MEDICINE IS THE BEST MEDICINE.

Much of medical education is an art, but just as frequently, it is an exercise in pattern recognition. A woman of child-bearing age who presents with abdominal pain must be given a pregnancy test - while the team might suspect an appendectomy, ectopic pregnancy must be ruled out. Hypoparathyroidism presents with “bones, stones, groans, and psychological overtones.” Ask any medical student who has gotten through a year or more, and they will tell you that medicine is just as much about being a super-memorizer as it is being able to tease out a history that allows for proper diagnosis of a patient.

One of the problems with studying medicine, though, is that we know the symptoms. What we don’t know, we can access resources to find it out. We spend hours hunched over our pathology texts. Over time, it’s inevitable that we recognize patterns in our own systems that may be consistent with diseases - the rarer, the better. This phenomena is so common that it has a name - hypochondriasis of medical students, or medical students’ disease.

The condition was first referenced in the 1960s. Frequently, preoccupation with a specific disease has more to do with recent study, and once the student moves on to something else, the concern usually passes. It is widely prevalent in medical students, though currently viewed more as a manifestation of normal perception and learning than as a psychiatric illness. When learning about a new condition, the medical student examines the constellation of symptoms that make up the disease. The student may then subconsciously apply the relevant symptoms, while ignoring those that he does not have.

After awhile, these concerns usually go away. We move on to the next lesson, the next disease. I no longer worry about a sinus infection that goes rogue, becoming a meningitis. Even though I have recurrent pain in my great toe, I’ve stopped worrying that I have gout - I’m far too young and I don’t honestly consume enough protein to make it a realistic diagnosis. Over time, one might even gain the skill of actually talking themselves out of such ridiculous possibilities. And yet, that too is as much a curse as it is  blessing - just ask my friend with an 18-hour history of right lower quadrant pain… no fever, or nausea or vomiting… it was appendicitis after all… and that’s a story for another time.

In 1994, Weekly World News - a tabloid - published a story about a chess master whose head exploded in the middle of the game. Naturally, the explosion was fatal - “experts” diagnosed him with a condition named Hyper-Cerebral Electrosis, in which the body’s electrical system becomes overloaded. The article references a physician, who states that highly intelligent people are at risk and that if one knows that they have the condition, they have better odds of surviving it. Three of the following “symptoms” establishes a diagnosis:

• Aching head when thinking too hard
• Ringing or humming in ears
• Unable to get a thought out of your head
• Spending more than five hours a day engaged in thoughtful activity
• Pressure in temples when feeling angry or frustrated
• Overeating ice cream, doughnuts, or other sweets
• Too much self-analysis

By my count, this fictional condition certainly afflicts everyone. Who doesn’t have trouble putting away the pint of Haagen-Daaz? Who hasn’t been afflicted with a bad case of earworm? Or get a headache when they spend too much time thinking, or being angry?At any rate, HCE is a fictional condition. However, Exploding Head Syndrome is an actual, valid diagnosis.

Exploding Head Syndrome is a sleep disorder, in which a sleeping subject hears a loud noise in their head. The noise originates from inside their head, but there is no pain, swelling, or other physical manifestation. It occurs just before or after deep sleep. Patients sometimes feel a “rush,” or experience a sense of fear or panic, but this appears to diminish as the patients become more familiar with the noise. It’s not dangerous in its own right, and doesn’t have much of an effect on sleep. Incidence increases with age, and more women than men are affected.

What causes Exploding Head Syndrome? It seems to be connected to stress and fatigue. It may be an aural seizure in the temporal lobe, or by movement of the middle ear or eustachain tube. It may be connected to some drug withdrawals. Treatment with clomipramine, a tricyclic antidepressant, has been effective in some patients.

Ascariasis: a parasitic roundworm that infects as much as a quarter of the world’s population. The eggs are eaten, they hatch, and the larvae burrow through the intestine, into the blood supply and migrate to the lungs and respiratory tract, where they are then swallowed back into the intestine. They can cause all kinds of problems, most notably, a fatal bowel obstruction. Awesome.

Teratomas: tumors made up of tissue from all three germ cell layers, caused by a failure of normal tissue migration. They can contain hair, teeth, and bone… and sometimes more complex organs. A tumor with an EYE? Gross. They are usually benign and are present at birth.

Caseating granuloma: a hallmark of pulmonary tuberculosis infection. Why are we seeking to give cheese a bad name?