Sidelined Senator Kennedy: Stroke or Seizure?

Much of the weekend's news coverage has been devoted to a health crisis involving Massachusetts' Senator Edward M. Kennedy. It appears that family members witnessed stroke-like behavior and called 9-1-1. The 76 year-old senator was promptly rushed to a community hospital in Cape Cod and evacuated by helicopter to Boston (Massachusetts General Hospital).

Medical experts who have evaluated Kennedy declared that the senator did not experience stroke, but instead he had sustained a seizure.

Sadly, many Americans automatically connect the words Kennedy and conspiracy: two assasinations, Teddy's plane crash, Chappaquiddick, William Kennedy Smith trial, JFK Jr.'s plane crash. Some folks are skeptical that any news item about the Kennedys is manipulated.

Once the news broke on Saturday a lot of TV viewers probably said to themselves, "I may not have graduated from medical school but I would know a seizure if I saw one!" Sure, but what if you didn't see the seizure? By that I mean, Senator Kennedy might have been alone when the seizure occurred and was not discovered until he was post-ictal (medical terminology for 'after the seizure').

After a seizure the victim may appear fatigued (lethargic), confused, and disoriented. They may not be able to speak clearly or ambulate without assistance. A first-time stroke can be even more dramatic because it is totally unsuspected. Those who observe post-ictal behavior could very easily assume that a stroke has happened. On top of that, Senator Kennedy's father suffered a massive stroke during JFK's presidency, so the family was sensitive to the problem.

Unlike stroke, a seizure by itself ought not to create any lingering neurologic deficits like limb weakness or loss of visual field. Time is precious if stroke is suspected, so it was very appropriate for the senator to receive such expeditious care. Hopefully it will be there for us, too, if we need it.

Senator Kennedy's health care team is very busy identifying possible causes of the seizure. Something as simple as dehydration or an undiagnosed infection could be responsible. An ophthalmologist has very likely been consulted because circulatory abnormalities that can lead to seizure (or stroke) can be directly visualized in the retinal blood vessels. The optic nerves are also studied for clues that might suggest elevated spinal fluid pressure. Visual field testing may even be performed to document that the complete visual cortex is receiving adequate oxygen. Many first-time seizures are idiopathic, meaning no specific underlying cause is identified. Nonetheless, a complete seizure workup will offer solid documentation for future comparison in case things deteriorate.

All of the preliminary reports have been very promising and the Senator's prognosis appears favorable. Despite the good news many Americans will withhold judgment until they see Senator Kennedy walk out of the hospital on his own without assistance. Time will tell.

Related Topics:

Geodesic Seizure Mapping for Epilepsy

First Aid for Seizures

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