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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.