CEREBROSPINALECTOMY
Resident: "He wiped his nose right after the seizure." Me: "Which hand?" Resident: "...His right." Me: "Then look at the right temporal lobe first." Resident: "You are localizing off a nose." Me: "I am localizing off a nose." Postictal nose wiping is a real lateralizing sign — the wiping hand usually points to the side the seizure came from. Send this to the resident who thinks semiology is soft.
EXPLAINED (ACCURACY-CHECKED)
Postictal nose wiping in temporal lobe epilepsy is a described lateralizing sign: the hand used is typically ipsilateral to the seizure focus. In a series of 391 patients with medial temporal lobe epilepsy it correctly lateralized the focus in about 75% of cases — useful, not absolute.
PubMed: Dupont et al., 'Lateralizing value of semiology in medial temporal lobe epilepsy,' Acta Neurol Scand 2015 — ipsilateral postictal nose wiping correctly lateralized in 75% (PMID 25855246, doi 10.1111/ane.12409). Review: Horvath et al., Ideggyogy Sz 2008 (PMID 18763478). Card says 'look there first,' not 'that is the answer,' which matches the 75% figure.
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