I saw a very interesting article in the Times Magazine recently. Mrs Blumenthal a youthful lady in her early 60s was used to running down the stairs, enjoyed driving her car, play the piano and was very good at painting and sketching horses. About 5 years ago her visual function, orientation and spatial awareness began to deteriorate. She would miss her chair and land on the floor in a train or at home. She would miss a step on a stair and end up sprawled at the bottom. No one could understand the reason as she looked normal and could speak and think rationally.

Driving which used to be a pleasure became a nightmare. She could not keep to a lane and would constantly hit the kerb or clip the wing mirror of an oncoming car. Reversing and parking became a nightmare. The stairs used to sway before her and coming down the stairs became frightening. She became petrified of using escalators. When she tried to play the piano the music score appeared jumbled that she could not read and hence was unable to continue. When she tried to read to her mother from her favourite book she could not comprehend the lines, the letters danced in front of her eyes and she could not proceed. Her mother who suffered from dementia and Parkinsons disease looked at her and told her that she hoped she was not getting the same disease that she herself was suffering from.

Mrs Blumenthal went to see her GP after this and discussed her fears. After examining her, he told her that she was imagining things and that she was perfectly normal. He added that perhaps she was suffering from depression / anxiety. She was not convinced as she was losing her confidence rapidly. A few months ago she saw her optician and told him about her problem. He checked her for macular degeneration and said he could find nothing wrong with her eyes. However he suggested that she should seek a neurologist’s opinion. The neurologist saw her and after extensive psychological tests and a brain scan confirmed that she was suffering from Posterior Cortical Atrophy. The scan showed substantial atrophy of the posterior cortex of the brain. Although she was told that there was no definite cure she did feel relieved as a diagnosis had finally been made for her odd symptoms.

She is now under a neurologist and a neuropsychologist who are monitoring and helping her to cope with the symptoms at John Radcliffe Hospital in Oxford.

Take Home Point for Doctors: Listen to your patients carefully. Spend time with them. Do not brush aside their odd symptoms as imaginary. If you are unable to find anything wrong clinically send them for a second opinion.