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A Neurologist's Collection
Meng Tan
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This list celebrates the practice of neurology, i.e. the diagnosis and treatment of diseases of the brain, spinal cord, (peripheral) nerves and muscle. Yup, that's what I do for a living, and I love it!

Each game entry corresponds to a common or well-recognized neurological disease. I include some interesting snippets of information about each disease, pitched at a lay audience.

The distinction between neurology and psychiatry has become increasingly blurred recently (although originally the two disciplines were one; neurologists were also psychiatrists, e.g. Freud) since many psychiatric disorders are related to "chemical imbalances" of the brain.

A common misconception is that neurologists are training to be neurosurgeons (brain surgeons), or somehow were not good enough to be neurosurgeons. Neurologists are often derided for choosing a specialty in which almost all diseases are "untreatable"; personally, I chose this career because there is more to medicine than prescribing drugs.
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1. Board Game: Memory [Average Rating:4.70 Overall Rank:10947]
Meng Tan
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Dementia: The most common form of dementia is Alzheimer disease (AD), which is extremely common especially in the elderly. Memory loss is prominent, especially for recent memories (i.e. what happened today rather than what happened decades ago). Behavioral disturbance (verbal aggression, physical violence) is also common and can make life difficult for spouses or other carers trying to look after AD patients at home. Medications may help a little but do not reverse the disease; they may delay the need for nursing home care.

Celebrities with AD: Ronald Reagan, Charlton Heston, Hazel Hawke (known to us Australians!!)
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2. Board Game: A Bold Stroke [Average Rating:6.48 Unranked]
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Stroke: also known as a "brain attack" (similar to a heart attack) or cerebrovascular accident (CVA). Stroke is actually the preferred medical term, not CVA (imagine calling any other disease an "accident"). A stroke may be due to a clot (more commonly) or a bleed (some of which are related to aneurysms). Once a stroke occurs, especially of the clot variety, there is little that can be done to improve outcomes; the patient's chances of recovery are largely dictated by factors beyond medical control. The only effective medical treatment is prevention, which means reducing the risk of (another) stroke, not completely eliminating it.

Celebrities with stroke: Ariel Sharon, Winston Churchill, Franklin Roosevelt

The book (and later film) The Diving Bell and the Butterfly was "dictated" by a stroke sufferer who could only communicate by blinking (this is a relatively uncommon type of stroke).
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3. Board Game: A Frozen Hell [Average Rating:6.54 Overall Rank:5222]
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Parkinson disease: also very common, especially in the elderly. It is characterized by slowness of movement, tremor, rigidity, and unstable stature. Underlying causes poorly understood; some diseases may present with similar features, but are due to factors such as toxic exposure or brain injury. Treatment (including surgical treatment) alleviates the symptoms, but does not reverse the disease. Some patients treated with the "latest and greatest" medications have developed addictive behaviors, e.g. compulsive gambling.

Celebrities with PD: Michael J. Fox, Muhammad Ali (something similar, perhaps secondary to head injury)
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4. Board Game: Fits [Average Rating:5.17 Overall Rank:9580]
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Epilepsy: also known as fits, seizures, "turns", "spells". These are caused by episodes of excessive/uncontrolled electrical activity in the brain. Not all seizures involve falling to the floor and biting the tongue, although kids who wear helmets all the time usually have very severe uncontrollable epilepsy and fall frequently. Treatment with drugs suppresses (but does not remove) the seizure tendency, while surgical treatment is potentially curative (by removing the "irritable" part of the brain).

Celebrities with epilepsy: Truman Capote
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5. Board Game: Pizza Box Baseball [Average Rating:6.28 Overall Rank:3381]
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Amyotrophic lateral sclerosis: also known as motor neuron disease, or popularly known as Lou Gehrig's disease. It involves degeneration of the nerves controlling muscle function, causing progressive weakness which may eventually compromise the ability to breathe. I believe someone completed their PhD thesis by analyzing Lou Gehrig's statistics in the seasons leading up to his diagnosis with ALS, and found that his batting averages dropped off significantly, suggesting an early, barely symptomatic phase of the disease. Treatment with drugs may extend life by several months.

Celebrities with ALS: Lou Gehrig (duh!), Stephen Hawking (at least has something similar to ALS, if not ALS itself)
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6. Board Game: Ms. PAC-MAN Game [Average Rating:4.69 Unranked]
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Multiple sclerosis: an inflammatory condition of the brain and spinal cord, usually involving "flares" or "attacks" of rapid worsening, followed by recovery. Contrary to popular belief, not all patients with MS will end up in a wheelchair, in fact most will not. Injectable treatments are available to reduce the frequency of MS flares.

Celebrities with MS: Jacqueline du Pre, Montel Williams
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7. Board Game: Double Vision [Average Rating:0.00 Unranked]
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Myasthenia gravis: an autoimmune condition causing weakness, involving antibodies that inhibit the transmission of nerve signals to muscle fibers. It often presents as double vision or difficulty chewing or swallowing, because of weakness involving those muscles. It is often associated with a benign tumor (of the thymus gland). Unlike most other neurological diseases, effective disease-modifying treatments are available.

Celebrities with MG: Aristotle Onassis
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8. Board Game: Zombies!!! [Average Rating:6.00 Overall Rank:2615] [Average Rating:6.00 Unranked]
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Brain death: as the name suggests, this is a state defined by the permanent loss of vital functions of the brain, such as control of breathing. Electrical testing (EEG) will show that there is no detectable electrical activity of the brain. Brain death is very different from potentially reversible comatose states (of reduced consciousness) that have occasionally caused controversies about doctors "giving up too soon". As long as it can be determined that the patient's condition is not caused by other factors such as drug overdose, the pronouncement of brain death is medically and legally a pronouncement of death. Brain-dead patients may be kept on "life support" for a short time if there is the possibility of organ donation (once blood stops circulating, most organs are no longer suitable for donation).
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9. Board Game: Phoney Baloney [Average Rating:4.00 Unranked]
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Psychogenic disorders: also known as "hysterical" illness (because it was thought to be a woman's problem related to a dysfunctional uterus!!), this is when patients experience neurological symptoms (could be almost anything, including paralysis, fits, blindness) but they have nothing "physically" wrong with them. The majority of patients are not "intentionally faking it" but are reacting to some stress/distress in their lives, whether current or remote (most are women and many suffered child abuse). The way I think of it is that different people react to stress in different ways: some get violent, some drink, some get depressed, and some get "sick". This is a not uncommon problem faced by neurologists, and it is very difficult to convince the patient of the diagnosis, and it is (consequently) very difficult to treat.
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10. Board Game: Ascent [Average Rating:5.33 Unranked]
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Guillain-Barre syndrome: also known as Guillain-Barre-Strohl syndrome (poor Strohl, he missed out on proper recognition), this is an inflammatory condition causing paralysis and numbness of the extremities, usually occurring in an ascending fashion (i.e., starting in the feet and spreading north). It may occur after a gastroenteritis or other infection, and is thought to have an immune basis.

Almost all patients lose their tendon reflexes, i.e., muscle jerks in response to being hit with a reflex hammer. Some patients may require mechanical ventilation to get them through the worst of the illness. Most patients make an excellent recovery over weeks (the disease usually attacks the nerve insulation rather than the nerve itself).

An apparent epidemic of GBS in the USA in the 1970s was attributed to a reaction to swine flu vaccination; in fact, the evidence in favor of an association is very controversial, and most likely caused unnecessary public alarm.

Celebrities with GBS: Joseph Heller, UhhhClem's dad
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11. Board Game: Headache [Average Rating:4.37 Overall Rank:10747]
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Migraine: perhaps the most common and well-known neurological condition (I'm kicking myself for not including it earlier). The classical migraine headache is preceded by blurred vision (or flashing lights), one-sided (left or right), throbbing, and associated with nausea/vomiting and an aversion to bright light or noise; but many migraines do not meet all of these criteria. Many drug treatments are available.

Recent interest has focused on a possible association with PFO (patent foramen ovale, a small hole in the heart), and it seems that closing off the PFO may help prevent migraines.
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12. Board Game: Drops & Co. [Average Rating:6.05 Overall Rank:7600]
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Syncope: otherwise known as fainting. This is caused by a brief reduction in blood flow to the brain at large, not to be confused with a stroke, a more long-lived reduction in blood flow to part of the brain. (So if someone faints, the correct thing to do is ensure they are lain flat on the ground.) Sometimes caused by violent coughing or straining to pass water. It can be mistaken for an epileptic seizure, which is usually the reason for referral to a neurologist.

Celebrities: Greg Page (the yellow Wiggle) had to retire because of orthostatic intolerance, a cause of syncope
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13. Board Game: For Whom the Bell Tolls [Average Rating:6.89 Overall Rank:4306]
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Bell's palsy: a reasonably sudden-onset weakness on one side of the face due to impairment of the nerve supplying those muscles. Suspected causes include viral infection or an inflammatory response following an infection. It is occasionally mistaken for a stroke by emergency room doctors (at least in my experience). Steroids and antiviral drugs may help. Most patients make a full recovery even without treatment, although some have permanent residual weakness.

Celebrities with Bell's palsy: Graeme Garden, Jean Chretien, John McCain
 
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14. Board Game: Korea: The Forgotten War [Average Rating:8.08 Overall Rank:1672]
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Chorea: this refers to a type of involuntary movement, that is neither violent or flinging (that's called ballismus) nor slow and writhing (that's called athetosis). It's not regular or rhythmic either, that would make it a tremor. It's a recognized feature of some diseases, including Huntington's disease (inherited dementia, psychiatric problems and chorea) and Sydenham's chorea (a.k.a. St. Vitus dance, chorea developing after rheumatic fever).
 
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15. Board Game: Quao [Average Rating:5.21 Overall Rank:10167]
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Creutzfeldt-Jakob disease: popularly known as Mad Cow Disease. This is a rapidly progressive dementia, often associated with twitching, and sometimes with other features like unsteadiness/incoordination, parkinsonism, hallucinations and seizures. Cases of variant CJD (as opposed to sporadic CJD) are associated with eating beef from animals with Bovine Spongiform Encephalopathy (spongy brain, which is what CJD brains look like too). There is no effective treatment.

I recently authored a paper on patients with an autoimmune condition that mimicks CJD, and the work was judged to be worthy of special mention at the upcoming American Academy of Neurology meeting in Chicago. ("My" patients respond to treatment, unlike CJD patients.)
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16. Board Game: F*ck This! (Supersized Rudeness) [Average Rating:6.25 Unranked] [Average Rating:6.25 Unranked]
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Tourette syndrome: this is a form of tic disorder, a tic being a repetitive, stereotyped movement or vocalization; not voluntary, although it can be controlled for brief periods. In popular culture, Tourette patients are invariably portrayed as having coprolalia (literally, "potty mouth"!), but this is an extreme form of speech tic.

Tourette was a French neurologist who was a protege of Charcot (another French neurologist and a giant of his time). Tourette is regarded as something of an intellectual pygmy, although he has been immortalized by this disease bearing his name.

Celebrities with Tourette's: Samuel Johnson, Howard Hughes, Mozart (??)
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17. Board Game: Havoc: The Hundred Years War [Average Rating:6.75 Overall Rank:1394]
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Meniere's disease: this is characterized by bouts of vertigo (dizziness), hearing loss and ringing in the ear. Patients generally recover completely in between attacks, but in the long-term may develop permanent hearing loss. It is related to imbalance of fluids in the inner ear, and may be treated by a salt-free diet.

Celebrities with Meniere's: Martin Luther, Jonathan Swift
 
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18. Board Game: Vertigo [Average Rating:4.91 Unranked]
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Vertigo: a sensation of swaying or spinning, also called dizziness. Hearing a complaint of "dizziness" causes most neurologists' hearts to sink, partly because the word means different things to different patients, but mostly because most of us have had little success in treating it. A common, and usually treatable, cause is benign (paroxysmal) positional vertigo, BPPV or BPV. It is caused by calcified debris in the inner ear, and can be treated by performing a maneuver that repositions said debris so that it causes less trouble.
 
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19. Board Game: Tortoise and the Hare Board Game [Average Rating:6.66 Unranked]
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Torticollis: nowadays called cervical dystonia, or colloquially known as wry neck, this is related to overactivity of neck muscles that regulate head position. It can not only be socially awkward, but quite painful too. An instrument for assessing severity of the condition is known as the Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS) - neurologists do have a sense of humor!

Treatment with oral medications may help, but many patients receive botulinum toxin (botox) injections into the overactive muscles. Yes, botox has other uses besides hiding wrinkles!
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20. Board Game: Axis & Allies: Battle of the Bulge [Average Rating:6.76 Overall Rank:1534]
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Benign intracranial hypertension: perhaps more accurately, idiopathic intracranial hypertension, is a condition causing headache (and in severe cases, visual loss). It affects young women mostly, many of whom are overweight. There is some speculation that it may be related to clots in the veins draining blood from the brain. Among other treatments, weight loss surgery has been investigated.
 
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21. Board Game: Elmo's Birthday Game [Average Rating:4.25 Unranked]
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Eclampsia: pre-eclampsia is a condition in pregnancy associated with high blood pressure and other features; eclampsia is when that condition progresses and causes the mother to have epileptic seizures. Treatment is by delivering the baby, and using magnesium and other anti-epileptic drugs to support the mother in the meantime.
 
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22. Board Game: Pandemic [Average Rating:7.66 Overall Rank:41]
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Meningitis: there are many infections causing neurological disease, but one that causes much public alarm is meningitis, especially meningococcal meningitis (often abbreviated to "meningococcal" by the lay press, as though that were a noun). Meningitis (of all types) can present with fever, headache, aversion to light, neck stiffness and decreased consciousness. If you come into contact with a patient with meningococcal disease, you may be prescribed rifampicin so that you don't develop the infection yourself. Rifampicin will turn your urine orange!

Personal note: "Meningitis" is a nickname given to me by a neurologist colleague; it never really caught on though.
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23. Board Game: Reflex [Average Rating:0.00 Unranked]
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Reflex epilepsies: these are a subset of epilepsies where the patient's seizures are reproducibly provoked by a specific stimulus. The best known is photosensitive epilepsy, where seizures are triggered by flashing lights. Other examples include seizures triggered by reading, water immersion, or telling lies (apparently there was a case in a used-car salesman, or perhaps a real-estate agent, I can't recall which).

The term is not used to refer to seizures related to alcohol or sleep deprivation, which make seizures more likely in most patients with "ordinary" epilepsy.
 
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24. Board Game: Don't Give Up Your Day Job! [Average Rating:0.00 Unranked]
Meng Tan
Australia
Bridgeman Downs
Queensland
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Writer's cramp: or more broadly, occupational dystonia. In a similar vein to reflex epilepsies, this describes when muscles go into spasm, triggered by a specific activity such as writing or playing a musical instrument. As with torticollis, botox may be helpful.
 
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25. Board Game: Sugar Frosted Breakfast Bombs [Average Rating:0.00 Unranked] [Average Rating:0.00 Unranked]
Meng Tan
Australia
Bridgeman Downs
Queensland
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Diabetes mellitus: no, diabetes is not a neurological condition itself, but it does predispose to neurological complications including:
- peripheral neuropathy (numbness of hands/feet)
- diabetic amyotrophy (an old term for weakness affecting a lower limb)
- retinopathy (bleeds into the back of the eye, threatening vision)
- stroke
 
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