November 21st, 2008
10:27 AM ET

What happened to Mukasey?

By Dr. Sanjay Gupta
CNN Chief Medical Correspondent

Last night, Attorney General Michael Mukasey collapsed while giving a speech. CNN had a camera rolling during the event, giving us an unusual look at what happened. I got a call in the middle of the night to come take a look. (Watch Video)  Even doctors, while we read about diseases and see patients after they end up in the ER, we hardly ever witness things like this. I decided to blog about it this morning, hoping we might all learn something from seeing what happened to Mukasey.

During his speech, he seemed to have word-finding difficulties. He started to say a word, paused and repeated it. He then began to slur his words, and had a slight drooping of the right side of his face. After that, he slumped forward and passed out, requiring assistance to the ground. All of these events serve as clues as to what may have caused the problem in the first place.

Word-finding difficulties are sometimes an indication there is a problem with the speech center of the brain, typically located on the left side of the brain. It could be because of inadequate blood flow to the brain or sometimes bleeding within the brain itself, as was the case in late 2006 with Sen. Tim Johnson. (Read more) The fact that the right side of his body began to droop and he slurred words was also important signs. After all, the right side of the body is controlled by the left brain. Another clue:  He seemed to pass out, probably because of overall decreased blood flow to the brain. And, finally, he reportedly is now doing well able to talk and in good spirits. Clearly, whatever caused this seems to be temporary.  It could have been a fainting spell.

In the emergency room, doctors probably checked his blood pressure to see whether he was dehydrated, drew his blood to look for a blood sugar that was too low or other abnormalities. They may have obtained a CAT scan of his brain and taken a look at his carotid arteries, the vessels that lead to his brain, to see if there is any blockage, and his heart to see if any clots were present that may have traveled from his heart to his brain.

One of the questions his doctor will most likely want to answer: Was this a TIA, a transient ischemic attack, also known as a mini-stroke? That is a temporary interruption of blood flow to the brain. The person may experience a sudden weakness or numbness of the arms, legs and/or face, difficulty with speech and loss of balance.

If you have ever experienced those things, you should definitely tell your doctor about it – even if the symptoms lasted just a few minutes. That’s because about a third of people who have a TIA go on to have a full stroke sometime in the future.

Here’s the good news: Preventing that stroke may be as simple as starting an aspirin a day or another blood thinner. That may be all that is needed for the attorney general as well. We wish him a speedy recovery.

Editor’s Note: Medical news is a popular but sensitive subject rooted in science. We receive many comments on this blog each day; not all are posted. Our hope is that much will be learned from the sharing of useful information and personal experiences based on the medical and health topics of the blog. We encourage you to focus your comments on those medical and health topics and we appreciate your input. Thank you for your participation.

soundoff (81 Responses)
  1. Joanne, Syracuse, NY

    My mother had a TIA last summer. Thank you for letting us know that one aspirin a day may help eliviate a future stroke.

    November 21, 2008 at 11:56 | Report abuse | Reply
  2. mark

    It's not a good idea to give blood thinners like asprin if a person is having a hemorragic stroke.

    November 21, 2008 at 13:21 | Report abuse | Reply
  3. Mr. okka maung

    Dear Dr. Sanjay Gupta,

    My name is okka maung and I live in carlsbad,NM. I have just watched the news about Our AG last night and this morning. Same thing happen to me on 11/7/08. I was passed out on 11/7/08 in the evening and woke up in ICU the next day. they took CAT scan,MRI,
    and brain EKG test. Heart specialist and neurologist also check on me. Eventually, they did not find anythying. Also, they also spinal test.
    All the test come back clean. Right now, they give me baby asprin and kepper for the brain.
    That's my story. have a nice day.
    okk maung

    November 21, 2008 at 15:03 | Report abuse | Reply
  4. Karen

    Hello Dr. Gupta,

    I had experienced weakness and numbness on my left and right sides of my body at different times. These episodes only lasted a few minutes. I told my doctor about it, but she said that I am too young to have a stroke. I am 58 years old. I would like to take an aspirin a day, but I suffer from gastro esophageal reflux disease and I am concerned that the aspirin may cause more acid to be produced in my stomach. What should I do>

    Thank you for your help.

    November 22, 2008 at 02:47 | Report abuse | Reply
  5. Brandi - bottom of the boot

    i agree with you Sanjay. the speech disruption was the first thing that stood out to me. looked like a TIA to me.

    if a person faints, they dont typically have those additional occurrences, do they? i have never seen that with a fainting spell.

    anywho, glad he is doing better.

    November 22, 2008 at 05:18 | Report abuse | Reply
  6. Jonathan Rodriguez

    As a first-year medical student, I may be ignorant of the details, but I thought it to be a little strange that considering his symptoms (and the evidence for those symptoms using the video tape) doctors diagnosed what had occurred merely as a fainting spell. I thought that slurred speech, unilateral paralysis, dizziness, and passing out are strong indicators for a stroke, even if it was temporary. What in particular led people to ignore these symptoms and declare it a "fainting spell"?

    November 22, 2008 at 10:37 | Report abuse | Reply
  7. Dan

    You don't have to be of a certain age to have a stroke. My wife had a catastrophic stroke in her early thirties. The doctor told us that while most stroke victims are older, he knew of an infant that had a stroke.

    November 22, 2008 at 11:49 | Report abuse | Reply
  8. anonymous

    To the person who said, "Thank you for letting us know that one aspirin a day may help eliviate a future stroke":

    THAT IS NOT CORRECT. He said, it "may be as simple as starting an aspirin a day or another blood thinner". There is a substantial difference...you should see a doctor or even a pharmacist before making medical choices like that.

    November 22, 2008 at 11:55 | Report abuse | Reply
  9. Shannon

    karen, I'm no doctor, but change doctors immediately. Any doctor that says 50 is to young to have a stroke, isn't a very good doctor. Your symptoms could be nothing, but ask a doctor who knows, not one who patronizes you.

    November 22, 2008 at 12:02 | Report abuse | Reply
  10. Anna, MO

    I have witnessed people having these same symptoms many times during the 30+ years as a nurse, and believe the "fainting spell" is for public relations rather than the real diagnosis. He as the patient has the right to refuse to let the real diagnosis become public, even if he is a public servant. It was probably decided that the news of a TIA would send a huge ripple through the news media and since he will be leaving the Justice Department in January it was more prudent not to release it. It keeps things more calm. It was also not unusual to see him being release so quickly and for him to look so good. The only thing that would have slowed his release compared with most people, is the fact that they were able to accomplish all of the tests so fast. Most people have to wait but I am sure that due to his position, things were made to happen quickly. I'm sure he probably needed to sleep when he got home, because he probably didn't get much in the hospital.

    November 22, 2008 at 12:20 | Report abuse | Reply
  11. Tony State College

    Having just suffered from a similar TIA with no permanent damage found, I have researched the subject and determined that sleep apnea may be a pre-cursor for such events. I am working on relieving this together with a baby aspirin daily hoping that this will greatly reduce the likelihood of a repeat. I would be interested in knowing whether the AT suffers at all from sleep apnea.

    November 22, 2008 at 12:27 | Report abuse | Reply
  12. CW

    It looked like a TIA to me. I think the press release said "fainting spell" to allay concerns. I have fainted a couple times due to extreme illness and it happens all at once – no slurring of words and then collapsing.

    Mukasey had all the "FAST" symptoms: Facial weakness, Arm weakness, Speech difficulties, Time in brain.

    Good thing others there noticed, kept him from falling and sought immediate medical care.

    November 22, 2008 at 12:38 | Report abuse | Reply
  13. lousiana neurologist

    The symptoms as described are not compatible with syncope or simple fainting. They suggest decreased blood flow but not eough info is given to distinguish left hemisphere from brainstem problems.Slurred speech differs from aphasia a more specific speech disturbance.
    I agree with some of the comments above. The history , especially the facial weakness is worrisome. More than fainting or syncope is sugested.
    He needs a carotid ultrasound, a very simple noninvasive test and possibly an mri/mra.

    November 22, 2008 at 13:06 | Report abuse | Reply
  14. Robert


    I can say for sure that 58 is not "too young" to have a stroke. Get another opinion. Both of my grandfathers passed away at 53 due to heart disease, and my Father had a stroke at 53 which paralyzed his left side, and left him unable to swallow. He fought his way back from that, recovering use of his left side though having no sensation. Two years later, he had a second stroke, which he again recovered from except for his left arm, which he can no longer use. Prior to the age of 53, I can only remember Dad being sick or seeing a doctor (even for a checkup) once, he was the healthiest person you would expect to meet.

    Don't ignore your symptoms, get a second opinion.


    November 22, 2008 at 14:08 | Report abuse | Reply
  15. michael

    i agree with jonathan rodriguez. this certainly looked like more than a locking of the knees-type fainting spell. why wouldn't his doctors want us to have the truth of his condition?

    November 22, 2008 at 15:44 | Report abuse | Reply
  16. Bob

    In response to Karen's concern about aspirin causing an increase in her stomach problems: they make an aspirin that is enteric coated for people with stomach problems. Not sure exactly what that entails, but it causes the aspirin to dissolve in the intestinal tract rather than the stomach. I take them because I have had ulcers in the past. I've had no problem taking a daily dose of this kind of aspirin. Of course, you should consult with your doctor before starting any such regimen.

    November 22, 2008 at 16:43 | Report abuse | Reply
  17. karin

    how can everything be just fine? he was shaking and then repeated his words and then passed out. if this wasn't a mini stroke – i would be amazed. just another white house lie. it is a habit with them.

    November 22, 2008 at 17:58 | Report abuse | Reply
  18. anon

    Mark is right about not giving a blood thinner to someone have a hemorrhage.

    November 22, 2008 at 18:35 | Report abuse | Reply
  19. Matt

    Even seemingly benign over-the-counter drugs like aspirin can lead to problems. If you (or your mother, Joanne) think you should take an aspirin for cardiovascular or other reasons, you should check with your doctor first.

    Also, aspirin is not necessarily contraindicated in people with GERD, if you think you have had a TIA or stroke you probably want to talk to your doctor about it, as the benefits probably outweigh the risks of taking it. And if you have a problem with it, there are other drugs you can take which will reduce your risk of stroke without as many GI adverse effects.

    58 is certainly not too young to have a stroke. I admitted a 55 year old to the hospital just the other night who had just had her third stroke. It depends on your risk factors. High blood pressure, high cholesterol, smoking, diabetes, and common heart arrhythmias are all risk factors (among others), and there are more and more people out there who have many or all of them.

    November 22, 2008 at 18:51 | Report abuse | Reply
  20. Barbara

    Jonathan– I am not a doctor but I am willing to bet that the AG does have a medical problem but it will not be disclosed unless there is another major episode before January 20, 2009. The fact that we have a huge financial crisis going on and it is the end of a presidential administration, the powers that be may have chosen to down play his health issues for now. I am no expert but I do follow the news closely and it would not be the first time that info was not disclosed because of potential security (physical and cyber) risks to the country. Let's just all pray that the AG is really fine and will live out the rest of his life in good health.

    November 22, 2008 at 21:06 | Report abuse | Reply
  21. Sterling

    I too thought what I was seeing on T.V. to be a TIA. I guess that's why I'm just an EMT and not a Dr.!

    November 22, 2008 at 21:28 | Report abuse | Reply
  22. Bubba Gump

    Any possibility he just locked his knees too long while standing? It was interesting that his legs did not buckle and fall. He appeared to have some sort of oxygen loss to the brain(slurred speach and droopy face) and fall forward a bit. We were taught in the military not to lock the knees as it would cause you to pass out.

    November 23, 2008 at 02:11 | Report abuse | Reply
  23. Tom Dawson

    Are physical exams of some sort part of the short list vetting process?

    If not probably should be.

    November 23, 2008 at 17:07 | Report abuse | Reply
  24. David

    Neurocardiogenic Syncope

    My brother had fainting episode in the past 48 hours and this is what Docs told him. He is fine and has been tested for everything. Maybe same happened to AG Mukasey.

    November 23, 2008 at 21:31 | Report abuse | Reply
  25. peedee

    Years ago I went numb on my LEFT side while writing a check at a supermarket. My whole left side (face, too) went numb and I collapsed on the floor. Within a few minutes I was ok enough to walk and get in the car and go to the hospital. I was checked for all kinds of things....(CAT scan, EKG, bloodwork, etc.).

    Turned out to be Lyme disease but was not diagnosed at the time – and only much later. Symptoms worsened over time. In my case it has gotten into my neurological system. I did not get Bell's Palsy (facial paralysys and accompanying symptons) – as my fahter in law had with his undiagnosed Lyme disease. But, I know many who have had Bell's Palsy who had Lyme disease. It's fairly well known now that Bell's can be a symptom of Lyme disease.

    People don't generally think of Lyme when someone passes out or faints, but I do now. Years after the original case, I still have a slight speech impediment as the Lyme apparently got into a part of the brain that antibotics cannot reach and eradicate completely.

    Stroke always come to mind first, but when someone 'recovers' as quickly as he seemed to, I naturally now always think of the neurological system and the potential of having Lyme disease. Tests for it, unfortunately, are still not definitive enough to rule it in or out but if caught early, antibiotics usually clear it up quickly and successfully.

    November 24, 2008 at 00:43 | Report abuse | Reply
  26. bmh, rt(r)(ct)

    this reply is for karen who was told she was too young for a stroke.
    get a second opinion from somebody that specializes in neuro...
    i'm a board certified ct tech with 16 years experience and examine alot of patients with these types of symptoms. just 4 hours ago, we had a 57 year old female patient that came into the er unresponsive. on her ct head exam, she had a severe intracranial hemorrhage (possibly from a ruptured berry's aneurysm), and she passed away less than 2 hours later. her family's devastated.
    take care and good luck.

    November 24, 2008 at 01:56 | Report abuse | Reply
  27. Tim M

    Everything I know about neurology comes from being a patient, but I wonder about whether a complex partial seizure couldn't produce symptoms like that? A bunch of my friends with epilepsy interpreted the video that way, but we have only our own experiences to compare.

    I'm not completely clear how one does a differential diagnosis to distinguish seizures from TIAs. I know from my own experience that one looks for evidence of bleeding or clotting in a brain scan, that one looks for carotid artery or heart issues, and that one looks for slowing or spiking in an EEG, and I think there's something about clotting enzymes? It would be interesting to hear a quick summary from a professional, though.

    Happy Epilepsy Awareness Month, anyway!

    November 24, 2008 at 08:48 | Report abuse | Reply
  28. Donald

    As strange as this may sound, the problem could be in how he was standing. The military ALWAYS warns its troops not to lock their knees while in formation (that is to push your knees all the way back to lock them). This causes restriction of blood flow that could lead to blacking out. I have personally seen this happen many times. Yes, it could be that simple.

    November 24, 2008 at 08:49 | Report abuse | Reply
  29. Melissa, Los Angeles

    @ Karen I would recommend you see another doctor as well. My friend had a stroke when he was a teenager (he's now in his early 30's). Luckily he didn't have any long term effects – he did have to relearn some skills though.

    November 24, 2008 at 18:15 | Report abuse | Reply
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