Fred Lepore
@FredLepore
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I'm a brain doctor, (more specifically, a neuro-ophthalmologist) at Rutgers U. and author of Finding Einstein's Brain and ,yes, we really found it!
6 blocks from Princeton University
Joined January 2020
Tools of the Trade There is a special level of diagnostic Hell reserved for the benighted souls who discard their reflex hammers with the intention of using the head of their Rappaport Sprague stethoscope to elicit deep tendon reflexes.
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2/ ..separate categories for "Best Of .." 1.Textbooks: Robbins for you & maybe Adams and Victor for me. Magisterial texts eg Duke -Elder for ophths. 2.Writers who happen to have MDs: Chekhov, Keats,Conan Doyle 3. Drs who do both: Sacks, Geoffrey Keynes Great Fun. More, please.
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Two Osler authors/latch-keyers 1. Try neuroscience belle lettrists 2.Medical biography is a tough sell but Cushing won the '26 Pulitzer for his Life of William Osler. And used him for a surgical text! 3.Don't forgo Penfield who mapped the homunculus & wrote med. hx - The Torch
Who was the best writer among medical authors? I feel like Osler gets all the glory, but is he rightfully the winner?
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Absolutely. The Chinese got The Little Red Book. America got the Red Hat. We both got bad outcomes (educational and otherwise).
Has anyone noticed the similarities of the US Cultural Revolution 2025 with the Chinese Cultural Revolution 1966? Are there differences?
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Picture of health 2025 Q. What "worm got into my brain & ate a portion of it"? RFK Jr 2012 A. Pork tapeworm [T. Solium] MRI of neurocysticercosis cysts (L). Actual worm in brain tissue (R) - suckers (short arrow) & digestive tract (*) I frequently treat these patients' seizures
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2/.. a full field stimulus which also evokes optokinetic after nystagmus, circular vection, & nausea. Full field test won't fit in my bag. One copes. Why have OKNs? Possibly w/prolonged head movement the VOR "saturates" & OKNs arise to diminish retinal "slippage" of moving images
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EEG & Encephalitis Through skull/meninges/CSF, ~21 scalp electrodes each measure summed post-synaptic potentials from 1000s of pyramidal cells & are sensitive to seizures (red box->absence sz), but not so much most encephalitis (HSV & NMDAR's ["delta brush"] possibly excepted).
All those 48 hr EEGs were worthless. Unfortunately lumbar puncture only way to definitively dx #AntiMNDAReceptorEncephaltis ‼️‼️‼️‼️‼️‼️‼️‼️‼️‼️ #RegressiveAutism
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Lawton Smith had an astounding ability to make arcane neuro-ophthalmology both compelling & practical - while throwing in a little Baptist lay preaching! JLS is pictured at work w/ his OKN tape/drum. Even in the MRI era, I use OKNs to screen for deep parietal lobe lesions.
@FredLepore I interned at Jackson Memorial Hospital in 1963 and was mesmerized by Lawton Smith in neurology rounds. Thank you Dr Lepore.
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4/ Where have you gone ... Taped to the wall of RD's office in Miami was DiMaggio's iconic "The Swing" (1941). I never saw DiMaggio roam center field in Yankee Stadium ... But I did learn from Robert Daroff. Godspeed.
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Treating Parkinson's Disease (& other longshots): 1 Cotzias hoped to treat PD by "repigmenting" substantia nigra 👎 2 When small L-DOPA doses didn't help,he prevailed w/3-16gms daily 3 Is PD the only common neurodegen dis. effectively tx'd w/a neurotransmitter precursor? Luck.
All the most efficacious types of medications for Parkinsons disease are at least 50 years old. The sixties and seventies were a golden age These treatments are vastly superior to anything molecular biology has come up with for any of the other common neurodegenerations.
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2/ Aneurysms .. published his finding. He was one of the last medical students who operated with Harvey Cushing at the Brigham. The utility of his aneurysmal sign notwithstanding, he allegedly did not favor the appellation "teat."
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2/..your doctors considered other causes of widespread fluid accumulation not easily explained by primary disorders of lymphatic vessels? Starling's Law tells us that excessive fluid (edema,anasarca,ascites)can result from hepatic, cardiac, & plasma protein disorders.
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Brain & Skin Embryologically (see Haeckel's drawings 1874 & 1910) both brain and skin derive from ectoderm but as a neurologist I will defer to your dermatologist. Were steroid injections continued? If not, were topical/oral steroids an option?
Consult Dermatology: Confirm whether "lymphocytic inflammation" observed on the scalp biopsy requires treatment. He said yes, the first time I received cortisone injections, approximately six were administered around the affected area. The provider mentioned that the cortisone shots should be effective, but if not, further evaluation will be considered. I am scheduled to return in three weeks for a follow-up and to discuss additional treatment options if necessary. He appeared slightly surprised by the negative beta-2 transferrin test result and reviewed it closely. Was that a good idea?
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