MEDICAL BAG
This month’s casebook of curiosities features amazing awakenings, an astonishing example of brain growth, and a prodigious case of polydactylism
BODY SYMMETRY
The symmetry of the human body is very striking. That the left side should be the mirror image of the right, growing together in synchrony from infancy to adulthood, is profoundly mysterious, as there is no physical connection between them. The muscles, ligaments, bones and nerves of the left hand are thus quite independent of the right, but the experience of a man troubled by bilateral carpel tunnel syndrome suggests there is a “sympathy” between them. Soon after the CTS in his left hand was treated, the symptoms in his right hand promptly improved. Another case history exemplifies the strange phenomenon: “When I consulted my family doctor about the severe eczema on my legs, he wrapped one in an ichthopaste bandage and told me to come back in a fortnight,” said my correspondent. “‘But what about the other leg?’ I asked. ‘That will go right with the other,’ he confidently asserted… as indeed it did.”
This sympathy between the two sides is also evidenced in the symmetrical involvement of the joints of both hands in arthritic conditions, and the way traumatic injuries may cause pain and limitation of movement in the uninjured limb. And while an attack of shingles is characteristically unilateral, biopsies of the skin on the opposing side show similar, though milder, forms of nerve damage. This would suggest that the two sides must be linked by some hidden “force” or lines of communication unknown to medical science. Acupuncturists, of course, have claimed this for millennia.
The symmetry extends to the acquisition of skills. Family doctor Francis Rutter, when young, learnt to play the cornet where the fingering is done with the right hand, before later taking up the French horn, which is fingered with the left. To his surprise, he found that little further learning was necessary – his left hand seemed to know instinctively what his right hand was used to doing. ‘The Surgery’ by James Le Fanu, D.Telegraph, 7+21 Jan 2019.
MAXIMUM FINGERS MAN
Devendra Suthar’s 28 fingers and toes earn him a world record for polydactylism. The 46-year-old carpenter, who is married with two children, is known as “maximum fingers man” in his hometown of Himmatnagar in Gujarat, northwest India. He says the extra four fingers don’t affect his work, though he has to be particularly careful when cutting. He wears specially made shoes so that his seven toes on each foot are comfortable. The most extreme case of polydactyly affected Akshat Saxena, born with seven fingers on each hand and 10 toes per foot, confirmed by doctors in India in March 2010. The extra digits were removed, so Mr Suthar holds the record for “living with” the most digits. Polydactyly affects around one in every 700 to 1,000 births worldwide. Those in developed countries usually have the extra digits surgically removed by the time they turn two. guinnessworldrecords. com; dailymail.co.uk, 3 May; D.Telegraph, 4 May 2019.
COMA LASTING 27 YEARS
In 1991 Munira Abdulla, 32, was involved in a road accident in the United Arab Emirates (UAE). She was cradling her four-year-old son Omar Webair moments before a school bus ploughed into their vehicle in the city of Al Ain. Along with Ms Abdulla’s brother-in-law, who was driving, Omar suffered only minor wounds, but Ms Abdulla sustained a severe brain injury. Transferred to London, she was declared to be in a minimally conscious state, able to feel pain but unable to gesture or speak. She was returned to the UAE, where for years she was fed through a tube and given physiotherapy to ensure her muscles did not deteriorate.
In 2017 the crown prince of Abu Dhabi funded specialist treatment for her in Bavaria. There, doctors prioritised physical therapies and gave her drugs to improve her wakefulness and sleeping patterns. In June 2018, her son, by now 32, was involved in an argument in her hospital room, which seemed to prompt his mother to stir. “There was a misunderstanding and she sensed I was at risk, which caused her a shock,” said Omar. “She was making strange sounds and I kept calling the doctors to examine her. They said everything was normal. Then, three days later, I woke up to the sound of someone calling my name. It was her! She was calling my name, I was flying with joy; for years I have dreamt of this moment.”
His 59-year-old mother had awoken after 27 years. She is
now back in Abu Dhabi with her family. She is wheelchairbound, but is able to hold a conversation, recite verses from the Koran and tell people when she is in pain. People who do regain consciousness after several years often have severe disabilities caused by brain damage. An extreme case of this kind was that of Terry Wallis, an American who entered a nearvegetative state after his truck careered off a bridge in 1984, when he was 19. He regained awareness after 19 years. It was thought he had been able to regrow brain tissue. Ms Abdulla’s recovery appears to be even more striking because her brain had wasted away over the years. Independent (online), 22 April; BBC News, 23 April; Times, D.Telegraph, 24 April 2019.
THE LYNX EFFECT
Kacper Krauze, 13, got into trouble while paddling with friends in the River Eden in Cumbria on 26 February. Unable to swim, he was submerged in the freezing water for 25 minutes before medics dragged him out and restarted his heart, but he remained in a coma and was taken to hospital. His mother Wioletta, 43, of Appleby, Cumbria, and her taxi driver husband Marek, spent hours talking to him and playing music at Newcastle’s Freeman Hospital. “A nurse suggested I bring in some of his toiletries to wash him with,” said his mother. “As soon as I sprayed the Lynx he opened his eyes immediately. He must have remembered his favourite smell.” It was 7 March. Kacper had been in a coma for nine days. At the time of the news report, he still struggled with his speech and using his right hand, but had otherwise made a full recovery. Metro, Sun, 28 May 2019.
GROWING A BRAIN
When Noah Wall from Abbeytown in Cumbria was born in 2012 with just two per cent of his brain, he was not expected to survive. His brain had failed to grow after he developed spina bifida, and hydrocephalus in the womb – and had rare chromosome abnormalities – but scans taken when he was three showed, astonishingly, the brain had grown to 80 per cent capacity. Now, after just weeks of brain training therapy in Australia, the six-year-old, who was told he would need a wheelchair for life, has begun to sit unaided and move his legs. NeuroPhysics Therapy involves encouraging the right and left sides of the brain to communicate in new ways to ‘open up’ the nervous system. Fired up neurons then bypass the damaged spinal cord to get messages to limbs. Noah can now write and hold a conversation. His parents hope that he will soon take his first steps. D.Mail, Newsweek 21 Feb 2019.
BLOODY MIRACLE
Frankie Morrison was born with just 35ml (two tablespoonsful) of blood in her body, seven times less than average. Her mother Maria, 32, from Hull, had been rushed into hospital for an emergency C-section after the baby stopped moving, having passed too much blood back through the umbilical cord just before birth. Her lungs were full of water and she was not expected to survive, but she soon rallied and was taken home after three weeks. A year later, she had only a slightly weakened immune system. Sun, 17 Oct 2016.
SEMI-IDENTICAL TWINS
Doctors have documented the world’s second known case of “semi-identical” twins – neither identical nor fraternal, but somewhere in between. The first case was in the US in 2007, reported in The Journal of Human Genetics. The phenomenon is extremely rare; such embryos seldom survive. Prof Nicholas Fisk, who led the team that cared for the mother and twins at the Royal Brisbane and Women’s Hospital, Australia, in 2014, said the discovery was made through a routine pregnancy scan.
The first-time mother was 28 at the time and had conceived naturally. The case was written up in The New England Journal of Medicine. “The mother’s ultrasound at six weeks showed a single placenta and positioning of amniotic sacs that indicated she was expecting identical twins,” said Prof Fisk. “However, an ultrasound at 14 weeks showed the twins were male and female, which is not possible for identical twins… Broadly, they are about three fourths identical. It’s almost as rare as hens’ teeth.”
In the case of semi-identical, or sesquizygotic, twins, the egg is thought to have been fertilised simultaneously by two sperm before it divided. If one egg is fertilised by two sperm, it results in three sets of chromosomes, rather than the standard two – one from the mother and two from the father. And, according to researchers, three sets of chromosomes are “typically incompatible with life and embryos do not usually survive”. The identity of the twins has not been revealed. BBC News, 27 Feb; Guardian, 28 Feb 2019.