Thoughts from Stroke Conference Day 1 Brazil

Questions from the floor, invariably bring out the occasional “nutter”.

Such performances at the microphone usually are a variation on two types. The first, with which I can cope if not empathize, is a request for a comment on an anecdotal case, provoked by a preceding brilliant discourse and objective lecture on a specific subject. The lecture may have been on “Current evidence based guidelines for anti coagulation in atrial fibrillation”.

The unique scenario presented from the floor goes something like this: a patient, from Eucador, a man aged 48, who for the last 12 years has, after 3 bottles of beer at night, followed by vigorous sexual intercourse, taken his prescribed Warfarin tablets and 20 minutes later develops severe palpitations….. Would Professor Bickersdorf care to comment?

The other is more of a dissertation. Following an eloquent, lucid lecture on “Current Theories of the Mechanism of Headache after a TIA”, a member of the audience approaches the microphone and explains that over the last 25 years he has gathered a cohort of 121 women who have had a TIA involving the carotid artery and has found in 29, calcification of the nipple. What is even more fascinating, the speaker theatrically emphasizes, is that it is only ONE nipple that is so afflicted and invariably it is the nipple contralateral to the diseased artery!

Having brought the auditorium to a stunned silence, including the guest lecturer, the man who has the floor, finishes his own presentation with an impassioned plea that ALL women who present with a TIA should have mandatory palpation of both breasts. It would, he exhorts with a flourish, be negligent for the audience to do otherwise. It has been, he states with a degree of pride, a routine part of his physical examination since he made this initial discovery more than 15 years ago.

Day 2 awaits me!