Author | Oliver Sacks |
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Language | English |
Publisher | HarperCollins |
Publication date | 1984 |
ISBN | 978-0060925444 |
A Leg to Stand On is a 1984 autobiographical account by neurologist Oliver Sacks describing his recovery from psychogenic leg paralysis following a mountaineering accident. The book has been described as a skillful description of the depersonalization of functional neurological symptoms. Neuropsychiatric specialists who have recommended reading the book to their patients have found it can help them cope with their depersonalization symptoms. [1]
On an early Saturday morning, Oliver Sacks geared up to climb a mountain in the Hardangerfjord in Norway. Despite the overcast and sullen weather, Sacks reached the summit before noon. However, he had not been alone. A bull stood no more than a few feet in front of him. Sacks, in a futile attempt to remain calm, lost his composure and tumbled down the side of the mountain landing atop his twisted, left leg. After examining the injury, Sacks determined that the entire quadriceps had been torn from the patella, leaving his leg useless. Sacks made a makeshift splint to immobilize his injured leg in order to slowly slide down the mountain, though he lost hope as the sun began setting. Fortunately, a couple of reindeer hunters found Sacks lying on the path during the last bits of light and were able to transport him to a local hospital for treatment.
Upon arriving at the hospital, Sacks was diagnosed with a torn quadriceps and was transferred to another hospital in Bergen to have an operation done to reattach the muscle. According to Sacks' surgeon Mr. Swan, the surgery was a success; however, Sacks was not convinced that it was. It had become quite obvious that the leg was not healing properly upon the arrival of the physiotherapist and Sacks' inability to contract the quadriceps no matter how hard he had tried. The following morning, Sacks was woken up to his leg hanging off the side of the bed and a feeling of nauseating estrangement towards the limb. Sacks had described it as a "foreign inconceivable thing." Sacks, having experienced something similar to this with a patient of his from the past, determined that he must have acquired some form of "anosognosia" as a result of his accident. Unfortunately, the physicians treating Sacks did not acknowledge his illness on the basis that the operation was a success and anything that the patient was experiencing was simply a result of his own hysteria.
Two weeks following the operation, Sacks begins to experience involuntary electrical pulses down his leg - something he attributed to neurological recovery. However, this improvement did nothing to improve Sacks' mental state. Although, when a friend of Sacks brought him his recorder and a cassette of Mendelssohn's Violin Concerto, the music brought back Sacks' hope along with his love and appreciation for life. The next day, Sacks had his cast removed, but he could not shake the estrangement he felt towards the now naked limb.
During a seemingly futile session with the physiotherapist, Sacks had the notion to play music while attempting to perform an exercise. He meditated on the music and without thought, he stood on both legs and miraculously began to walk with the music despite weakness. Sacks described this epiphany as the most eventful and crucial ten minutes of his life. The patient now began to recover.
Sacks was then moved to a convalescent home in Highgate, London, England referred to at the time as Caen Wood. There, Sacks met a group of fellow patients and veterans who offered him solace by sharing their own stories about the war and how they deal with their phantom limb syndrome (the ironic opposite of Sacks' ordeal). Sacks found that this group of men had been more wise and understanding than any doctor that had treated him. Upon permanent removal of his cast, Sacks found his leg remained numb to the touch despite his progress with recovery. It had been determined that the lack of sensitivity was due to a severance in the femoral nerve that had occurred during his operation, thereby, inhibiting any nerve activity and causing Sacks to feel disconnected from the leg (It was only four years later that Sacks was put through nerve conduction tests to better understand the severity of the nerve damage). Oliver Sacks then graduated from the convalescence home and found himself in the office of Mr. W.R. of Harley Street. Mr. W.R. asked Sacks what he enjoyed doing most before the incident. When Sacks responded with swimming, Mr. W.R. called up a lifeguard and sent Sacks on his way to a local pool. Upon arriving, the lifeguard pushed Sacks into the pool (on Mr. W.R.'s directions) despite his protests. Feeling outraged and challenged, Sacks began to swim without any regard to disability until the lifeguard told him he was finished. Without any thought, Sacks got out of the pool and began to walk around normally despite the notion that his left leg was still limp. Sacks was left astonished by Mr. W.R.'s simple and effective solution to being incapable of physical activity: "condelectari sibi."
The next morning, Sacks received a letter from his friend Professor Luria outlining the possible reasons for the alienation Sacks felt towards the leg along with possible treatments. At this point, Sacks has been met with such clarity and support allowing him to finally heal.
Vic Sussman from the Washington Post Book World wrote "[i]n calling for a neurology of the soul and a deeper more humane medicine, Sacks' remarkable book raises issues of profound importance for everyone interested in humane health care and the human application of science." [2]
Ronald Carson from Johns Hopkins University Press wrote "A Leg to Stand On is a marvelous mixture of neurological observation, psychological insight, mystical experience, and speculative vision." [3] Jon Stone of the Western General Hospital in Edinburgh, writing for the Journal of Neurology, Neurosurgery and Psychiatry defined it "a unique autobiographical account of functional paralysis". [4]
Ramsay Hunt syndrome type 2, commonly referred to simply as Ramsay Hunt syndrome (RHS) and also known as herpes zoster oticus, is inflammation of the geniculate ganglion of the facial nerve as a late consequence of varicella zoster virus (VZV). In regard to the frequency, less than 1% of varicella zoster infections involve the facial nerve and result in RHS. It is traditionally defined as a triad of ipsilateral facial paralysis, otalgia, and vesicles close to the ear and auditory canal. Due to its proximity to the vestibulocochlear nerve, the virus can spread and cause hearing loss, tinnitus, and vertigo. It is common for diagnoses to be overlooked or delayed, which can raise the likelihood of long-term consequences. It is more complicated than Bell's palsy. Therapy aims to shorten its overall length, while also providing pain relief and averting any consequences.
A tremor is an involuntary, somewhat rhythmic, muscle contraction and relaxation involving oscillations or twitching movements of one or more body parts. It is the most common of all involuntary movements and can affect the hands, arms, eyes, face, head, vocal folds, trunk, and legs. Most tremors occur in the hands. In some people, a tremor is a symptom of another neurological disorder.
Morvan's syndrome is a rare, life-threatening autoimmune disease named after the nineteenth century French physician Augustin Marie Morvan. "La chorée fibrillaire" was first coined by Morvan in 1890 when describing patients with multiple, irregular contractions of the long muscles, cramping, weakness, pruritus, hyperhidrosis, insomnia and delirium. It normally presents with a slow insidious onset over months to years. Approximately 90% of cases spontaneously go into remission, while the other 10% of cases lead to death.
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Conversion disorder (CD), or functional neurologic symptom disorder, is a diagnostic category used in some psychiatric classification systems. It is sometimes applied to patients who present with neurological symptoms, such as numbness, blindness, paralysis, or fits, which are not consistent with a well-established organic cause, which cause significant distress, and can be traced back to a psychological trigger.
Astasis is a lack of motor coordination marked by an inability to stand, walk or even sit without assistance due to disruption of muscle coordination.
Otfrid Foerster was a German neurologist and neurosurgeon, who made innovative contributions to neurology and neurosurgery, such as rhizotomy for the treatment of spasticity, anterolateral cordotomy for pain, the hyperventilation test for epilepsy, Foerster's syndrome, the first electrocorticogram of a brain tumor, and the first surgeries for epilepsy. He is also known as the first to describe the dermatomes, and he helped map the motor cortex of the cerebrum.
Blepharospasm is a neurological disorder characterized by intermittent, involuntary spasms and contractions of the orbicularis oculi (eyelid) muscles around both eyes. These result in abnormal twitching or blinking, and in the extreme, sustained eyelid closure resulting in functional blindness.
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Chronic inflammatory demyelinating polyneuropathy (CIDP) is an acquired autoimmune disease of the peripheral nervous system characterized by progressive weakness and impaired sensory function in the legs and arms. The disorder is sometimes called chronic relapsing polyneuropathy (CRP) or chronic inflammatory demyelinating polyradiculoneuropathy. CIDP is closely related to Guillain–Barré syndrome and it is considered the chronic counterpart of that acute disease. Its symptoms are also similar to progressive inflammatory neuropathy. It is one of several types of neuropathy.
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Constantin Freiherr von Economo was an Austrian psychiatrist and neurologist of Romanian origin. He is mostly known for his discovery of encephalitis lethargica and his atlas of cytoarchitectonics of the cerebral cortex.
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Sunil Pradhan is an Indian neurologist, medical researcher and writer, known for the invention of two electrophysiological techniques. He has also described five medical signs, of which one related to Duchenne muscular dystrophy is known as Pradhan Sign, and the others associated with facioscapulohumeral muscular dystrophy (FSHD) and similar neuro diseases. The Government of India awarded him the Padma Shri, the fourth highest civilian award, in 2014 for his contributions to the field of neuroscience.
Konstantin Slavin is a Professor and Head of the Department of Stereotactic and functional neurosurgery at the University of Illinois College of Medicine. He is a former president of the American Society for Stereotactic and functional neurosurgery and current vice-president of the World Society for Stereotactic and Functional Neurosurgery. His specialties include Aneurysm, Brain surgery, Brain Tumor, Cerebrovascular Disorders, Craniotomy, Dystonia, Essential Tremor, Facial Nerve Pain, Facial Pain, Glioblastoma, Headache disorders, Laminectomy, Lower back pain, Movement Disorders, Multiple Sclerosis, Neck Pain, Neurosurgery, Neurosurgical Procedures, Pain, Parkinson Disease, Spinal Cord Injuries, and Stroke.