The Masquerade … often an essential part of the neuro-diagnostic detective work illustrated beautifully by Lisa Sanders’ Diagnosis columns in two recent New York Times Magazine pieces.
A spot of static in the middle of a patient’s visual field and unequal pupil sizes may just be a variant of migrainous experiences. That’s the most likely explanation. When you hear hoofbeats in Central Park, don’t look for zebras — right? After all, what’s the likelihood that a healthy, middle-aged, athletic woman would experience a spontaneous carotid artery dissection (SCAD)? Read all about it here.
By the same token, a normally spry 94 year old patient experiencing ptosis, diplopia, slurred speech and progressive weakness is most likely experiencing a stroke, right? Well what happens all signs point to a stroke, but conventional tests come back negative. And what’s the likelihood that an injection for macular degeneration could be exacerbating ptosis and diplopia? Think along with Dr. Sanders here.