Remember that reporter stroke garbled speech video of Serene Branson showing aphasia and stroke like findings while giving that now infamous post Grammy Awards report?
She has just come out this morning on the CBS Early Show to describe her ordeal. She said she had some some of the best doctors in the world. Of course she did. Everyone has the best doctor in the world, in their own mind. Common things are common. Best doctors should be reserved to those who have specialized themselves out of a community based job and can only make a living taking care of one disease for which they have become super experts.
Otherwise, most doctors in their field of expertise are equal, all things considered with great variations in bedside manner. You could be an average doctor and manage average conditions, even with extreme presentations with the same level of expertise as the best doctors in the world. That's because, for common conditions, the differential diagnosis is the same and the work up is the same no matter where you go.
Watch the video
Her neurosurgeon says she had a complex migraine. I don't know about you, but if I'm having a heart failure exacerbation, I'm not going to a cardiac surgeon any more than I'd go to a neurosurgeon for a possible stroke. I wouldn't even get a neurosurgeon involved. They have no role what so ever in the evaluation and management of a patient who presents like Serene Branson did.
Watch the video
Her neurosurgeon says she had a complex migraine. I don't know about you, but if I'm having a heart failure exacerbation, I'm not going to a cardiac surgeon any more than I'd go to a neurosurgeon for a possible stroke. I wouldn't even get a neurosurgeon involved. They have no role what so ever in the evaluation and management of a patient who presents like Serene Branson did.
In my eight years as a stroke expert in the scope of hospitalist medicine I have consulted a neurosurgeon zero times for a patient with Serene Branson's presentation. That says volumes about the politics of academic medicine and marketing lengths a hospital system will go to elevate their view in the public's eye. I'm a bit embarrassed at UCLA for using a neurosurgeon to discuss with pretty MRI films to discuss migraine. It's a level of doctor humor only us medical types can appreciate.
Unfortunately, the public will never know the games that are played. Who's more impressive than a neurosurgeon? Right? If you put a hospitalist on that camera, a hospitalist that sees hundreds of stroke patients a year, people would be asking What is a hospitalist? Put a neurosurgeon on camera to discuss migraine and the lay public will hang onto every word.
That's the medical world we live in where image is everything.
She says she spent three days, nine hours a day, getting tests by some of the best neurologists and cardiologists. She even saw a migraine specialist. She made it sound like she was allowed to leave every day and come back as an outpatient. That's a bit odd, if true, but not unexpected with a VIP, where rules are often bent to accommodate levels of comfort.
She says she had a migraine march with her symptoms preceding the event including a headache and some blurry vision. Serene Branson said she knew exactly what was happening and dropped the microphone immediately after she went off air and then experienced cheek and right arm numbness, which interestingly involves the same side of the brain as the area of Brodmann area 44 for Broca's aphasia. Left brain involvement equals right sided symptoms.
She has been ordered a triptan on an as needed basis, which is a standard migraine medication treatment. She said she's never had a migraine but has had headaches most of her life.
The neurosurgeon said her MRI was clean.
What happens next for Serene Branson? We are being told she doesn't smoke and is not on hormones. Assuming none of her labs are still waiting to return, she will go on her merry way and hope this doesn't happen again.
This is a very likely explanation of her symptoms, as I said originally. I have previously cared for patients who present with a hemiplegia from migraine. Complex migraine can look exactly like a stroke. It's just scary for the patient and to be honest, for the physician as well. Because TIA and complex migraine can look exactly the same and no doctor in the world could ever tell you with one hundred percent certainty that this wasn't a fluke transient stroke finding.
As doctors, we just have to do what we do with our workups and tell the patient what we know at that specific point in time. The diagnosis for Serene Branson is most likely a complex migraine but a TIA cannot be entirely excluded with 100% certainty.
Then you move on to the next patient and hope you got it right. Or you ask Watson the supercomputer of the Jeopardy computer vs man video fame if he has any other ideas.
