CEREBROSPINALECTOMYThings that only make sense if you did the training. Four of them. The second one is the one you cannot explain at dinner. SEND this to the person who will get every one. ER: "Neuro, quick one." Me: "There are no quick ones." ER: "This one's quick." Me: "Then why am I here." Locums week, small hospital. A man set an MRI on the desk. Me: "Whose is this?" Him: "Duke's." Me: "Is Duke a person?" Him: "Duke is a very good boy." Veterinary neurology is its own board-certified specialty with its own residency. I am not it. I told him that. He did not seem to accept it. ER: "Neck pain and a droopy lid. She is twenty-nine." Me: "Same side?" ER: "Same side." Me: "What did she do yesterday?" ER: "Nothing. Painted a ceiling." Me: "That is not nothing. Image the neck, not just the head." Friend: "Can you just watch the film?" Me: "He has had a stroke." Friend: "He is a vampire." Me: "Left face, left leg, same side. Right hemisphere. He had a stroke and THEN he became a vampire."
EXPLAINED (ACCURACY-CHECKED)
(1) Neurology consultation requires a full history and localising examination; the specialty's diagnostic method is not amenable to abbreviated assessment. (2) Veterinary neurology is a separate board-certified specialty (ACVIM, neurology specialty); physician neurologists are not trained or credentialed to interpret veterinary imaging. (3) Cervical artery dissection can follow trivial neck hyperextension and classically presents with ipsilateral neck or head pain plus a partial Horner syndrome (ptosis and miosis, sparing sweating in internal carotid dissection); it requires vascular imaging of the neck, which a plain head CT does not provide. (4) A unilateral lesion in one cerebral hemisphere produces contralateral weakness of the face and limbs on the same side of the body; left facial droop together with left leg weakness localises to the right hemisphere.
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