March 2, 2024

Mitch McConnell episode has important public health takeaway

The handling of Senate Minority Leader Mitch McConnell’s abrupt medical issue this week is raising concerns among medical experts that the event sent a potentially dangerous public-health message — that when someone experiences an episode with symptoms like McConnell’s, they can simply return to work as though nothing had happened.

McConnell experienced the episode on Wednesday — freezing and remaining silent for about 20 seconds during a press conference, then showing signs of disorientation — and was led away by aides while cameras rolled.

Minutes later, the Kentucky senator, 81, returned to the press briefing and said, “I’m fine.” He didn’t answer specific questions about whether he was examined by a doctor. A McConnell aide later said the senator had felt light-headed.

It’s impossible to say what happened to McConnell without direct medical examination, experts told STAT. But many said they’re concerned his issue, whatever it was, was treated as business as normal.

“If someone else is in that type of situation, it could be a medical emergency,” said Monica Verduzco-Gutierrez, the chair of rehabilitation medicine at the University of Texas Health Science Center at San Antonio. Speech impairment is one of the five key signs of a stroke, and it’s important to rule out the most serious possible explanations when someone experiences such symptoms.

“When you see something like that, which is essentially a neurological event — we don’t know what it was, but his brain malfunctioned — you always assume the worst, not because that’s the most likely cause, but you want to address the things that are the most immediate threat to your health and you,” said Bernard Ashby, a professor of medicine at the University of Miami and a vascular cardiologist.

Context is essential: If someone has experienced speech difficulty before without permanent consequences, and knows how to handle them, everything may indeed be fine, said Jose Vega, a neurologist at the East Carolina Medical Center in Greenville, North Carolina.

It’s unknown whether McConnell was examined by a doctor who cleared him to resume the press conference, and McConnell’s office did not respond to a request for comment on that matter. Vega notes that he doesn’t necessarily think it would have been appropriate or essential to rush McConnell to the ER in front of cameras. But he added that people with “this very symptom, the very thing that this man suffered in front of those cameras — these are people who are brought to the hospital routinely to be examined for a potential acute stroke.”

“Time is brain. So if you are having a stroke, it’s important to get access to care and treatment for that as soon as possible,” said Verduzco-Gutierrez.

In the case of someone like Mitch McConnell — an older person with a recent concussion history — a typical medical response to abrupt speech difficulty would include not only checking vital signs but running an electrocardiogram and laboratory tests as well as ordering brain imaging scans, said Ashby. (That’s provided the person has no history of similar episodes and no known cause for them, such as a brain mass.)

“That he came back out and spoke after having a neurological event, at the minimum did not seem like a good idea,” said Ashby. “You don’t want to waste any time given the possibility that whatever happened could happen again.”

Sarah Owermohle contributed reporting to this story.

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