Monday, December 31, 2012

Hillary Clinton and Subdural Hematoma

 Addendum to the post below:  New reports show she may have a venous blood clot in a vein that goes to the brain, rather than a bleed under the skull known as a subdural hematoma.  The treatment is quite different as venous thrombi (clots) are treated with blood thinners.  The information below is still quite accurate but may not apply to Madame Secretary Clinton.....

 

 

Secretary of State,  Hillary Clinton has been hospitalized with a subdural hematoma after fainting, hitting her head and suffering a concussion less than a month ago.  Here is a repeat of a blog I did a few years ago about "a bump on the head".


Even a minor blow to the head can lead to serious trouble. A close relative of mine is an active, sharp guy in his 80's. He was hospitalized a few weeks ago with an infection and like many older folks, he wasn't aware of how weak he was and he tried to get out of the hospital bed and go to the bathroom and "whoops", he slipped and fell. Hospitals all have procedures in place to prevent falls and they monitor the number of patient falls and try very hard to get to zero. But, try as they do ...falls happen. OK, he got a bump on the forehead and a bruised shoulder but, fortunately no broken bones.

Fast forward 4 weeks. One weekend Allen was slurring his words and not walking well. You would think they would rush to the hospital to get things checked out, but they decided to wait and see if he was better the next day. This is a HUGE mistake. In a prior post I wrote about stroke and the need to seek immediate attention for any change in speech or one sided weakness. I am always surprised at how many patients do not seek medical help and instead wait to see if things will improve on their own. Ten out of ten times, symptoms like this do not improve.

Allen and his wife finally went to their doctor and he was immediately admitted to the hospital. A computed tomography (CT) scan revealed a large hematoma on his brain. The fall that occurred several weeks earlier had caused bleeding around the brain. Blood vessels can be damaged when the skull receives a blow, especially when the head hits a hard surface like the pavement. A hematoma is caused by a bleeding vessel and a subdural hematoma occurs when blood collects in the small space between the brain and the skull. The blood clot presses against the brain and the resulting pressure can severely damage the brain unless a neurosurgeon removes the blood. Fortunately, blood and blood clots are easy to detect with a CT scan.

After the subdural hematoma was diagnosed, Allen was rushed to surgery and the blood clot was removed. He has a large "s" shaped scar where the skull was removed (and replaced) and he is now home and doing great. His speech is back to normal and he continues to improve each day. Without surgery, Allen would not have made it. It is always nice when a story has a happy ending.

There are several take home messages here:
1. Any sudden change in speech or weakness or trouble walking needs immediate attention at the Emergency Department of the closest hospital.

2. Any fall that causes facial bruising or loss of consciousness needs evaluation.

3. Any time the head smacks against a hard surface, there is a chance of brain trauma because the brain can strike the inside of the skull.

4. Symptoms can show up weeks after trauma so don't ignore changes in personality or behavior, especially in older folks.

5 comments:

Anonymous said...

Fascinating. I didn't know what type of clot she had. I thought it was a vein clot from being immobile from the fall. Thanks for the great explanation of subdural hematoma

Anonymous said...

Have you (or any readers) heard 1st hand success stories of offlabel etanercept (enbrel) injection treatment having a beneficial neurological effect on stroke patients?

Saw this in the chron and been wondering what physicians think:
http://www.sfgate.com/health/article/How-etanercept-is-aiding-stroke-victims-4128887.php

Perat said...

I think that she had venous sinus thrombosis. because the treatment that someone told in interviews are the use of blood thinner.
And long time ago she told reporter about her fear in venous thrombosis traid .

Bonsaiwino said...

I (67 yrs. - non-smoker) had a very similar situation like the man in your example. After falling & hitting my head a few months ago, I went to the ER & the initial CT scan was clear. However, as time passed I developed loss of balance & erratic writing. Three weeks ago, I began talking in nonsense syllables. We immediately went back to the ER, where I had a 2nd CT scan; this time it revealed a large subdural hematoma putting pressure on my brain, presumably the result of a slow bleed over the past 2 months. The following day a mini craniotomy was performed. This was 2 weeks ago. 4 days later, I was discharged from the hospital with no apparent deficits. Needless to say, I am very lucky & grateful for the results. My final post-op appt. is in 4 weeks; in the meantime I am not driving or having any alcohol. Here is my question -- is it safe to take Viagra 1/week to have intercourse? Thanks very much.

Bonsaiwino said...

I (67 yrs. - non-smoker) had a very similar situation like the man in your example. After falling & hitting my head a few months ago, I went to the ER & the initial CT scan was clear. However, as time passed I developed loss of balance & erratic writing. Three weeks ago, I began talking in nonsense syllables. We immediately went back to the ER, where I had a 2nd CT scan; this time it revealed a large subdural hematoma putting pressure on my brain, presumably the result of a slow bleed over the past 2 months. The following day a mini craniotomy was performed. This was 2 weeks ago. 4 days later, I was discharged from the hospital with no apparent deficits. Needless to say, I am very lucky & grateful for the results. My final post-op appt. is in 4 weeks; in the meantime I am not driving or having any alcohol. Here is my question -- is it safe to take Viagra 1/week to have intercourse? Thanks very much.