Is ‘Rabies’ A Neurological Diagnosis?

IS ‘RABIES’ A NEUROLOGICAL DIAGNOSIS?

OP KAPOOR
Ex. Hon. Physician, Jaslok Hospital and Bombay Hospital, Mumbai, Ex. Hon. Prof. of Medicine, Grant Medical College and JJ Hospital, Mumbai 400 008.
By the time a patient of Rabies develops widespread paralysis, associated ‘Hydrophobia’ can help a doctor to make a spot diagnosis. But, by then, it is too late. Though the patient is certainly going to die, he may have infected (though the chances are remote) a relative or a medical attendant. More important is the ‘shock’ to the relatives. They have less time to accept the ‘Death of the patient’. Early diagnosis can ‘prepare’ them for an eventual death.

The diagnosis has to be made by a GP, rarely a psychiatrist, if he is called early in the picture. With a history of dogbite by a stray dog (or unknown dog), after a period of one to two months, the patient develops severe anxiety symptoms. The ‘restlessness’ seen is very severe. The symptoms of ‘panic’ are so severe that the GP would start having second thoughts!

All these three symptoms are found specially in severely neurotic women in day to day practice. It is the degree of these symptoms, from which the diagnosis of Rabies could be made, much before hydrophobia, paralysis and mania appear!