Tricks of the Trade: Neurology

This cracked me up:

So, one of the parts of a neurological assessment (making sure people’s brains and nerves are working right) is getting people to move their eyes in certain ways, because different eye muscles are controlled by different cranial nerves.

(If they have a problem moving their eyes in a certain way, you can deduce from the pattern of movement which nerves are having problems, and use that information even to help determine the location of a lesion in a person’s brain!)

To do this part of the assessment, usually you just tell the person to watch your finger as you move it around in a particular pattern.

But some patients are hard to assess in this way, if they’re demented (medical definition, people!) or have some kind of altered mental status or whatever.

So how do you get a patient to move their eyes in a particular pattern if they can’t follow directions? Fingers aren’t inherently interesting, and even someone who initially follows the movement of your hand just because it’s moving will get bored and look away before you’re done with the full assessment.

But interestingly, it turns out that there’s something that even patients with altered mental status pay close attention to….

Money.

Yes, that’s right.

To get a person who doesn’t understand that they’re supposed to be looking at your hand to actually look at your hand, just pull out a twenty. And then move the twenty in the appropriate pattern. They’ll track it. And they’ll track it until the end of the exam. Even when they wouldn’t track anything else.

I just used this trick yesterday, immediately after my resident told me about it, on my own minimally-interactive dementia patient. Why? Equal parts disbelief and delight. I had to try it out.

And guess what?

It works!!!

HAHAHAHAHAHAHAHAHAHAHAHAHAHAHA!!!!!!!!!