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June 8, 1984

Perfect Case

Author Affiliations

Rochester, NY

JAMA. 1984;251(22):3000. doi:10.1001/jama.1984.03340460078031

In 1959, when I was finishing my residency in neurology, back home in a Great Lakes city after two years in New York, and eager to show what I had learned while I was away, I had a "perfect case" and I missed it—but not in the way you might suppose. My patient was a librarian in the medical school, where her husband was a student, but I first met her in the emergency ward of the medical center because she was suffering uncontrollable twisting spasms of her neck and body. Her breathing was irregular and she struggled to speak. She was in great discomfort, and she was frightened.

This was not her first experience with such an alarming condition. She managed to make me understand that the same thing had happened just one year before. She had been admitted to the hospital, and, as I learned from her chart,