Polite Dissent

A request has been made for me to review New Excalibur #17 which details Talia’s recovery from her stroke. First, however, I’d like to take a look at New Excalibur #16, which features the stroke itself.

New Excalibur #16 “Fallen Friend, part 1”
Chris Claremont, writer
Scot Eaton, penciler

In Excalibur #16, Talia (Nocturne) suddenly suffers an apparent stroke. Visiting Dazzler in the hospital, she suffers a sudden loss of coordination, headache, numbness of both arms and legs, and then unconsciousness.

Generally speaking, there are two types of strokes. The most common (80%) is an ischemic stroke, where blood flow to one of the blood vessels in the brain is blocked by a clot. This prevents blood from getting to part of the brain, and this part will almost immediately stop functioning, and will die if blood flow is not restored quickly. The leading treatment for ischemic strokes are clot-busting drugs (also known as thrombolytics), but they have to be given within 3 hours of the onset of symptoms. Blood thinners may be used to prevent a subsequent stroke,

The second type of stroke is a hemorrhagic stroke, where one of the blood vessels in the brain starts to leak or bleed. This causes damage in several ways. First, the brain tissue beyond the bleed is denied its blood supply and can die, just like in an ischemic stroke. Second, blood is irritating to the brain tissue which causes swelling and inflammation. Third, if enough bleeding occurs, it can raise the intracranial pressure which can restrict blood flow to the entire brain. The treatment of a hemorrhagic stroke should come as no surprise: stop the bleeding. This may require surgery. Additionally, if a large amount of blood has collected, it may need to be surgically drained. Since the treatment for an ischemic stroke, clot-busters and blood thinners, will make a hemorrhagic stroke worse, you need to be sure what type of stroke has occurred before treatment is started.

So far, it’s not clear which type of stroke Talia suffered. Given her headache and loss of consciousness, a hemorrhagic stroke seems more likely as these are symptoms of increased intracranial pressure. However, no mention has been made of any surgery or neurosurgical evaluation. On the other hand, no mention has been made of thrombolytics or blood thinners either, though when Sage explains what a stroke is to Pete Wisdom, she only mentions ischemic strokes. Frankly, I’d be surprised if we ever find out for sure what type of stroke she had.

Doctor: Set up a fell series of x-rays — chest and skull. MRI’s as well — someone find out if we have to worry about her super-powers? And check with her teammates, she’s got different hand and feet structures, blue skin and weird eyes — are there any internal differences we need to know about?

I’m not certain why the x-rays were ordered. Talia was showing neurological symptoms and then she lost consciousness. The differential diagnosis would include stroke, seizure, hemorrhage, drugs, infection, or metabolic disorders — none of which show up on x-ray*. There is only a limited time window to treat a stroke, particularly an ischemic stroke, so there is no need to waste time getting unnecessary x-rays. An MRI makes sense because it has a good study for showing a stoke, either ischemic or hemorrhagic.

It’s nice to see a doctor taking super-powers into account , one would presume both for his sake as well as the patient’s. It’s what I would expect to see in a comic book hospital. Of course, in a comic book universe, we should probably add “telepathic disorder” to the differential — but then again, she doesn’t have a nosebleed, so maybe not.

Tomorrow: The requested review of New Excalibur #17 (plus I believe #18 is available in stores UPDATE: Oops. Not yet)

*to be fair, “trauma” would also be on the differential – and that would seem a likely possibility in a superhero who had recently been in a fight — and while trauma should show up on x-ray, it would show up on the MRI as well, so there’s no reason to waste time getting an x-ray. (Plus the x-ray wouldn’t give a good view of the brain itself, just the skull. ) Just go straight to the MRI (or CT).