The Modern Day Phineas Gage

Where would the field of neuroscience be without the extraordinary case of Phinease Gage? Gage was a railroad worker in the mid 1800's and at the time, his job was to drill holes and plant explosives to clear the way for a new railroad. After planting an explosive, he had to pack down the sand with what is known as a tamping iron. In a major accident, the explosive went off while tamping down the sand and the iron bar penetrated his left frontal lobe. After the accident, he survived, but had major changes in personality and his friends and family barely even recognized him anymore. He was studied by John Harlow. While this was the first time that a brain injury could almost certainly have been said to cause a change in personality, it sure was not the last.

Lisa Sanders of the New York Times wrote an article called Why Was Their Brother's Memory and Behavior So Strange? The article discusses a 49 year old man who, like Phineas Gage, experienced strange changes in his personality that progressively worsened. His family was dumbfounded as to why he was acting like a completely different person. In his 20's he had a problem with alcohol, but it was noted that even at the worst of times, he was still tidy and meticulous. Now he seemed to be very tired as he slept frequently and for long periods of time. He was also somewhat dirty and did not shower as much as he should have. The man had become very forgetful, was getting lost in familiar situations, and was let go from his job. Prior to his sister picking him up to go to brunch one day, he had called  her over 12 times to confirm the time and place. However, to her surprise, when she arrived to pick him up he was undressed and seem to have completely forgotten. What was his family to do? His sister decided enough is enough and took him to the emergency room.

The second doctor he saw noted that the man displayed no emotion, could not focus, had a very limited vocabulary, and could not even say what year or week it was. The doctor thought it could be dementia, but would be unlikely since the patient was so young. The man had a CT scan done and blood work which were both unrevealing. After taking an EEG, the brain appeared to be performing slower than usual. The next step was to get an MRI. The doctor got a call regarding the analysis of the MRI which indicated that the man had a rare condition known as severe spontaneous intracranial hypotension. The brain is normally surrounded by cerebral spinal fluid (CSF) which provides protection and helps the brain maintain its form. With his condition, the brain was lacking CSF and his brain was lying on the base of his skull. The cause was predicted to have been from a leak coming from a small hole in the dura which surrounds the brain and spinal cord. Eventually, with the help of a neurosurgeon from the West coast and an innovative procedure, the leak was able to be patched. The full recovery took four months and was strenuous. Today, the man is back at work and was able to enjoy seeing his family again.

References:

https://www.nytimes.com/2017/11/02/magazine/why-was-their-brothers-memory-and-behavior-so-strange.html