Mini seizures and mini strokes: What you need to know after Mitch McConnell health scare

No matter one’s political leanings, U.S. Senate Minority Leader Mitch McConnell gave the world a real-life — and real-time — public health scare late last month.

While conducting his regular weekly Republican leadership news conference, the 81-year-old Kentucky senator suddenly stopped speaking, appearing to freeze mid-sentence, and then went completely silent for more than 30 seconds.

Concerned colleagues and aides came to his side and led him away from the podium.

About 10 minutes or so later, McConnell returned to the podium and continued his press conference. An aide told reporters that McConnell had “felt lightheaded and stepped away for a moment.”

However, virtually everyone who has observed the episode — either in person or on videotape — believes that the senator suffered from something more serious than a brief spell of lightheadedness.

And that includes the nation’s neurology experts.

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What might have happened to Mitch McConnell when he froze during news conference

CNN chief medical correspondent Dr. Sanjay Gupta said on the night of the incident that McConnell “clearly had some kind of neurological event” when he froze and that “he should be checked out” by his doctors as soon as possible.

Gupta conceded that McConnell’s abrupt change in “medical status” might have been potentially related to common issues like dehydration or a side effect of medication, but he also said more serious causes “like a mini stroke, a mini seizure, things like that” were possibilities.

Speaking to Newsweek, Peter Silburn, co-director of the Asia-Pacific Center for Neuromodulation at the Queensland Brain Institute, concurred with Gupta and notedthere were other possibilities as well.

"This sort of freezing — i.e., speech arrest, staring into space of sudden onset and non-responsiveness — can be seen in complex partial seizures in epilepsy, transient ischemic attacks (also known as TIAs or mini-strokes), psychological issues and fugue states, in anxiety and panic disorder to name a few," said Silburn. "These certainly need full neurological workups such as brain imaging and electroencephalography.”

In light of McConnell’s fall in March — which resulted in a concussion and broken ribs — Gupta, Silburn and other experts, such as Dr. Jeffrey Saver, a neurologist at the UCLA School of Medicine, and Dr. Lee Schwamm, a neurologist and stroke expert at Yale University, speculated that last month’s episode may potentially have been related to his previous injuries.

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‘Mini seizures’ v. 'mini strokes'

One of the reasons that so many experts speculated that McConnell may have suffered a petit mal seizure (also known as an absence seizure) is that these can develop after traumatic brain injuries.

Harvard University Medical School notes that “an absence seizure causes a loss of consciousness for 30 seconds or less. It is barely noticeable, if at all. The person simply stops moving or speaking. He or she stares straight ahead blankly and does not respond to questions. The seizure is short and hard to notice.”

The National Institutes of Health says that for every 10 people who suffer a traumatic brain injury, between 1 and 5 may experience post-injury absence seizures.

During a seizure caused by a concussion, there is a sudden abnormal electrical disturbance in the brain. That disturbance will emanate from the region in the brain where the injury occurred.

The Mayo Clinic explains that “a person having an absence seizure may stare blankly into space for a few seconds. Then the person typically returns quickly to being alert.” 

Doctors typically diagnose absence seizures via electroencephalogram (EEG) tests. These non-invasive tests record electrical patterns and any abnormalities in the brain.

To treat absence seizures, doctors usually prescribe antiseizure medications.

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‘Mini strokes’ or TIA

Some experts speculated that McConnell may have suffered from a transient ischemic attack (TIA).

A TIA occurs when there is a small disruption or problem in the blood vessels of the brain. This will cause a temporary decrease in blood flow to a certain region of the brain.

Harvard University Medical School notes that with a TIA (which can last anywhere from a few seconds to a few minutes) “the effects are most likely to be localized to a specific brain function, such as speech or vision.”

To diagnose a TIA, doctors will typically rely on magnetic resonance imaging (MRI) and/or magnetic resonance angiography (MRA) scans.

If they determine that a patient has had one or more TIAs, the goal then becomes preventing another one. TIAs are considered an early warning sign that a patient is at risk for severe stroke.

The first line of treatment to prevent future TIAs may include the patient being prescribed anti-platelet and/or anticoagulant medications.

What happened to Mitch McConnell that day remains a mystery

After his episode at the podium, McConnell later revealed that “the president called to check on me. I told him I got sandbagged” — a joking reference to President Joe Biden’s trip and fall over a sandbag at the U.S. Air Force Academy commencement in June.

McConnell has since appeared in public while the Senate is on summer recess but has not commented further about his health — other than to say he plans to continue serving in the Senate.  

One of the more interesting observations about McConnell’s episode — one that perhaps explains why he wasn’t immediately rushed to a doctor — came from Brigham and Women's Hospital emergency room physician and Harvard Medical School instructor Dr. Jeremy Faust.

“McConnell's colleagues didn't seem fazed by this [incident],” he wrote on MedPage, where he serves as editor in chief. “It's almost as though they'd seen this before and knew how to handle it. Partial seizures ... are always a risk after concussions like the one the senator suffered earlier this year. Based on the video alone, my impression is that any patient who experienced such an acute change in mental status would have required an immediate transfer to an ER for tests and observation.

“There's a caveat, though. If these events have happened to McConnell many times in recent months, it might have been determined by the senator's doctors that he and his staff need not activate 911 every time it happens.”

This article originally appeared on Palm Beach Post: Mitch McConnell freezes during presser. Was it seizure or stroke?