All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher. This isn’t a beginners guide to neurology and psychiatry, but it is well explained and rationale is given for decisions made by the author and his team for the care of his patients. Your co-authors must send a completed Publishing Agreement Form to Neurology Staff (not necessary for the lead/corresponding author as the form below will suffice) before you upload your comment.

He had a bad headache from the beginning," she told me, "and a fever." The residents had neglected to mention this, but it was important. A week earlier, Cindy Song, a sophomore at Boston College, had started acting a bit withdrawn. Her roommate was concerned enough to call Cindy's sister. The first phone call was not too worrisome. "Not a big deal," the sister said. "She gets that way. Just give her time. She'll be okay." The next call could not be taken so lightly. Vincent knew who he was. He was sharp enough to find himself amusing. Did his colonoscopy earlier in the week bring this on, or, more to the point, did the anesthesia bring it on? My guess is that it was just a coincidence. A straw poll of the team leaned toward a diagnosis of tumor, possibly stroke, maybe a seizure, but they were basing their guesses on Vincent's MRI. I had seen the scans and knew they did not hold the answer. On the other hand, Vincent's wife, who was sitting in an armchair at the foot of his bed, did.

Dr Allan Ropper(the author) comes across as the doctor we would all want to have if the chips were down. He seems very approachable and concerned for his patients on the basic, human level as well as treating their illnesses. What Burrell and Ropper produce is a portrait of an immensely talented neurologist and teacher who is always the smartest man in the room. Almost every anecdote ends with Ropper emerging the hero of the moment. It’s too carefully written to be crassly boastful, but it’s not exactly an essay in professional humility. I could see that over the course of the previous week, Hannah had begun the transition from resident to full-fledged physician. I could see it in her bearing, in the assertive physicality with which she carried out her examinations, in the firmness of her tone with some of the more difficult patients, and in the controlled sympathy she adopted in family meetings when she had to deliver bad news. She had turned out to be one of our strongest clinicians.

What are you watching?" Hannah asked Vincent, in an inflection she would later inform me was Kansan rather than Missourian. Reaching Down the Rabbit Hole does not particularly try to be funny, yet its commentary on how events happen to arrange themselves has a comic sensibility. Ropper's mirthless exchange of one-liner jokes with a hospital visitor who turns out to be a former comedy writer establishes a fellowship between the men and helps us understand the origins of this show business take on clinical neurology. I’m not sure that those statistics are entirely up to date, but in any case this is not a book for hypochondriacs or anyone who worries that their difficulty in remembering film stars’ names might stem from something more troubling than unmemorable film stars. Because the fear it plays on, consciously or not, is the sudden and cruel inversion of normality.Hannah was in charge. Her service, the culmination of three years as a neurological resident, had started a week before I came on board. A "service" involves running the neurology inpatient ward, admitting and discharging the patients, and directing a team consisting of three junior residents, two medical students, and a physician's assistant—a cohort that could barely squeeze into Vincent's curtained-off half of the room.

He is clearly a very reflective practitioner who has learnt from his patients over the years. He is inquisitive and wants to look below the surface (down the rabbit hole), wants to constantly develop his learning and comes over as very compassionate. He also talks quite frankly about cases he did not get right and analysed why that was, making assumptions, being fixed on a diagnosis and also about errors he has found in others such as radiology. He talks about very unusual presentations of neurological problems and odd presentations. The title comes from wanting to go down the diagnostic rabbit hole to try to get the patient out. There are cases discussed about confusion, malingering and functional problems, and motor neurone disease. In fact two patients are highlighted, one who decides that this is no life to carry on with and the description of her demise is quite uncomfortable. The other takes life by the horns and carries on in spite of considerable adversity, although admittedly helped by their very supportive wife and insurance company (great if you have the cover). Parkinson’s Disease is also studied and in particular the relationship with celebrity Michael J. Fox, who was one of his patients. Gilbert, the medical student who had made the initial exam, recorded this as "orientation times one." In instances of conversion hysteria, the family of the patient is frequently overbearing and probably causal to the symptoms. Some families demand that the neurologist solve this problem right now and provide a solution that will indicate easy treatment with drugs or reassurance that the illness is nothing to worry about at this point in the patient's life. Either solution is rarely the case. The neurologist is often blamed by these families because he or she is regarded as a shaman who can cure all ills and provide happy endings. Somehow the illness becomes the doctor's fault.This was an interesting book. A little hard to follow at times but full of fascinating insights and stories into the world of neurology. It was a little sad, in fact most of the stories are sad as there is not always a happy ending and this is real life.