What happened to Mitch McConnell?

[Dr. Rude]

He was just observing a moment of silence for Ukraine.

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[ScepticSkeksis]

He was just observing a moment of silence for Ukraine.

He was thinking about all that kickback money deposited into his offshore account after being laundered through Ukraine.

 

[allantois]

If you watch him take questions 10 mins after, he certainly did not return to baseline - he was confused and kept mumbling "I am fine"

 

[southerndoc]

Have you ever seen a TIA where the pt is motionless and speechless? I have not. I won’t put the probability at 0, but it’s very very low IMO. Moreover he responds when spoken to. It’s more likely a simple partial seizure (if that was pathology).

Some other congressman or senator had a video of him talking and he actually had a TIA or stroke. I think it was rand Paul or Ron paul, can’t remember.

I read all these twitter comments and everyone is like call 911 STAT!!! One MD! wrote “he needs a stat head CT!!!!”

Jeez

You've never had a stroke/TIA where a patient was aphasic only? We see it all the time, and about half of them have a stroke identified on MRI even though they recovered fully.

 

[wareagle726]

I agree with genius. I think it was a well endowed journalist.

 

[Postictal Raiden]

Yes, SDH can affect the temporal lobe for sure and you do not need to have significant mass effect to have seizure from SDH. I am not saying he certainly has a SDH affecting the temporal lobe, just saying that I would not be surprised if he did. I've seen dozens of patients with no symptoms from SDH other than seizure and with no motor deficits at all. He could have a new GBM or many other causes of seizures originating in the temporal lobe. Also, automatisms are very frequently absent in complex partial seizures. If you require them for a dx of complex partial seizures then you are missing tons of seizures.

I also agree that this could have been presyncope. I already said that. Without a time machine and full ECoG coverage, we will never know. The one certainty was that it was not a TIA so lets stop the stroke code madness and protect our EM brothers/sisters from the medmal liability monster. 50% of Neurologists would have gladly called this a "TIA" and sent the guy home on DAPT.

I’m not missing anything
I can confidently tell you that because I’ve seen hundreds of these consults
All of their EEGs and MRIs were unremarkable

And automatism is not an infrequent association with temporal lobe seizures. Look up the literature. The majority of focal lobe epilepsy is associated with automatism

I still maintain that common things being common. This was either a BP or blood sugar problem. Perhaps he has a UTI who knows.

It is not aphasia and he didn’t have a facial droop like some people here are claiming

Also it’s too short for it to be a seizure. It was what 20 seconds long?

 

[Postictal Raiden]

You've never had a stroke/TIA where a patient was aphasic only? We see it all the time, and about half of them have a stroke identified on MRI even though they recovered fully.

Aphasia can occur in isolation in TIA or stroke. However this was not aphasia. This was anarthria with behavioral arrest.

 

[Tenk]

He was just observing a moment of silence for Ukraine.

You mean Russia?

 

[Mount Asclepius]

I’m not missing anything
I can confidently tell you that because I’ve seen hundreds of these consults
All of their EEGs and MRIs were unremarkable

And automatism is not an infrequent association with temporal lobe seizures. Look up the literature. The majority of focal lobe epilepsy is associated with automatism

I still maintain that common things being common. This was either a BP or blood sugar problem. Perhaps he has a UTI who knows.

It is not aphasia and he didn’t have a facial droop like some people here are claiming

Also it’s too short for it to be a seizure. It was what 20 seconds long?

This just illustrates the dangerousness of a single organ specialist working up an undifferentiated complaint. They don’t know anything broad about pathology. They don’t know what they don’t know (the good ones admit that). There is no way this was due to a UTI, unlikely to be due to hypotension without collapse, and also unlikely to be due to hypoglycemia. This is where the expertise of an EP comes through. We frequently see presentations of pathology from every specialty. Conjecture from subspecialist about other subspecialties is often errant. Befuddlement, brain fart, old brain, and the vapors are more valid explanations than UTI. TIA, focal seizure and presyncope are much higher on the differential.

 

[Postictal Raiden]

This just illustrates the dangerousness of a single organ specialist working up an undifferentiated complaint. They don’t know anything broad about pathology. They don’t know what they don’t know (the good ones admit that). There is no way this was due to a UTI, unlikely to be due to hypotension without collapse, and also unlikely to be due to hypoglycemia. This is where the expertise of an EP comes through. We frequently see presentations of pathology from every specialty. Conjecture from subspecialist about other subspecialties is often errant. Befuddlement, brain fart, old brain, and the vapors are more valid explanations than UTI. TIA, focal seizure and presyncope are much higher on the differential.

Lol okay

 

[ProReduction]

This just illustrates the dangerousness of a single organ specialist working up an undifferentiated complaint. They don’t know anything broad about pathology. They don’t know what they don’t know (the good ones admit that). There is no way this was due to a UTI, unlikely to be due to hypotension without collapse, and also unlikely to be due to hypoglycemia. This is where the expertise of an EP comes through. We frequently see presentations of pathology from every specialty. Conjecture from subspecialist about other subspecialties is often errant. Befuddlement, brain fart, old brain, and the vapors are more valid explanations than UTI. TIA, focal seizure and presyncope are much higher on the differential.

Amen. Be very afraid of any physician that claims they never miss anything ("I’m not missing anything") because he is about to be humbled. About 25% of complex partial seizures have extra-temporal origin and are more likely to lack automatisms. One of us has read the literature already on this. I've also seen hundreds of these consults and have seen hundreds of video EEGs with CPS recorded and many lacked automatisms. I never said that "automatism is an infrequent association with temporal lobe seizures". Majority have them and 25%ish do not. Last I checked 25% != 0%.

This very well could have been presyncope as I already said again and again. However, if you had seen a thousand presyncope cases then you would be familiar with a tell-tale sign of a patient trying to stabilize himself prior to and during the event. Old Mitch made zero attempt to do so. He likely has an amnestic window to the entire event.

And come on man UTI? You are just pouring gas on the negative fire stereotype of Neurologists. This is why ED MDs are stop listening 5 seconds into a Neurologist giving recommendations.

 

[Postictal Raiden]

Amen. Be very afraid of any physician that claims they never miss anything ("I’m not missing anything") because he is about to be humbled. About 25% of complex partial seizures have extra-temporal origin and are more likely to lack automatisms. One of us has read the literature already on this. I've also seen hundreds of these consults and have seen hundreds of video EEGs with CPS recorded and many lacked automatisms. I never said that "automatism is an infrequent association with temporal lobe seizures". Majority have them and 25%ish do not. Last I checked 25% != 0%.

This very well could have been presyncope as I already said again and again. However, if you had seen a thousand presyncope cases then you would be familiar with a tell-tale sign of a patient trying to stabilize himself prior to and during the event. Old Mitch made zero attempt to do so. He likely has an amnestic window to the entire event.

And come on man UTI? You are just pouring gas on the negative fire stereotype of Neurologists. This is why ED MDs are stop listening 5 seconds into a Neurologist giving recommendations.

You wrote automatism “very frequently absent”.

Look, we all agree that nothing is definitive, but common things being common. Temporal seizures typically associate with automatism and typically have a duration of 30 seconds to 2 mins. Neither of these two features were present.

Presyncope has triggers. Orthostatic hypotension is a very common one. The poster Mount doesn’t think it’s BP problem without collapse, yet he still maintains presyncope is among the highest differentials.

Regarding the UTI comment, it was to illustrate that encephalopathy (or delirium) in elderly can be provoked by a simple infection.

Mount’s post was insulting. He painted specialists with a broad brush saying we lack sufficient knowledge about broad pathology. Yet, he dismisses the input of two neurologists that this event was unlikely to be a TIA. He could use his own advice to learn some humility.

 

[Mount Asclepius]

You wrote automatism “very frequently absent”.

Look, we all agree that nothing is definitive, but common things being common. Temporal seizures typically associate with automatism and typically have a duration of 30 seconds to 2 mins. Neither of these two features were present.

Presyncope has triggers. Orthostatic hypotension is a very common one. The poster Mount doesn’t think it’s BP problem without collapse, yet he still maintains presyncope is among the highest differentials.

Regarding the UTI comment, it was to illustrate that encephalopathy (or delirium) in elderly can be provoked by a simple infection.

Mount’s post was insulting. He painted specialists with a broad brush saying we lack sufficient knowledge about broad pathology. Yet, he dismisses the input of two neurologists that this event was unlikely to be a TIA. He could use his own advice to learn some humility.

Presyncope isn’t syncope. Presyncope isn’t always due to orthostatic hypotension.

I didn’t state the top differential diagnoses. I just listed a few that were more likely.

Simple infections don’t cause this quick of a presentation.

You do lack knowledge of broad pathology. EPs are the experts in acute disease across specialties. Don’t try to deny that. We fought this fight decades ago and won.

I didn’t argue this was a TIA. It’s also not off the differential.

 

[EthylMethylMan]

You guys see that video of him? He was talking and just froze.



So much speculation that he had a TIA or a stroke…or absense seizure.

I think no way this was ischemic in nature. I suppose it could have been a partial seizure, maybe an absense seizure but he is definitely out of the age group for that.

To me it looks like he just stared into space for awhile. We all do that. Notice how he conveniently wakes up when someone addresses him?

He knew too much, the aliens got him with the seizure UAP laser.

 

[GassYous]

I just think it's amazing that the greatest country in the world has 80 year olds running things.

 

[emergentmd]

l

I just think it's amazing that the greatest country in the world has 80 year olds running things.

We need term limits. I think most Americans would vote for this but those in power would never. Dems/Rep all play in the same sandbox, set the same rules, and fight with each other with the only goal of being voted back in. I

Dems propping up Difi, Fetterman and Reps propping up Mitch just shows you how congress cares only about themselves and not the American people.

Thats like our ER group knowing a doc is dangerous but then just letting them work.

 

[thegenius]

Looks like a pretty clear cut near syncopal episode. He appears quite unsteady on his feet. Although this discussion of people saying he was aphasic from a TIA or having a seizure just brings me back to how annoying these patient and mostly patient family interactions can be when they describe clear cut syncope prodrome, lack of focal neuro deficits, and near immediate return to mental baseline and you explain this to them, and you get the “I’m a nurse/doctor, I know what I saw, this was a” insert stroke/seizure/TIA. I’ve found that even many of my EM colleagues have a hard time differentiating syncope from seizure when it is happening right in front of them.

When I get lightheaded I don't freeze and stand still though.

 

[thegenius]

If you watch him take questions 10 mins after, he certainly did not return to baseline - he was confused and kept mumbling "I am fine"

That video I didn't see.

 

[thegenius]

Aphasia can occur in isolation in TIA or stroke. However this was not aphasia. This was anarthria with behavioral arrest.

THAT's THE DIAGNOSIS. I've never seen or heard of anarthria. Love it.

 

[southerndoc]

THAT's THE DIAGNOSIS. I've never seen or heard of anarthria. Love it.

So you're saying he knew what he was going to say but his muscles were paralyzed preventing him from doing so? Wouldn't he also exhibit facial droop when this occurred? Anarthria usually means people can understand speech but can't speak it. Did he seem to understand what was going on around him?

 

[thegenius]

So you're saying he knew what he was going to say but his muscles were paralyzed preventing him from doing so? Wouldn't he also exhibit facial droop when this occurred? Anarthria usually means people can understand speech but can't speak it. Did he seem to understand what was going on around him?

I have no idea what McConnell thought in his mind. Nobody does. What I'm suggesting is that you can't temporarily block a cerebral artery in a brain to produce what was shown in the video. it doesn't make sense and I agree with the Neurologists (who agree with me) who have posted on this thread that it's highly unlikely a TIA.

 

[Jabbed]

Definitely a seizure. Take a close look at his eye movements. He has right upward deviation that resolves shortly before he recovers. I would CT him and wager on a chronic left SDH.

Theoretically possible for this to be a TIA localizing to right frontotemporal, but unlikely.

 

[Dr. Rude]

Doctors Confirm McConnell Had A Stroke After Imagining A Happy Black Person

WASHINGTON—Having determined the cause of an episode in which the minority leader froze midway through remarks to the press and then remained silent for 19 seconds, doctors confirmed Thursday that Sen. Mitch McConnell (R-KY) had suffered a stroke after imagining a happy Black person. “We ran...

www.theonion.com

 

[MechEDoc]

Since we're all speculating, does anyone know if his evaluation has been released? I'm guessing he wouldn't have any issues getting a full workup in a timely manner.

 

[JacobMcCandles]

Since we're all speculating, does anyone know if his evaluation has been released? I'm guessing he wouldn't have any issues getting a full workup in a timely manner.

He’s still in a hallway bed.

 

[Kryptocoin]

He’s still in a hallway bed.

I hope that's the case because nothing will initiate real healthcare reform like an upset US Senator.

 

[skougess]

I hope that's the case because nothing will initiate real healthcare reform like an upset US Senator.

Lol you know they all get “vip” service and are shielded from the realities their constituents face.

 

[southerndoc]

I hope that's the case because nothing will initiate real healthcare reform like an upset US Senator.

Didn't work when I had a very prominent US Senator sandwiched between two smelly homeless patients separated by curtains.

 

[BulgeDaTwine]

You guys r overthinking this.

1. CT, pan labs, ekg, cxr
2. Call hospitlaist
3. Move on. Majority of the time the neurologist won’t have an answer anyhow.

Remember to bill Critical care time, serial neuro exam, discussion with family: 32 minutes

 

[ProReduction]

You guys r overthinking this.

1. CT, pan labs, ekg, cxr
2. Call hospitlaist
3. Move on. Majority of the time the neurologist won’t have an answer anyhow.

Amen. The Neurologist is more than happy to be left out of these "spells" where the clinical event was vague and the patient is totally back to normal prior to ED arrival. When you call me and describe in third-hand info what the patient's wife told EMS who told you who is now telling me, my answer is always going to be: "I have no idea what this was either. If you are asking me whether this was presyncope or seizure or stroke I will never be able to answer that for you. If that is the concern then you can work-up all of the above. I'm more than happy to write that in a note so that the Hospitalist does not try and block the admission."

We have video of ole Mitch's "spell" and there is still contention.

 

[MechEDoc]

Amen. The Neurologist is more than happy to be left out of these "spells" where the clinical event was vague and the patient is totally back to normal prior to ED arrival. When you call me and describe in third-hand info what the patient's wife told EMS who told you who is now telling me, my answer is always going to be: "I have no idea what this was either. If you are asking me whether this was presyncope or seizure or stroke I will never be able to answer that for you. If that is the concern then you can work-up all of the above. I'm more than happy to write that in a note so that the Hospitalist does not try and block the admission."

We have video of ole Mitch's "spell" and there is still contention.

 

[Siggy]

View attachment 375580

Have you ever seen an MRI in action? It doesn't go "BRRR," it goes "BANG BANG BANG."

 

[southerndoc]

Have you ever seen an MRI in action? It doesn't go "BRRR," it goes "BANG BANG BANG."

 

[RustedFox]

APE STRONG TOGETHER

 

[Birdstrike]

What happened to Mitch McConnell?

Mitch McConnell happened to Mitch McConnell.

 

[Goro]

It happened again!

 

[Kryptocoin]

It happened again!

He's clearly not well. Still not a TIA. Absence seizure? His eyes rolled back a bit. There's a better video of the event on YouTube.

 

[ProReduction]

The best part was his staffer acting like the press was at fault for not asking questions loud enough, trying to pretend he just did not hear the question. DC is the worst of the worst.

 

[Jabbed]

Here’s a higher quality video. Right upward eye deviation with postictal period.

Definitely a seizure. Take a close look at his eye movements. He has right upward deviation that resolves shortly before he recovers. I would CT him and wager on a chronic left SDH.

Theoretically possible for this to be a TIA localizing to right frontotemporal, but unlikely.

 

[JacobMcCandles]

Very apropos it was after a question on running for re-election.

 

[southerndoc]

He's clearly not well. Still not a TIA. Absence seizure? His eyes rolled back a bit. There's a better video of the event on YouTube.

That's what I'm thinking. His eyes looked deviated up and to the right.

Maybe he just needed to rebuffer his thought stream.

In all seriousness, dude needs a major workup.

 

[ScepticSkeksis]

Proof that there is severe debility and incompetence in both parties.

 

[JacobMcCandles]

Proof that there is severe debility and incompetence in both parties.

In a not-so-shocking revelation, they govern better while they’re seizing. Less chance they mess something up.

 

[Emapp20177]

Partial seizure

 

[thegenius]

He's clearly not well. Still not a TIA. Absence seizure? His eyes rolled back a bit. There's a better video of the event on YouTube.

Yea he’s having some sort of seizure. He had conjugate right eye horizontal gaze deviation in that poor quality video above.

 

[Tenk]

He was just thinking about all the insider trading he would lose out on if he didn’t run again and his brain can’t count that high.

 

[ScepticSkeksis]

In a not-so-shocking revelation, they govern better while they’re seizing. Less chance they mess something up.

Agreed. He's done a terrible job of representing the wishes of his constituents. Best he freeze up and stop the government from doing anything.

 

[Kryptocoin]

That's what I'm thinking. His eyes looked deviated up and to the right.

Maybe he just needed to rebuffer his thought stream.

In all seriousness, dude needs a major workup.

I think Mitch has probably had more workups than most of us combined. His doctor needs to put him on keppra and call it a day.

Oh, and keep him away from live mics too.

 

[alphaholic06]

 

[Fox800]