Pink Elephants?

Our regular Friday seminars are enhanced by a monthly session where scans undertaken are reviewed by experts based in the Cerebral Function Unit in Salford. This is something I did not get to when the visits were in the flesh – requiring a car journey through difficult traffic and parking – likely to be a nightmare on or near a busy, unfamiliar hospital site. I am grateful to be allowed in on the internet as a guest via the Teams system.

Patients are presented from services around Greater Manchester and beyond. It gives chance to see and hear consultants based all around this area – some I know or have known, others are strangers to me, but this way I am gaining some understanding of who they are, how they work and think. The system requires that the clinician provides a brief vignette of the patient’s characteristics, current symptoms and the questions which may be answered from analysis of the scans. Scans appear magically on the shared screen – often a series of scans from examinations taken over a period of time, or scans using differing techniques but current. What is amazing for me is to see the scans transformed into rotating three dimensional images – these are accompanied by commentary from the neuro-radiologist and further reflection from the neuropsychiatrist and responsible clinical team.

It is a sort of magic – with practice even I can see changes in the temporal lobe associated with Alzheimer’s disease. There are changes associated with small vessel disease and occasionally larger infarcts, tumours - suspected or surprising. Quite often there are no obvious anatomical changes which are beyond what is accepted within a given age range. Even ‘negative’ findings are met with thanks.

Whatever the findings, it is the clinical history – its understanding and interpretation which will determine what we believe is going on – and what will be – and be done for the future.

I am not sure how securely this happens – but the clinical team’s grasp for the patient’s ‘being’ from very first contact and in the context of their family and social situation is all important. Waiting to be seen because of a waiting list. Being seen only at a hospital-based clinic. Passed from one team to another because of administrative rules. Dependence on a system which discharges patients back to primary care until a crisis demands an adjustment of care and treatment. All these mitigate against best care and a feeling of confidence in the face of changing experiences in the course of dementia or other related disorders.

Our scans and their interpreters are helpful – but their images have to find application in the real world.