This is a case of lumbar facet arthropathy by Dr. Stephan Ritland, one of my neurosurgeon mentors. Note the hyper intense T2 signal in the facet joints on this axial T2 MRI of the lumbar spine. Follow the link to read about the Ritland submuscular approach for treatment.
This is a T2 MRI C spine demonstrating a “swan neck deformity” – draping of the spinal cord over a kyphotic deformity of the cervical spine. Typically, extensive cervical fusion is required for correction and prevention of deterioration in symptomatic patients.
This is a CT head demonstrating agenesis, or absence, of the corpus callosum. The corpus callosum is a broad band of axons interconnecting the two hemispheres of the brain. Agenesis of the corpus callosum, although rare, is one of the most common brain malformations in human beings. It can be completely asymptomatic, or it can be associated with autism, seizures, and motor, auditory and/or speech symptoms. The anterior corpus callosum has been noted to be more pronounced in musicians and left handed and ambidextrous people.
Baastrup’s syndrome (aka “kissing spines”) results from osteoarthritis of spinous processes (usually lumbar). The spinous processes rub up against each other which leads to hypertrophy and sclerosis. This can cause a patient pain that is exacerbated with extension and relieved with flexion. The disease is named after Christian Ingerslev Baastrup, a Danish radiologist (1855-1950).
This is an axial FLAIR MRI sequence of a third ventricle colloid cyst. These cysts are benign in nature, however they can quickly cause a deadly hydrocephalus by blocking the foramina of Monro and CSF flow out of the lateral ventricles. The hydrocephalus, or ballooning, of the lateral ventricles can cause herniation of the medial temporal lobes across the tentoirum cerebelli, and eventually herniation of the brainstem through the foramen magnum, resulting in death. Treatment includes placement of an external ventricular drain (“EVD”) in the lateral ventricle to relieve hydrocephalic pressure on the brain, followed by endoscopic surgical removal of the colloid cyst.
Trust is absolutely pivotal in the practice of medicine. Patients need to trust their physicians. Physicians need to trust other members of the medical community. The medical community needs to trust the medical literature and evidence-based guidelines. But what if much of day-to-day medicine is actually rooted in subtle lies, bias, faulty perceptions and misconceptions?
The Lies We Tell – Social Bias, Myths and Blindspots in Medicine is a brilliantly written piece by Dr. Charles Odonkor and a worthy read for any aspiring medical student or young physician. It is a call to first, be honest with yourself. It will be the next generation of physicians’ unique challenge to “reconcile the disharmony between stated ideals vs. the realities, which often arise in the imperfect science and art of medicine.”
More to come on the topic of trust in medicine in the coming weeks.