Free Man Who MIstook His Wife for a Hat by Oliver Sacks Page A

quite like this before . . . '
       I thought, and they thought, we thought together.
       'Could it be a biparietal syndrome?' one of them asked.
       'It's an "as if',' I answered: 'as if the parietal lobes were not getting their usual sensory information. Let's do some sensory testing-and test parietal lobe function, too.
       We did so, and a picture began to emerge. There seemed to be a very profound, almost total, proprioceptive deficit, going from the tips of her toes to her head-the parietal lobes were working, but had nothing to work with. Christina might have hysteria, but she had a great deal more, of a sort which none of us had ever seen or conceived before. We put in an emergency call now, not to the psychiatrist, but to the physical medicine specialist, the physiatrist.
       He arrived promptly, responding to the urgency of the call. He opened his eyes very wide when he saw Christina, examined her swiftly and comprehensively, and then proceeded to electrical tests of nerve and muscle function. 'This is quite extraordinary,' he said. 'I have never seen or read about anything like this before. She has lost all proprioception-you're right-from top to toe. She has no muscle or tendon or joint sense whatever. There is slight loss of other sensory modalities-to light touch, temperature, and pain, and slight involvement of the motor fibres, too. But it is predominantly position-sense-proprioception-which has sustained such damage.'
       'What's the cause?' we asked.
       'You're the neurologists. You find out.'
       By afternoon, Christina was still worse. She lay motionless and toneless; even her breathing was shallow. Her situation was grave- we thought of a respirator-as well as strange.
       The picture revealed by spinal tap was one of an acute polyneuritis, but a polyneuritis of a most exceptional type: not like Guillain-Barre syndrome, with its overwhelming motor involvement, but a purely (or almost purely) sensory neuritis, affecting
       the sensory roots of spinal and cranial nerves throughout the neu-raxis. *
       Operation was deferred; it would have been madness at this time. Much more pressing were the questions: 'Will she survive? What can we do?'
       'What's the verdict?' Christina asked, with a faint voice and fainter smile, after we had checked her spinal fluid.
       'You've got this inflammation, this neuritis . . . ' we began, and told her all we knew. When we forgot something, or hedged, her clear questions brought us back.
       'Will it get better?' she demanded. We looked at each other, and at her: 'We have no idea.'
       The sense of the body, I told her, is given by three things: vision, balance organs (the vestibular system), and proprioception-which she'd lost. Normally all of these worked together. If one failed, (he others could compensate, or substitute-to a degree. In particular, I told of my patient Mr MacGregor, who, unable to employ his balance organs, used his eyes instead (see below, Chapter Seven). And of patients with neurosyphilis, tabes dorsalis, who had similar symptoms, but confined to the legs-and how they too had to compensate by use of their eyes (see 'Positional Phantoms' in Chapter Six). And how, if one asked such a patient to move his legs, he was apt to say: 'Sure, Doc, as soon as I find them.'
       Christina listened closely, with a sort of desperate attention.
       'What I must do then,' she said slowly, 'is use vision, use my eyes, in every situation where I used-what do you call it?- proprioception before. I've already noticed,' she added, musingly, that I may "lose" my arms. I think they're one place, and I find they're another. This "proprioception" is like the eyes of the body, the way the body sees itself. And if it goes, as it's gone with me, it's like the body's blind. My body can't "see" itself if it's lost its eyes, right? So I have to watch it-be its eyes. Right?'
       *Such sensory polyneuropathies occur, but are rare.