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Gary Cordingley, MD, PhD Profile and Articles
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1). Cervical Radiculopathy: Diagnosing a Pinched Nerve in the Neck
When a nerve is pinched in the neck’s spinal column, pain can be such a prominent symptom that more subtle, but diagnostic, aspects are overlooked.
By way of background, the spinal cord in the neck is connected to the nerves of the arms through pairs of spinal nerves. These spinal nerves, also known as roots or “radicles,” transmit in...
2). Epidural and Subdural Hematomas: Dangerous Blood Clots on the Brain
To understand epidural and subdural hematomas -- two serious consequences of head injuries -- we need to know the basic anatomy of the brain and its coverings. Imagine an evil carpenter with an electric drill intent on drilling into a person's brain. What layers would the drill encounter in its passage from the outside of the head to its destinatio...
3). Early Diagnosis of Multiple Sclerosis: Difficult But Important
The principal dilemma in current management of multiple sclerosis is that while early diagnosis enables damage-sparing treatment to begin, diagnosing MS too early increases the likelihood of treating people who don't actually have the disease. Current disease-modifying drugs are all given by injection and cost about $14,000 per year. Apart from bei...
4). Seven Toxic Effects of Drug Companies
I'm the first to admire the strengths and virtues of the free-enterprise model as it applies to drug development and sales. This model encourages drug companies to employ talented people and to take risks in developing new drugs for serious medical problems. But let's face it, current practices also produce undesirable effects.
1. W...
5). Radial Neuropathy: The Wrist-Drop of Saturday Night Palsy
So here's the scenario. It's Saturday night and I've had a long week. I hit the bars and tip back one or two too many. Stumbling out of the last bar, I find I can't make it past the city park without landing on my nose, so I plop onto a park bench. Slinging an arm over the back of the bench to stabilize myself, I fall into a deep slumber.
6). Subarachnoid Hemorrhage: When a Brain Aneurysm Bleeds
Spontaneous subarachnoid (pronounced sub-uh-RACK-noid) hemorrhage is rightfully the most feared cause of sudden headache. Usually due to rupture of aneurysms (abnormal, balloon-like outpouchings of arteries) located near the base of the brain, subarachnoid hemorrhages involve bleeding into the space between the brain and its surrounding membrane, k...
7). Carpal Tunnel Syndrome: Pinched Median Nerve at the Wrist
Carpal tunnel syndrome is by far the most common and widely known of the "pinched nerve" conditions. This article addresses: What is it? Who is at risk for this condition? How is it diagnosed? What kinds of treatments work best?
Carpal tunnel syndrome refers to symptoms caused by entrapment of the median nerve in the carpal tunnel. "Ca...
8). Cervical Radiculopathy: Treating a Pinched Nerve in the Neck
Let's suppose that you have been diagnosed as having a pinched nerve in your neck, also known as cervical radiculopathy. If so, you probably have pain in the neck and one shoulder. The pain might radiate into your arm and you might have weakness or numbness in the arm as well. Moving your neck in certain positions probably worsens the pain.
9). Seven Sloppy Uses of Medical Tests
Even excellent tools can be mis-used. Here are seven "sins" of medical testing:
1. Ordering the wrong test for the right condition.
If I had a nickel for every time a doctor ordered a carotid artery test in a patient with a fainting spell, I could fund my retirement several times over. And this is despite the fact t...
10). Preventing Headaches and Reducing their Impact
Do you find yourself treating one headache after another? Do headaches interfere with your usual activities? Do your treatments cause annoying or i
11). Intracerebral Hemorrhage: Bleeding Inside the Brain
All strokes damage the brain by disrupting circulation, but strokes come in multiple varieties. Because different parts of the brain are specialized to perform specific functions, symptoms produced by strokes vary according to what part of the brain was injured. In one patient the symptom might be weakness on one side of the body. In another it mig...
12). Stroke Rehabilitation: A Novel Treatment Pays Off
In a landmark study, researchers at the University of Alabama at Birmingham used a randomized controlled trial -- the gold standard method for evaluating the effectiveness of a treatment -- to show that immobilizing the good arm of stroke patients and intensively exercising the weakened arm actually improved recovery, even when performed long after...
13). Polyneuropathy: A Disease of the Longest Nerve-Fibers
The peripheral nerves are bundles containing many individual nerve-fibers, and are similar to telephone cables carrying many individual wires. There are two basic types of nerve-fibers--motor and sensory. The motor fibers carry electrical impulses outward from the spinal cord to the muscles, causing them to contract. The sensory fibers carry electr...
14). Electroencephalograms (EEGs): Catching a Brain Wave
Would you believe that a brain-test invented in 1924 can detect abnormalities invisible to the latest-generation MRI scanner? The test in question
15). Ulnar Neuropathy: Sane Treatment of a Crazy Bone
Do you remember what it felt like when you banged your elbow on a hard surface and it sent shocks through your forearm and into your little finger? Not too pleasant, to be sure. But on the plus side, the unpleasantness was merely temporary and, for the time being, you remembered not to do that again.
The part of the nervous system resp...
16). So You've Had a Stroke -- Now What?
You have had a stroke. Hopefully, you went to the hospital when you developed your symptoms of weakness, numbness, altered speech or visual impairment. Your hospital care enabled you to limit the damaging effects of the loss of circulation to a portion of your brain. You've made it through the acute phase of stroke management. Now what?
17). Blepharospasm: That Blinkety-Blink Movement Disorder
The range of ailments falling under the umbrella-term of "abnormal involuntary movement disorders" is diverse and includes conditions as different from each other as Parkinson's disease, restless legs syndrome and blepharospasm. Cases of blepharospasm, like those of other movement disorders, often go unrecognized or are blamed on other causes.
18). Guillain Barre Syndrome: When Legs (and more) Turn to Rubber
Looking on helplessly while a wave of weakness climbs one's body from the ankles upward can cause dismay. This is what happens in Guillain Barre (pronounced GHEE-on bah-RAY) syndrome, known more formally as acute inflammatory demyelinating polyradiculoneuropathy. Occurring in just one or two people per year in a population of 100,000, Guillain Barr...
19). Using Probability in Medical Diagnosis: A Headache Example
Experienced clinicians begin the process of making a diagnosis upon first laying eyes on a patient, and probability is one of the main tools they use in this process. A glimpse "behind the scenes" from the point of view of a diagnosing physician might help to explain an otherwise mysterious process.
The diagnostic process can begin eve...
20). Chronic Daily Headache: Same Old, Same Old
“Chronic daily headache” (CDH) refers to the unhappy situation in which headaches are present at least fifteen days per month. Headaches can even occur every day or almost every day. CDH is more of a category than a final diagnosis, and different, recognizable patterns of headache are included in this category. It is important to distinguish among ...
21). How Are Brain Contusions Different from Brain Concussions?
For a problem as pervasive as traumatic brain injury one would think that the different forms it can take would be widely known and understood. However, in my practice of community-based neurology I find this is not the case. Patients and their families are seldom familiar with the concepts of cerebral (brain) contusion and concussion, and a common...
22). Nailing a Migraine: Hitting It Hard and Early
Most people with migraine attacks learn that they have more success if they treat their attacks early rather than delaying medication until two or more hours have passed. They find there is a window of opportunity during which they can resolve their headaches completely, but if they wait too long, then in most cases the treatment is not nearly as g...
23). Bias in Health Information: Understanding the Agendas
Writers of medical advice--including columnists, insurance companies, governmental agencies, medical organizations, drug companies and even practitioners--are all biased. They always have agendas. They all choose to write about certain topics and not others. They make choices about what to include in their articles, what to leave out and how to sta...
24). Staring-Spell Seizures: They're Not All the Same
Most people understand that there are multiple types of epileptic seizures. The best known variety--and certainly the most spectacular--is often termed "grand mal," which is French for "major illness." In these attacks the patients lose consciousness, fall to the ground and experience convulsive jerking of their bodies that lasts for 1-2 minutes be...
25). Dr. Walter Freeman's Frontal Lobotomies at Athens (Ohio) State Hospital
Few chapters in the medical history of Athens County, Ohio, are more notorious or fascinating than that concerning Walter Freeman, M.D., and the more than 200 frontal lobotomies he performed at the Athens State Hospital in seven visits between 1953 and 1957.
Until the middle of the twentieth century, treatment for most inpatients in l...
26). Peroneal Neuropathy: Waiting for the Other Foot to Drop
A "foot-drop" is a medical term which--thankfully--does not mean that the foot suddenly disconnects from the leg. Rather, it means that when the leg is lifted from the ground, the foot droops downward at the ankle. The muscles that are supposed to prop up the foot have become so weakened that they cannot overcome gravity's downward pull. When peopl...
27). Thigh on Fire: Lateral Femoral Cutaneous Neuropathy
At the age of 32 Sigmund Freud developed a new problem. Pricking and other unpleasant sensations had overtaken the skin on the outer side of his right thigh. Walking made his symptoms worse. The affected skin was exquisitely sensitive to touch and even the usual rubbing of his underclothes irritated the area.
Seven years later in 1895...
28). Horner's Syndrome: A Medical Discovery from the American Civil War
Unequally sized pupils in combination with a drooping eyelid on the side of the smaller pupil and decreased sweating on the same side of the face is known as Horner's syndrome, named for Johann Friedrich Horner, a Swiss ophthalmologist who wrote up a case in 1869. When present, Horner's syndrome indicates interruption of the sympathetic nervous sys...
29). Gender Bias in Stroke Care
I can't think of any adequate excuse for women to receive medical care that is less good than that which is received by men. However, evidence for this continues to surface. The latest study to demonstrate this unsettling fact was published in the September 27, 2005, issue of Neurology, the official journal of the American Academy of Neurology. Mel...
30). Meningitis and Encephalitis: What's the Difference?
"Meningitis" and "encephalitis" are two words that pop onto most people's radar screens from time to time, and usually in some scary context, like hearing of a cluster of cases in their child's school, or reading media reports of epidemics occurring nationally or internationally. While most people understand that these words mean there is some sort...
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