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    Tuesday, May 18, 2004

    Reader Mail: A reader wonders about the woman with only half a skull who complained that her brain shifted during the night. He asks "Really? Is that acutually possible?"

    Yes, it is. The brain isn't attached to the skull in any way. It's only attached to the spinal cord. In cases of severe trauma, the brain even slides around inside the skull, causing coup-contra-coup injuries.

    Another reader describes her first-hand experience with whooping cough:

    Despite a full complement of vaccines, I acquired pertussis in medical school, back in 1986. The whooping sound you linked to is spot-on, but what it doesn't portray is the air-hunger, or how awful it looks to someone else. After having it for a few days, I wouldn't talk, cough or clear my throat for fear of a laryngeal spasm (which lasts much longer than the coughing fit), and walked around looking four month's pregnant due to air swallowing! I had an attack in a call room, and one of my chief residents walked by. In less than a minute I found myself in the ER, hooked up to all manner of monitors. It was very embarrassing, as I knew it would pass and I would recover, but I wasn't able to communicate that to anyone. The pediatrician on-call nailed the diagnosis and told me to stay home so I wouldn't give it to the patients. For me with an adult airway, it was very frightening. I can't imagine what it would be like for a child or his parents. I can see why it could be deadly. It's like being choked from the inside.

    UPDATE: A neurosurgeon corrects me about the brain's mobility:

    Actually the brain is constrained in its movement. There are attachments to all the cranial nerves, as well as the internal carotid arteries and vertebral arteries. The falx also limits side to side movement, and the tentorium limits movement up and down.

    What that person was experiencing was a change in the amount of CSF in the ventricles and subarachnoid cisterns, and blood volume in the cerebral vessels. It is quite common to have variations in the "fullness" of a skull defect, depending on time of day, activity level, degree of hydration. Generally, though, it ain't from having a shifty brain!


    posted by Sydney on 5/18/2004 07:43:00 AM 0 comments


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