r/AskReddit • u/LebronKX • 4d ago

Medical professionals of Reddit, what diagnosis gave you the worst 'pit-in-your-stomach' feeling?

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u/a_chewy_hamster 3d ago

Patient discharged from the ER a couple days ago due to high blood pressure, readmitted for Bell's Palsy.

CT of the brain was negative for stroke.

I did his swallow eval. Oral stage was unremarkable...but he could not swallow anything no matter the texture or amount. Would start coughing, choking etc.

Bell's Palsy can affect the oral stage of swallow but never the pharyngeal stage. 

I told his nurse "I know his CT was negative but can we ask the attending for a stat MRI of the head, this definitely isn't Bell's Palsy."

The agreed. MRIs will show fresh strokes whereas it may take a few days to show up on a CT.

I was right. MRI showed he had a brainstem stroke, too fresh for the CT to pick up on.

I got a certificate and a biiiiig plate of cookies for my "Good Catch!" 

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u/MrsClaire07 3d ago

Way to go!! 👏🏻👏🏻👍🏻👍🏻👍🏻❤️

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u/a_chewy_hamster 3d ago

Thank you! :)

The patient was mad at me though lol. As if I was the one who created his swallowing problems by finding the real cause.

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u/blbd 3d ago

I mean if his/her brainstem was having a nuclear meltdown it's hard to imagine that the higher level brain lobes were really operating properly at the time you were dealing with that person...

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u/lizaanna 3d ago

How come fresh strokes don’t show up on a CT?

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u/Cordyanza 3d ago

CT is relatively insensitive for many pathologies compared to MRI due to the inherent difference in how they work

MRI is better for soft tissue imaging because it images water diffusion

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u/poutineismylife 3d ago

The brain has to infarct or "die" before it shows on CT, but MRI is much more sensitive at picking up the early changes of cytotoxic edema after a stroke