Stroke symptoms, a clear-ish MRI, and a psychiatric hold

I went to a local hospital’s emergency department with worsening visual saccades, dizziness, slurred speech, worsening dizziness, and left-sided weakness. These are textbook stroke symptoms, and I knew that—I’m a former first responder.

At the time, I had already been diagnosed with visual saccades and double vision for over a year. I had a positive perilymph fistula (PLF) diagnosis and was awaiting surgery. My autonomic nervous system has been declining. None of this was new, but the severity was—and the new symptoms were alarming to me. I can no longer drive.

New and worsening symptoms

On top of the existing issues, I was experiencing difficulty swallowing.

• Severe, sharp left-sided throat pain
• Worsening tremors and left sided weakness
• A slight facial droop that had been getting progressively worse

These aren’t symptoms I would wait and see. I went to the ED because that’s what you’re supposed to do.

Five days earlier, the throat symptoms had been severe enough that my inhaler wasn’t controlling the throat swelling—I had to administer an EpiPen at home before going in. A CT of my neck with contrast was ordered to look for “deep space abscess vs foreign body vs globus sensation.” It came back normal. No one looked any further.

The MRI

A brain MRI was performed. It was mostly clear—a white matter pattern was still present from a baseline MRI, consistent with what had been seen before. I was asked whether I believed my MRI was clear. I said yes, because it was. Likewise, I agreed with the imaging. I wasn’t there to argue about MRI results; I was there because my body was doing things it shouldn’t be doing, and the clinical picture warranted evaluation regardless of what a single scan showed.

The hold

After agreeing that my MRI was clear, I was told that I had been to the ER too many times without any findings, that my family had concerns, and I was placed on a psychiatric hold.

Let that sit for a moment. I presented with stroke-like symptoms. I had documented neurological diagnoses. Furthermore, I agreed with the imaging findings. And the response was to question my mental state and restrict my freedom.

Getting out

I was placed in an unlocked room with other psychiatric patients. As a former first responder, I’ve seen what can happen in those environments—and I calmly explained that I could not safely be in that setting. I had people advocating for me, which helped. Eventually, I was released.

What I found later on the MRI

After the fact, I went back and reviewed the MRI report carefully—with help.

The findings section of the radiology report documented “mild cerebellar tonsillar ectopia not meeting criteria for Chiari I malformation with only partial effacement of the CSF in the foramen magnum.”

But here’s the thing: that finding was completely omitted from the radiologist’s impression. The impression—the part that every other provider reads—listed only two items: no stroke and unchanged white matter. Any provider who glanced at the impression instead of reading the full report would have missed it entirely. And based on what happened, it appears that’s precisely what occurred.

Cerebellar tonsillar ectopia—even when it doesn’t meet the formal threshold for a Chiari I malformation—can cause exactly the kind of symptoms I presented with: dizziness, swallowing difficulty, slurred speech, weakness, and facial involvement. The cerebellar tonsils pressing into or near the foramen magnum can disrupt brainstem function—the very area that controls the things that were going wrong.

This is a pattern I’ve seen throughout my diagnostic journey. A finding that doesn’t meet the full threshold for a named condition gets dismissed as insignificant—even when the symptoms match perfectly. I was diagnosed with thin bone in my inner ear that doesn’t meet the criteria for a full dehiscence, but a specialist confirmed it was still symptomatic and performed surgery. The cerebellar tonsillar ectopia follows the same logic: “not meeting criteria” does not mean “not causing symptoms.”

So the MRI wasn’t as clean as the ED team concluded. The finding was documented in the body of the report, excluded from the impression, and never addressed. Instead of further neurological workup, I got a psychiatric hold.

What this says about complex patients in the ED

I’m not writing this to be dramatic. I’m writing it because this is what happens to patients with complex, multi-system conditions when they walk into an emergency department. The symptoms are real. The diagnoses are documented. But when the imaging doesn’t show something obvious and the presentation doesn’t fit neatly into a protocol, the path of least resistance is to call it psychiatric.

A positive PLF diagnosis, documented visual saccades, double vision, autonomic dysfunction, worsening neurological symptoms—none of that mattered once someone decided it was in my head.

If you’re a complex patient reading this: document everything, bring someone with you, and know your rights. The ED is built for emergencies it can recognize. When yours doesn’t fit the mold, you may find yourself fighting for something more basic than treatment—you may be fighting to not be held against your will. Find an ER willing to work with you, not against you.