Neurology week 2 begins

The day started with a COVID-19 lateral flow test (LFT) before leaving home. In case you're wondering, no I do not have any symptoms. The hospital requires that I take an LFT every two to three days and the last test I had taken was at the end of last week. I waited the recommended 15 minutes and as I expected, the LFT was negative, so I made my way to Queen Square. 

When I got to the hospital, I headed upstairs to the Acute Brain Injury Unit (ABIU)/Rehab ward. The first thing on my agenda today was to arrange my weekly COVID-19 PCR test. I had hoped to have the PCR on Wednesday since that was the day I had it last week. To my surprise, the secretary immediately printed and handed me the labels and a test kit with a nasopharyngeal swab and a tube to do the swab now. In just 2 hours, I shoved two swabs into my nasopharynx. Ewww. Owwww. My eyes watered, but I would be fine. I returned the test kit to the secretary and entered the doctor's office on the ward to meet up with my doctors. They were pretty busy running from patient to patient and I tagged along.

In the Eye Clinic at UCL Queen Square Institute of Neurology.

In the afternoon, I attended the Neuro-Ophthalmology Outpatient Clinic with a Consultant Neuro-ophthalmologist. Neuro-Ophthalmology is a subspecialty that merges Neurology and Ophthalmology. It focuses on diagnosing and treating complex neurological and systemic diseases that cause vision problems and affect eye movements. 

Today, we saw cases of ophthalmoplegia, ptosis, diplopia, and third cranial nerve (CN III) palsy. For the first time, I performed a funduscopy and swinging flashlight test on patients.

The swinging flashlight test is used to identify retinal afferent pupillary defect (RAPD). A patient is said to have RAPD if there is a difference between the pupillary reaction of the two eyes when a light is shone into them. In normal, healthy eyes, when you shine a light into the eye the pupil constricts, and when you remove the light the pupil dilates. 

Sometimes RAPD is obvious, today that was the case in a patient I examined. When the light was shone into the right eye, the right pupil constricted, but when I swung the flashlight to the left eye, the left pupil dilated. The Consultant reminded me that not only is the clinical examination important, but so is the patient's history. In a patient with RAPD, to confirm the findings of your examination are correct, you can ask the patient, "is the light brighter in one eye? If so, which one?" You expect that the light will be dimmer in the eye with the abnormal pupillary reaction. This patient complained about vision loss in the left eye which was consistent with our findings in the swinging flashlight test. 

The Consultant referred to this test as 'a get out of jail free card' because it is an easy, non-invasive test that can be done at the patient's bedside. "It is important even for doctors that are not Ophthalmologists," he explained, as it can confirm if there is a physical problem when both eyes appear normal upon inspection and confirm the localisation of the problem in either the retina or the optic nerve. 

You better believe I won't forget this examination.

Wishing all of you a Happy Valentine's Day!