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In a Worsening Situation, Treatment can do More Good than Harm

Service de Neurologie, Hôpital Lariboisiere, Paris, France; E-mail: mg.bousser{at}lrb.ap-hop-paris.fr

EXTRACT

A long time ago, at the Salpêtrière hospital in Paris, I was involved as ‘Chef de Clinique’ (roughly similar to a senior resident) in the management of a patient whose story has not only greatly modified my own practice, but also that of many neurologists in that famous institution.

THE STORY

The patient was a 69-year-old right-handed woman, a good tennis player, with no relevant past medical history, who had woken up on 12 December 1975 with a weak right arm. She was admitted a few hours later. She was conscious, but slightly apathetic. She had a dense right brachial monoplegia and a right extensor plantar response. The rest of the neurological examination was normal, in particular there was no facial or leg weakness, no dysphasia, no sensory disturbance and no papilloedema. General examination, temperature, and routine blood tests were all normal. Blood pressure was 145/85. Electrocardiogram was normal.

At ...

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