Post by Russell Letson on Oct 16, 2021 10:18:45 GMT -5
Short version: in the hospital, where C. was observed and tested and then released. She's OK, but the whole experience was scary and very tiring. I'll just paste in the account I wrote to notify our family members. May be more detail than some need, but I don't have the time to write something shorter:
Thursday morning I woke at 4 a.m. (as one does if one is an old man) and noticed that Cezarija's breathing sounded odd. Usually this is just snoring, and I poke her to change her position and it stops. But she didn't move, and I couldn't awaken her, so I called 911, and within ten minutes there were four EMTs and a cop in the bedroom, trying to get her to respond. When she didn't, it was off to the ER. I was a few minutes behind the ambulance (had to get dressed and secure the house and cats), by which time her eyes were open and she recognized me. OK, I said, she's in there.
They had already done the usual checks for stroke (all negative), so we were moved from the intake area to an ER room, where we talked to the on-duty doctor and several LPNs and RNs. The doc wanted her admitted for observation, so after an interminable wait she was on the neuro floor, where the on-duty internist again applied the stroke tests (result: no stroke) and agreed with the ER doc that she had experienced a seizure, cause unknown.
Eventually we did get to the neurologist, who gave a (clearly much-rehearsed) chalktalk about seizures, distribution of same, difficulty of diagnosis, possible outcomes, and the testing regimen to follow. Also, that only one in three people who have a seizure will have a second one--after which, chances of repeats increase. C. had already had a CT scan in the ER, but the follow-up included an EEG and an MRI, neither of which showed any of the possible, easy-to-spot causes. The EEG tech was actually more forthcoming than the neurologist about what the tests can and can't determine. (He has 30 years on the job, tests a lot of children, and is generally a kind of observational standup comedian. But I trust his observations.)
Short version of the outcomes: No sign of stroke or tumor--but one slice of the MRI showed white spots that the neurologist said look like the effects of MS--but that would have presented thirty years ago. I did some quick & dirty Googling and discovered that subclinical or asymptomatic MS is a Thing, mostly discovered via MRIs given for other reasons (and sometimes via autopsy). So despite never having had any symptoms of MS, it's possible that C. "had" it sometime in middle age. Whether this condition has anything to do with the seizure is Yet To Be Determined. Or maybe Never To Be Determined, due to lack of evidence. Though there's a lot of research being done on RIS--radiologically isolated syndrome. Just for fun, here's a teaser from a 2017 journal article on the subject:
journals.sagepub.com/doi/abs/10.1177/1352458517717808
We await further wisdom from the radiologist and neurologist, since the last test done this afternoon was another CT scan, this time looking for occlusions in the arteries that feed the brain. (Update: no signs of disease or stroke, though there is a bit of "calcified atherosclerotic plaquing " in the carotids, which I suspect is not unexpected in a 76-year-old.)
C. is home now and feels fine, doesn't feel any effects of the seizure--but she has no memory of the evening before after 6:00 pm or so and does not remember events in the ER, even after she seemed completely recovered and was talking to me, the nurses, the admitting doc, and so on. Confusion and brain-fog are common accompanying effects, so this failure of short-term memory formation seems to be part of the package.
Again: C. is feeling OK. I'm OK, and less terrified than I thought I might be--though this reinforces my sense that any "OK" condition is subject to change at a moment's non-notice.
Thursday morning I woke at 4 a.m. (as one does if one is an old man) and noticed that Cezarija's breathing sounded odd. Usually this is just snoring, and I poke her to change her position and it stops. But she didn't move, and I couldn't awaken her, so I called 911, and within ten minutes there were four EMTs and a cop in the bedroom, trying to get her to respond. When she didn't, it was off to the ER. I was a few minutes behind the ambulance (had to get dressed and secure the house and cats), by which time her eyes were open and she recognized me. OK, I said, she's in there.
They had already done the usual checks for stroke (all negative), so we were moved from the intake area to an ER room, where we talked to the on-duty doctor and several LPNs and RNs. The doc wanted her admitted for observation, so after an interminable wait she was on the neuro floor, where the on-duty internist again applied the stroke tests (result: no stroke) and agreed with the ER doc that she had experienced a seizure, cause unknown.
Eventually we did get to the neurologist, who gave a (clearly much-rehearsed) chalktalk about seizures, distribution of same, difficulty of diagnosis, possible outcomes, and the testing regimen to follow. Also, that only one in three people who have a seizure will have a second one--after which, chances of repeats increase. C. had already had a CT scan in the ER, but the follow-up included an EEG and an MRI, neither of which showed any of the possible, easy-to-spot causes. The EEG tech was actually more forthcoming than the neurologist about what the tests can and can't determine. (He has 30 years on the job, tests a lot of children, and is generally a kind of observational standup comedian. But I trust his observations.)
Short version of the outcomes: No sign of stroke or tumor--but one slice of the MRI showed white spots that the neurologist said look like the effects of MS--but that would have presented thirty years ago. I did some quick & dirty Googling and discovered that subclinical or asymptomatic MS is a Thing, mostly discovered via MRIs given for other reasons (and sometimes via autopsy). So despite never having had any symptoms of MS, it's possible that C. "had" it sometime in middle age. Whether this condition has anything to do with the seizure is Yet To Be Determined. Or maybe Never To Be Determined, due to lack of evidence. Though there's a lot of research being done on RIS--radiologically isolated syndrome. Just for fun, here's a teaser from a 2017 journal article on the subject:
journals.sagepub.com/doi/abs/10.1177/1352458517717808
We await further wisdom from the radiologist and neurologist, since the last test done this afternoon was another CT scan, this time looking for occlusions in the arteries that feed the brain. (Update: no signs of disease or stroke, though there is a bit of "calcified atherosclerotic plaquing " in the carotids, which I suspect is not unexpected in a 76-year-old.)
C. is home now and feels fine, doesn't feel any effects of the seizure--but she has no memory of the evening before after 6:00 pm or so and does not remember events in the ER, even after she seemed completely recovered and was talking to me, the nurses, the admitting doc, and so on. Confusion and brain-fog are common accompanying effects, so this failure of short-term memory formation seems to be part of the package.
Again: C. is feeling OK. I'm OK, and less terrified than I thought I might be--though this reinforces my sense that any "OK" condition is subject to change at a moment's non-notice.