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Post-stroke mutism
  1. A J Larner
  1. Consultant Neurologist, Cognitive Function Clinic, The Walton Centre for Neurology and Neurosurgery, Lower Lane, Fazakerley, Liverpool L9 7LJ, UK; a.larner@thewaltoncentre.nhs.uk

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    Neurologically unexplained symptoms are not unusual. In my clinical practice, most patients thus labelled do not appear (to me) to have “neurological disease” unless affective disorders be classified as neurological rather than psychological. Sometimes, however, unequivocally “neurological” disorders may have unexplained symptoms and signs. This may be particularly poignant, even galling, when the patient involved happens to be a member of the neurologist’s family.

    In March 2001, my father, a 78 year old, right handed, insulin-requiring diabetic, had a stroke. From my mother’s account, this came on one morning after breakfast. Sitting on the bed, he slumped forward and she had to help him to the floor. She wondered if he was having a hypoglycaemic attack but thought it unlikely, and fingerprick blood sugar was normal. The general practitioner attended promptly; he anticipated improvement, but said to call again if my father’s condition deteriorated. A neighbour, summoned to help get my father from the floor to the bed, asked my father to put his arms around his neck, but he was unable to do this with his left arm (retrospectively my mother thought that one side of his mouth was also down).

    He improved sufficiently by lunchtime to eat some food, and then slept, but by late afternoon he was “strange” again and my mother called an ambulance. The paramedics checked his blood sugar and again it was normal. At the small local hospital he was kept in overnight. When my mother left the hospital, my father was sitting up and talking; he asked if she was going to walk home, and when she replied that she would phone a taxi he gave her the (correct) number for the local cab firm. My mother anticipated he would be out of hospital the next day, and phoned to tell me not …

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