Never Too Young to Stroke, Never Too Old to MG

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.

Saunders Anisocoria Image

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.

Sanders 3

Sanders 2

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