TOSCANINI'S FUMBLE: And Other Tales of Clinical Neurology

Neurology is known for its wide range of lamentable disorders, from stroke, dementia, and Parkinson's disease to rare conditions such as trigeminal neuralgia and post-coital headache. Chicago-based neurologist Klawans touches on all these and more in this collection of case studies, presented with compassion but also by way of illustrating the skilled diagnostician and didact at work. Toscanini suffered a ""transient ischemic attack,"" a reversible stroke that deprived part of his brain of oxygen while he conducting an NBC symphony concert in 1954. Klawans conjectures that the maestro's vigorous arm movements led to a compression of the subclavian artery on one side of the body, which forced blood to flow down into the other subclavian artery and not up to the arteries supplying the brain. But in 1954, such a syndrome--associated with exercise--had not yet been described, and Toscanini never conducted again. Klawans has specialized in movement disorders (he was the first Chicago neurologist to use L-dopa to treat patients with Parkinson's disease), so a number of tales deal with that condition as well as Huntington's disease. He provides a scholarly background--when and where the first cases were diagnosed--and current research, including the experimental use of adrenal and fetal brain tissue transplants to treat Parkinson's disease. There are no effective treatments for Huntington's disease, but Klawans discusses genetic studies and traces the origin of the disease in America to 17th-century English settlers in New England. He emphasizes how the symptoms may have fed the witch-hunt hysteria of the time. Transient global amnesia, acromegaly, viral brain disease, loss of the ability to play music, and Klawans' own scary attack of sleep paralysis following exhaustive jet lag are among the other conditions described, along with assorted White Sox lore and autobiographical details. Fluent, informative, but heavy on the ""we now know. . ."" medical authority at work.