Funtabulously Frivolous Friday Five 104 • LITFL • FFFF

Just when you thought your brain could unwind on a Friday, you realise that it would rather be challenged with some good old fashioned medical trivia FFFF, introducing the Funtabulously Frivolous Friday Five 104

Question 1

As you pull back the curtain, your next patient bursts into a bout of uncontrollable laughter. Because it surely can’t be due to your appearance, you decide this patient must suffer from…?

Reveal the funtabulous answer

Gelastic seizures

Gelastic seizures are epileptic events characterized by bouts of laughter. Laughter-like vocalization is usually combined with facial contraction in the form of a smile. Autonomic features such as flushing, tachycardia, and altered respiration are widely recognized.

Téllez-Zenteno JF, Serrano-Almeida C, Moien-Afshari F. Gelastic seizures associated with hypothalamic hamartomas. An update in the clinical presentation, diagnosis and treatment. Neuropsychiatr Dis Treat. 2008 Dec; 4(6): 1021–1031.

Question 2

What is the meaning of this phrase “j’ai des papillons noir”? How did Dr Freeman (the lobotomist) use this imagery on the cover of his publication “Psychosurgery”?

Reveal the funtabulous answer

“I have black butterflies” – a euphemism for depression

Walter Jackson Freeman II (1895 – 1972) published “Psychosurgery” in 1942 which featured a picture of a skull Freeman had sketched with a crack in it, out from which circled black butterflies.

des papillons noir Psychosurgery Walter Freeman

Freeman W, Watts JW. Psychosurgery. Intelligence, Emotion and Social Behavior Following Prefrontal Lobotomy for Mental Disorders. 1942
Freeman W, Watts JW. Psychosurgery : in the treatment of mental disorders and intractable pain. 1950

Question 3

Johann Sebastian Bach (1685 – 1750) underwent a procedure called “couching” in his later life. What is this procedure and what was the outcome for the great composer?

Reveal the funtabulous answer

Couching is the earliest documented form of cataract surgery

A sharp instrument is used to push the opaque lens to the bottom of the eye

The ancient Indian surgeon Maharshi Sushruta first described the procedure in “Sushruta Samhita, Uttar Tantra” in 800 B.C

Outcomes are often little better than the initial visual impairment and complications rates are high. Despite this – the procedure is still commonplace today in countries such as Burkina Faso and Mali [PMID 11262674]

J.S Bach became totally blind after bilateral couching and died four months later. Intractable glaucoma secondary to phacoanaphylactic endophthalmitis the significant complication leading to his permanent blindness [PMID 22339937]

Question 4

What forms Schamroth’s Window?

Reveal the funtabulous answer

Schamroth’s window – the diamond-shaped gap formed when two opposing fingers are placed back to back
Schamroth’s sign occurs in finger clubbing, when this window is obliterated and the distal angle formed by the two nails becomes wider

Leo Schamroth (1924-1988) described this sign in himself – following 3 episodes of infective endocarditis.