-responsive and just staring into space. 

She was admitted as an acute psychiatric patient due to the trauma of breaking up with her boyfriend. When we discussed possible diagnoses with the intern, he decided to look into those other possibilities.

One of the tests he did was an EEG. It was consistent with what we find in individuals who have seizures that take the form of brief staring spells. In this case, she was having a permanent staring spell seizure.

The issue with her boyfriend was coincidental. We treated her with seizure medication. She responded to the medication. Like the adolescent with the paranoia, she too was wondering what she was doing in the hospital.

There is an old saying in medicine. It goes: “When you hear of hoofbeats think of horses not zebras.” It means that most illnesses are common so look for common causes. However, every now and then you do indeed run into a zebra of a neurological nature.