Reckless speculation--Are you out of your mind?

David Mckalip dmmckali at gibbs.oit.unc.edu
Sat Apr 2 16:47:04 EST 1994

Newsgroups: bionet.neuroscience
Subject: Re: Reckless speculation--Are you out of your mind?
References: <2974148851.3.p00907 at psilink.com> <Pine.3.05.9403311048.A23801-b100000 at essex.hsc.colorado.edu>
Distribution: bionet
Organization: University of North Carolina, Chapel Hill

In article <Pine.3.05.9403311048.A23801-b100000 at essex.hsc.colorado.edu>,
Santhosh <santhosc at ESSEX.HSC.COLORADO.EDU> wrote:
>glad to see rvival of classical neurology.
>my thoght for today
>No man's opinions are better than his information ---Paul Getty 1960
>On Wed, 30 Mar 1994, Richard E. Cytowic MD wrote:
>> In reply to a fascinating post about unilateral goosbumps in response 
>> to stimuli in different modalaties, we get the following:
>> >DATE:   28 MAR 94 18:01:06 GMT
>> >FROM:   jtaenzler at vax.clarku.edu
>> >
>> >Have you ever had some sort of brain imaging?  Sounds like you could have
>> 	Are you out of your mind? Several peeves here, none of them pet:
>> 1) The unthinking rush to imaging technology, as if that would give a 
>> better "answer" than thoughtful reflection. The word diagnosis means 
>> "through knowledge," not technology. Machines are superb--but not when 
>> they're used for fishing expeditions.
>> 2) The anterior commissure and callosum perform different functions, 
>> and have different evolutionary histories. Does EITHER have anything to 
>> do with hypothalamic, autonomic outflow (which is the subject of the 
>> earlier post)? Your opinion is stupendously misplaced.
>> ------------------------------------------------------------
>> Richard E. Cytowic, MD                  p00907 at psilink.com  
>> 1611 Connecticut Ave NW Suite 2B        Fax:   202-265-3311
>> Washington DC 20009-1033  USA           Voice: 202-265-8989

I found quite interesting the post re: unilateral piloerection in response
to different stimuli and emotional states.  I unfortunately am at a loss
to give a precise neuroanatomic pathway to explain it.  The function of
piloerection is a sympathetic action that is mediated by the lateral and
posterior hypothalamus.  The hypothalamus is, in turn, highly integrated into
the pathways involved in emotion and has many other influences as well. 
Ablation of the anterior and medial hypothalamus can produce a hypertonic
(overactive) sympathetic response.  I am not suggesting that you have a
lesion here, but it is likely that you merely have some form of
sympathetic hypertonia for piloerection in particlular that is likely
harmless.  If, as I recall, this has been present for the entire lifetime,
then there is no need for concern or expensive imaging (for other than
academic reasons).  However, if this were a new development, then imaging
of the brain with an MRI would probably be required to rule out any
lesion.  I doubt that any new lesion is responsible for this given the
fact that it can occur on either side (How intersting :-) ).
     Of more concern is the difficulty distinguishing left from right.  If
this is something that has been present for a lifetime, then it is not of
concern and should not be evaluated unless it is impairing the person's
function.  However, if this is new, then it could be part of GERTMANN's
SYNDROME.  That usually comes from a lesion of the dominant parietal lobe
(usually the left in most people, but possibly the right side in a
left-hander if the family history is positive for left-handedness). 
Gerstmann's syndrome consists of 1)left-right confusion, 2) agraphia
without alexia (patient can read but can't write) 3)Acalculia (difficulty
with mathematical computation), and 4)digit agnosia (inability to identify
finger by name).  If any of these symptoms arise in the future, you may
want to make a visit to your local pysiscian :).

David McKalip, M.D.
Neurosurgery Resident
UNC-Chapel Hill

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