Friday, September 26, 2008

Diagnosis by You Tube

ER types are fond of saying they operate on sheer adrenaline. Maybe that adrenaline, driven by leftist passion, is why Shadowfax is so quick to suggest that John McCain has had a stroke. Given that the portion of the 7th nerve nucleus representing the upper facial muscles has bilateral cortico-bulbar representation how, pray tell, could a stroke wipe out those muscles? (OK, so is it a brain stem stroke, wiping out the 7th nucleus with no detectable central manifestations? That seems a bit of a stretch). Well, if I present to an ER with Bell’s Palsy please don’t anybody give me TPA.

More from Kevin and Orac.

Update: Many bloggers and commenters have emphasized McCain's ptosis in addition to the peripheral 7th nerve manifestations. As Steve Novella has pointed out:

Isolated ptosis would be an extremely uncommon presentation of a stroke or tumor, other signs would almost certainly be present. Ptosis is most often physiological - meaning normal for that person. This type of ptosis can also come and go, so it may be more noticable at some times than at others.

Novella points out that benign ptosis is very common and may be physiologic. If the chance of a stroke causing upper facial weakness is slim, the chance of one causing this and ptosis at the same time are slim to none.

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