第３１回："Tip of the Tongue"
タイトルは、「舌先」と「ことばのヒント」という意味を掛けたのでしょうか。リハビリの分野では、「舌先現象」という言葉もあるそうです。TOTとか略すそうです。（参考："Tip of the tongue" Wikipedia)
Word Count：2886語 (Time: 15'17'', 189 wpm)
参加人数：５名
クリニカル・パール：
- Clinically significant dysarthria is not seen with unilateral hypoglossal nerve palsies.
- Bilateral lower motor-neuron lesions of the tongue result in bilateral atrophy, weakness, and fibrillations of the tongue with marked flaccid dysarthria and dysphagia.
- The overall incidence of leptomeningeal carcinomatosis is approximately 5% among patients with solid cancers, and this rate has increased over time, probably owing to better diagnostic methods as well as better therapies.
- Cytologic analysis of the initial CSF sample is negative in 30 to 50% of patients, and a second lumbar puncture should be performed if clinical suspicion is high; only 8% of patients require more than two assessments to yield positive cytologic results.
- Gadolinium-enhanced MRI of the entire neuraxis is the imaging method of choice, with reported sensitivity ranging from 70 to 94%.
感想：
- Her prognosis is poor, on the order of months. 「月単位」とか言うとき、こんな表現をするのですね。
- 発話がヒントになるということは、診察は、入ってきた時の挨拶、それ以前に待合室での話し声から始まっているということを再認識させられました。（Her case is a reminder that clinicians must listen not only to what the patient says, but also to how the patient says it.）
