CEREBROSPINALECTOMYDaughter: "His watch gave him a sleep score of 41." Me: "Out of what?" Four of these. If you know, you know. SEND this to the person who will get every one. Daughter: "His watch gave him a sleep score of 41." Me: "Out of what?" Daughter: "It does not say." Me: "Then it is not a number. It is a mood." Team: "His pupils are different sizes — should we scan him?" Me, holding up his driver's license from 2011: "They were different sizes here, too." Cousin: "My MRI report says something about white matter." Me: "Read me the whole sentence." Cousin: "A few nonspecific white matter spots, likely age-related." Me: "You read four words of that sentence." Cousin: "I read the scary four." ER: "Facial droop, twenty-nine, nothing else wrong with him." Me: "Has he been outside?" ER: "...it is August." Me: "Then that is a yes, and I want the tick question asked out loud." Late summer, a young adult, an isolated facial palsy, and a tick-endemic zip code. The season is part of the differential, which is why the calendar hangs where I can see it.
EXPLAINED (ACCURACY-CHECKED)
(1) Consumer wearable sleep scores are proprietary composite indices, not validated diagnostic measures; polysomnography remains the reference standard for diagnosing sleep disorders. (2) Benign physiologic anisocoria is common (present in roughly one in five people) and is stable over time; comparing old photographs is a standard bedside method for establishing that a pupillary asymmetry is chronic. (3) Nonspecific T2/FLAIR white matter hyperintensities are extremely common incidental findings on brain MRI, increase in prevalence with age and vascular risk factors, and are routinely reported with qualifiers such as 'nonspecific' and 'likely age-related'. (4) Lyme neuroborreliosis is a recognized cause of peripheral facial nerve palsy, particularly in endemic regions and with a marked seasonal (late spring through summer) distribution; bilateral facial palsy is a classic presentation.
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