reaching down the rabbit hole  by allan ropper & b d burrell  (atlantic £1799) some years ago a policeman stopped a driver who had been circling a roundabout for nearly an hour when he asked him if there was anything wrong, the man replied: ‘i don’t know how i got here’ ropper gives a fascinating account of his work as a neurologist in boston (stock image) the confused driver, a salesman, was taken to hospital, where a junior doctor found nothing wrong with him, apart from memory loss he concluded that it was an episode of transient global amnesia (tga), a dramatic, but harmless condition the junior doctor asked dr allan ropper, then the hospital’s senior resident in neurology, to authorise the patient’s discharge, expecting that his memory loss would, as usual in incidents of tga, return within hours ropper examined the man himself together, they worked out that the roundabout incident had come at the end of a 12 hour drive the patient recalled only getting in his car that morning and heading for somewhere completely different he couldn’t retain the names of the doctors examining him or what he’d just eaten unconvinced by the tga diagnosis, ropper decided to keep him in overnight, suspecting a stroke the following morning, the salesman’s memory had returned, but with huge gaps: had he been suffering only an episode of temporary amnesia, it would have returned completely after 23 hours, the patient’s speech became slurred and ropper knew instantly he was suffering a stroke an arterial blockage was restricting blood flow to part of his brain treated with anticoagulants and other drugs, the man quickly recovered with only minimal memory difficulties ropper’s fascinating and gripping account of his work as a neurologist at boston’s brigham and women’s hospital in massachusetts reveals what a mysterious and little understood organ the brain is, not least in the list of all the things that can go wrong with it sometimes it simply seizes up because of psychological pressure, as in the case of a 23 year old woman who was admitted after suddenly losing the power of speech extensive testing showed no evidence of brain damage, seizure or stroke but questioning of her family revealed she’d broken up with her boyfriend that day next day, she’d recovered so called hysterical symptoms that have no basis in disease often present like neurological diseases they include paralysis, the inability to walk or talk, blindness, deafness and weakness spotting genuinely serious malfunctions and distinguishing them from merely harmless tics and tremors is far from easy, but there are some symptoms a neurologist doesn’t want to see in the case of a young mother admitted with what appeared to be a severe asthma attack, ropper’s heart sank when he spotted the muscle between her thumb and forefinger twitching he knew he was looking at als or lou gehrig’s disease, a fatal illness that would see her body begin to shut down until it was kept alive solely by machines at some point this woman would have to decide when her life became so unbearable she would ask for the machines to be switched off quite how someone works with that kind of trauma almost every day is unimaginable to the layman what comes over in this remarkable book is ropper’s humanity and his unremitting sympathy for his patients if only all doctors were like him
boston
ropper gives a fascinating account of his work as a neurologist in boston  he treated a man who lost his memory and spent 12 hours driving his car  unconvinced by the original diagnosis he kept him in for further testing  he found an arterial blockage was restricting blood flow to  his brain 