The heavyset man with a bandage on his throat is having trouble repeating a phrase. "No ifs..." he says to the medical students and doctors around his bed at Brigham and Women's Hospital in Boston.
"Can I hear you say no ifs, ands or buts?" says Dr. Allan Ropper, the Harvard neurologist in charge. The patient tries again. "No ifs, buts, ands or," he says.
Ropper's heard enough. "I think he's probably had a little left temporal, maybe angular gyrus-area stroke," he tells the students and doctors, once they're assembled outside the patient's room. A brain scan confirms his diagnosis.
Later, Ropper tells me that the patient's inability to repeat that simple phrase told him precisely where a stroke had damaged the man's brain. "What we did was, on clinical grounds we nailed this down to a piece of real estate about the size of a quarter," he says.
This reliance on bedside observation and conversation is what makes neurology such a remarkable specialty, Ropper says. "The rest of medicine has moved very strongly toward laboratory diagnosis" and scans like MRI and CT, he says. But the brain, he says, "is too complicated to believe that by looking just at the images you can sort out what's going on for an individual patient."
[For more of this story, written by Jon Hamilton, go to http://www.npr.org/blogs/healt...talking-and-watching]
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