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It is a nice and chilly December evening; snow is softly falling. The entrance door of the Willis house is beautifully decorated; Christmas carols may be heard in the distance. It is easy to be hypnotised by the splendour of the moment. However, do not lose your focus! The neurologist starts the diagnostic process even before the patient steps into the examination room, and the same rule applies to our house diagnostics.
Mrs and Mr Willis are coming back from shopping, hands full of grocery bags for the upcoming dinner. Their son-in-law is unlocking the door, but he seems to have difficulties as he repeatedly tries to handle the keys. No, he is not already tipsy before dinner! Unlocking the door can be quite challenging for someone with small hand muscle palsy. Possible causes? Asymmetrical distal weakness caused by peripheral nerve, brachial plexus or cervical roots disease/injury, or bilateral distal weakness caused by polyneuropathy or motor neuron disease.1 Entering through the front door can also be problematic for patients with hemianopia,2 who will bump into the left or right side, not influenced by their political orientation, but caused by half of their visual field missing. The reason may be any structural brain lesion from the optic chiasm to the occipital cortex. Getting home may also be tricky in different circumstances: Mr Willis’s father, who has Alzheimer’s, likes to leave the house unattended but gets lost coming back. Tonight, they will keep the door safely locked. They do not want to spoil the evening by searching for a missing person. Besides, it is very cold outside and patients with dementia may suffer serious consequences staying outdoors during winter.3
Stairs and basement
Now we are closing the front door and stepping into the house of neurology. Before heading to the most important …
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