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October 13, 1989

Inferring Cortical Function From the Patient's Job: He Made Grass Trimmer, But Could He Have Made Vice President?-Reply

Author Affiliations

The Francis Scott Key Medical Center Baltimore, Md

The Francis Scott Key Medical Center Baltimore, Md

JAMA. 1989;262(14):1951-1952. doi:10.1001/jama.1989.03430140065023

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In Reply.—  I disagree with Dr Roberts' suggestion that a patient's job provides no information about mental status. The patient had a Mini Mental State score of 23 or 24 on repeated tests, which is clearly abnormal and required explanation. We determined that there was no evidence of mass lesions in the brain by computed tomographic scan and no abnormality on lumbar puncture. However, since he was going to be treated only with ketoconazole, there was a good deal of angst among the house officers about whether we were missing subclinical central nervous system blastomycosis, which would require amphotericin B therapy.The history of severe head injury at age 9 years was clearly relevant, but since head injury does not necessarily impair cortical function we sought further reassurance. The patient did not graduate from high school, although this information was edited out of the manuscript. He had the kind of