Medical Marvel: Infinite Memory

While reading random blogs online (Daily Dish, if you must know), I came across an interesting story about a woman with "perfect memory":

Price can rattle off, without hesitation, what she saw and heard on almost any given date. She remembers many early childhood experiences and most of the days between the ages of 9 and 15. After that, there are virtually no gaps in her memory. "Starting on Feb. 5, 1980, I remember everything. That was a Tuesday."

She can also date events that were reported in the media, provided she heard about them at the time. When and where did the Concorde crash? When was O.J. Simpson arrested? When did the second Gulf war begin? Price doesn't even have to stop and think. She can effortlessly recite the dates, numbers and entire stories.

"People say to me: Oh, how fascinating, it must be a treat to have a perfect memory," she says. Her lips twist into a thin smile. "But it's also agonizing."

In addition to good memories, every angry word, every mistake, every disappointment, every shock and every moment of pain goes unforgotten. Time heals no wounds for Price. "I don't look back at the past with any distance. It's more like experiencing everything over and over again, and those memories trigger exactly the same emotions in me. It's like an endless, chaotic film that can completely overpower me. And there's no stop button."

She's constantly bombarded with fragments of memories, exposed to an automatic and uncontrollable process that behaves like an infinite loop in a computer. Sometimes there are external triggers, like a certain smell, song or word. But often her memories return by themselves. Beautiful, horrific, important or banal scenes rush across her wildly chaotic "internal monitor," sometimes displacing the present. "All of this is incredibly exhausting," says Price.

Based on other research I have read casually, it seems that we evolved the ability to selectively remember items because it helped with learning. Having too much information was not beneficial. As the article notes, Price's episodic memory is nearly flawless, but her semantic memory (the memory associated with learning facts and concepts) is average, which is why she did not stand out in school. Still, if she exists, there are likely people with nearly flawless semantic memory, right? The whole thing makes one wonder where the true limits of human ability lie.

(Image Source: ImpactLab)

Medical Marvel: Biracial Twins

One twin, black; the other, white. Unpossible, you say? Well, probably, but the difference is striking enough to make the news:

It's kind of like that subplot in "Me, Myself, and Irene," but... not really.

Medical Marvel: Pruritus

Pruritus, you say? Plain ol' itching? How could that be a medical marvel? Yet, in his new piece for The New Yorker, Atul Gawande manages to do just that. Like most people, I have not given itching much thought (except when I have one), but "The Itch" shows what happens when pruritus is taken to the extreme:

“Scratching is one of the sweetest gratifications of nature, and as ready at hand as any,” Montaigne wrote. “But repentance follows too annoyingly close at its heels.” For M., certainly, it did: the itching was so torturous, and the area so numb, that her scratching began to go through the skin. At a later office visit, her doctor found a silver-dollar-size patch of scalp where skin had been replaced by scab. M. tried bandaging her head, wearing caps to bed. But her fingernails would always find a way to her flesh, especially while she slept.
One morning, after she was awakened by her bedside alarm, she sat up and, she recalled, “this fluid came down my face, this greenish liquid.” She pressed a square of gauze to her head and went to see her doctor again. M. showed the doctor the fluid on the dressing. The doctor looked closely at the wound. She shined a light on it and in M.’s eyes. Then she walked out of the room and called an ambulance. Only in the Emergency Department at Massachusetts General Hospital, after the doctors started swarming, and one told her she needed surgery now, did M. learn what had happened. She had scratched through her skull during the night—and all the way into her brain.

And if you think that is nuts, read the whole article. Done reading? Have a few questions about how real all that stuff is? Check out this Q&A with Gawande about some of the more incredulous points in the piece. And, if you're still curious, keep on reading at Gawande's personal website or check out one of his books:

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Updated 2015-12-13

Medical Marvel: Sulfhemoglobinemia (Green Blood)

Sulfhemoglobinemia is:

... a rare condition in which there is excess sulfhemoglobin (SulfHb) in the blood. The pigment is a greenish derivative of hemoglobin which cannot be converted back to normal, functional hemoglobin. It causes cyanosis even at low blood levels.

Sulfhemoglobinemia is usually drug induced. Drugs associated with sulfhemoglobinemia include acetanilid, phenacetin, nitrates, trinitrotoluene and sulfur compounds (mainly sulphonamides). Another possible cause is occupational exposure to sulfur compounds. The condition generally resolves itself with erythrocyte (red blood cell) turnover, although blood transfusions can be necessary in extreme cases.

A case report appeared in The Lancet last year, documenting one instance of this condition:

The man - a 42-year-old white Canadian - had developed a compartment syndrome (localised tissue/nerve damage due to restricted blood flow) in both lower legs after falling asleep in a sitting position. He was a smoker whose medical history included chronic shoulder pain and migraine, and was taking a number of regular medications, including sumatriptan to treat the migranes.

Doctors decided he needed urgent fasciotomies (a limb saving procedure in which tissue is cut into to relieve pressure) and he underwent emergency tests, which determined he was mildly tachycardic (rapid heart beat) but had normal blood pressure and his only initial abnormal blood result was an extremely high creatine kinase concentration.

In the operating theatre, multiple attempts to insert a radial arterial catheter yielded dark greenish-black blood, which was immediately sent away for analysis. Meanwhile the catheter was eventually fully inserted, and the man recovered well.

Sulfhaemoglobinaemia, rather than cyanosis, was diagnosed as the cause of the green-black blood.

Green blood! Who knew?


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Medical Marvel: Aortic Dissection in a Woman Pregnant with Triplets

I suppose I have generally been putting images up here, but I came across this rare case about a woman who was pregnant with triplets who started to have chest pains:

Patient: Roseann Errante, 36, mother-to-be
Doctors: Alan Monheit, obstetric surgeon, and Frank Seifert, heart surgeon, Stony Brook University Hospital
Patient’s husband: Joe Errante

Roseann: At 30 weeks I woke up with chest pains. It was like nothing I’d ever felt. The pains went up to my neck, ears, and head.

Monheit: I was on call when she came in. Her tests looked fine, but with the pain traveling to her neck, we called a cardiologist.

Joe: I was joking with the technicians that we were praying for preeclampsia—which is terrible. But at least we would’ve known what it was. They were looking at the scan and suddenly everyone stopped joking.

Seifert: She had aortic dissection, a tear in the inside wall of the aorta. The aorta is the largest blood vessel in the body. It starts at the heart and goes up to the great vessel, which supplies the brain, then loops around and goes down the back and supplies all the organs. Roseann’s dissection was in the part between the heart and the great vessel. Think of it as a run in a stocking. It could either stay where it was or just keep on going.

Read the article to find out how things turned out. Also, New York Magazine apparently had a series of 11 "medical marvels" so check 'em out as well.

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Medical Marvel: Sternal Foramen

Image courtesy of Radiology Picture of the Day

I suppose a sternal foramen isn't so impressive, but I found the accompanying blurb to be funny:

A sternal foramen is a round or ovoid congenital bony defect that results from incomplete fusion of the sternal ossification centres. The estimated prevalence is 4.5%. It is typically asymptomatic and of no clinical significance, except in the setting of sternal acupuncture due to the risk of pericardial puncture and tamponade. There have been two such reported cases in the literature, one of them fatal.

Oh the accupuncturists! I feel bad for them. Can you imagine how they felt after learning what happened?


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Medical Marvel: Lithopedion

Image courtesty of Radiology Picture of the Day

If it's Monday, it's Medical Marvel time. Well, as long as I keep finding interesting stuff, I guess. Today, we investigate lithopedions. According to Wikipedia, a lithopedion is:

A Lithopedion (Greek:litho = stone; pedion = child), or stone baby, is a rare phenomenon which occurs most commonly when a fetus dies during an ectopic pregnancy, is too large to be reabsorbed by the body, and calcifies on the outside, shielding the mother's body from the dead tissue of the baby and preventing infection. Lithopedia may occur from 14 weeks' gestation to full term. It is not unusual for a stone baby to remain undiagnosed for decades, and it is often not until a patient is examined for other conditions or a proper examination is conducted that includes an X-ray that a stone baby is found. The oldest reported case is that of a 76 year old woman, whose lithopedion had probably been present for 46 years.

There is one case report discussed on Radiology Picture of the Day. What surprises me about all this is that I always thought ectopic pregnancies had a high mortality rate. However, this condition, especially given the size of the lithopedion, makes me wonder about that. I should note, I have not taken my ob/gyn rotation yet, so maybe I am mistaken about the nature of ectopic pregnancies. At any rate, can you imagine living with a lithopedion inside of you for potentially several decades? Strange, no?


Looking for more marvels? Check out craniofacial duplication, or fetus in fetu.

Medical Marvel: Craniofacial Duplication

Perhaps you saw the news last week, but if not, here it is: a two-faced baby was recently born in India. The condition is known as craniofacial duplication or diprosopus. Apparently, the condition is not due to abnormal twinning, but rather a protein abnormality in the SHH (Sonic the Hedgehog) Protein that leads to facial features being duplicated.

Image courtesy of The Huffington Post

Interesting stuff, but again... why India? Why?

Medical Marvel: Fetus In Fetu

My friend sent me an interesting story about a man in India who was found (at the age of 36!) to have his twin living inside of him:

At first glance, it may look as if Bhagat had given birth. Actually, Mehta had removed the mutated body of Bhagat's twin brother from his stomach. Bhagat, they discovered, had one of the world's most bizarre medical conditions -- fetus in fetu. It is an extremely rare abnormality that occurs when a fetus gets trapped inside its twin. The trapped fetus can survive as a parasite even past birth by forming an umbilical cordlike structure that leaches its twin's blood supply until it grows so large that it starts to harm the host, at which point doctors usually intervene.

A fetus in fetu is quite rare. In fact, when I first read the article, I thought the punchline was going to be that he had the world's largest teratoma or something. As often as humans are called 'parasites' metaphorically, I guess this is a literal case of a human being as parasite. One other point: why does stuff like this seem to always happen in India?