So… I’m writing a medical memoir/nonfic book, and as part of the research, I’m going over old medical records from after a car accident several years ago. There are a lot of xrays and lab reports. One summary of a CT scan stated that a subdural hemotoma was found in my brain (between the dura and the brain itself, I think, to get technical.) The next scan (2-3 days later) didn’t find anything, or any evidence that there had been one.
Is that result normal, and is it what you’d expect to see? I honestly don’t know if the answer to that question is yes or no. But there are so many smart people here-- I’ll bet somebody knows the answer!
I am not a medical person, but injuries and bodies are really interesting to me.
You’re probably thinking about brain bleeds as being really dangerous, really worrisome, and they are, but maybe not for the reasons you’re thinking about. The main reason that a brain bleed is considered dangerous is a question of immediate pressure. (There is a related issue of the bleeding blood not actually getting to where it is supposed to get to nourish other brain tissue, but this seems from your description like it was a small leak, not a huge enormous thing, so I’m not going to deal with that bit.)
Your personality and abilities are all contained in a really squishy spongey thing that doesn’t react well to increased pressure (from anything - concussions, swollen bits from infections, extra brain fluid, bleeding… ) so doctors are usually pretty on-point about watching out for your brain to release the pressure or fix the problem so that it doesn’t ever impact the brain (or at least, as much as possible).
Otherwise, blood vessels break and heal all the time - it would act just like a bruise anywhere else, the fluid leaks out, dribbles all over the place, clots up and goes nasty colors, and then eventually gets re-absorbed by the system and cleared up as part of the healing process. If you looked really closely at the exact point in your vascular system where the break happened, you might find a tiny little bit of a scar, or ghostly remnants of bits of dribbled blood that got incorporated into neighboring tissues, but that’s not a given.
Our bodies are pretty phenomenally good at cleaning themselves up from injuries, and the brain is no exception to that - it’s just that even a phenomenally good clean-up can be rough on a very delicate and personally important organ.
Subdural hematomas are one of the more common brain bleeds. They can get better (as yours did), stay the same for a while, or get worse. The repeat scan was mostly looking for the last possibility.
When they get better, it is usually a slow and steady process, but sometimes it can be very fast, especially for small ones. Sometimes the improvement is so fast, one wonders where the blood went; it’s possible that it spread out over a larger area, becoming MUCH thinner.
In your case, the bleed had become undetectable by CT. Possibly an MRI would have shown it. An autopsy done at that time would definitely show the abnormality. An autopsy done now might show microscopic changes at the site (if they knew where to take slides fom.
As a CT Tech who worked Trauma a lot, I can say that a sub-dural is NOT a brain bleed. We called 'em cranial bleeds, fwiw. It is outside the brain’s thin 3 layers of meninges (dura layers) ‘container’, per se. Actual brain-bleeding is readily visible w/ CT with proper contrast/level of preparing images from data - soft-tissue levels -v- bone detail and in-betweens to tweak things as needed, almost an art form at times. Many times, with Level I Traumas (worst types, like ejection from car wreck, multiple body-area injuries, etc), I’d inject the iodinated IV-contrast and do the chest/abd/pelvis-bladder portions first, then do the head/cervical scan as, if there was a brain bleed, the IV-contrast would be very apparent where it should not be, so to speak.
The amount of bleeding between brain and cranium can/will compress the actual brain itself (including ventricles), causing too-high pressures for bloodflow/function. Never good news. Really bad ones get a ‘nail’ installed into cranium to monitor pressure upon brain - ugly looking to have an ~8" big ‘stick’ w/ lots of wires attachedd to it atop your head, trust me.
I’ve done many follow-ups of bad head-trauma, and usually, if scan is done at higher detail-level than ‘routine’ scan protocol, the residual (slightly thicker dura and/or teensy bits of blood clots, etc) is seen if known to look for it. Quick view by a Rad can easily miss such things without a good ‘history’ to work from, IME. I remember only a few where all signs of sub-dural bleeds were gone totally, and the Neuro Docs said that was because it was resorbed/dispersed before it could ‘solidify’, so to speak. Rare, per the experts I worked with regularly.
Typical/routine CT Brain protocols use thicker slices (5 &10mm) than post-traumatic ones (2-4mm in my times), fwiw. A fast spiral CT unit can do the scan fast enough for the extra computer recon-time not being a deterrent to getting patient into surgical suite stat w/ surgeons having exacting details of what they are getting into… Depends on the Tech/Radiologist/Trauma Team taking care of patient and how much info they need to treat effectively. Keeping the image-slices on the thin side means more rads, but its risk-v-benefit in the end. My nuking of numerous serious MVA’s/traumas has literally saved lives, and I do not feel guilty of that part at all. A slice of 10mm can easily not show a smallish defect when computer averages up the data of each slice, but doing many thin ones will show detail MUCH better.
MRI is obviously best at soft tissue(s), but its rare to use such in Traumas since all the eqpt is not non-affected by mag-field. MRI’s are usually done days/weeks later, when patient is not life-threatened, and can lay still long enough. MRI excels at that point. The number of folks/eqpt in a Trauma situation makes MRI impracticle initially, of course. Too much time and too much risk to others unaware of mag-fields effects, etc.
The OP would have been better served if he/she had gotten an MRI instead of annother CT - no ionization and better viz of possible soft tissue damage. Dead brain tissue and functioning tissue look alike on CT most of time unless IV-contrast is used, IME. And MRI IV-contrast (gadolinium-type, IIRC) really highlights the areas of non-working brain, IME.
Yes, a subdural bleed is not technically ‘in the brain’, but in starting the discussion, it is reasonable to lump all intracranial hemorrhages together. A subdural bleed lies *within *the meninges, under (‘sub’) the dura and outside the arachnoid.
If Anise was asymptomatic, she probably did not need an MRI (and some might even question the value of a repeat CT, for that matter).
Well, I’d kind of rather NOT do an autopsy right now… :eek: An MRI done about two years after the accident showed diffuse axonal injury, I think.
Anyway. Thanks so much for all the info! Yes, it was a CT scan without contrast (they both were.) Asymptomatic is… um… not the word I’d use. It was one of the MANY injuries in a car accident, and a Level 1 trauma situation, all right. Many serious things wrong, and lots and lots of surgeries to follow. Even more :eek:. I don’t actually remember any of this (or basically anything that happened for at least the next three weeks.) It’s all from the medical records.
Okay, here’s another question. My grandmother told me afterwards that (and this is pretty much an exact quote, from what I can remember) “they almost put a steel plate in your head.” Again, I don’t remember anything about it, and Grandma wasn’t always completely reliable… is this something that realistically would/could have been done?
I rarely came across use of steel plates on craniums, but it does happen in unique situations. I’ve seen a LOT more use of ‘plastic-type’ cranial repair, but in distant past maybe steel-type material was more appropriate (?). I’ve done a fair number of 3-d CT’s for modeling of plastic/polymer implant(s) for cranial/facial repair post-trauma.
More commonly, if there is massive/persistent sub-dural swelling, then it is not unusual to remove portion(s)/plates of cranium itself and embed it surgically into abd/pelvis area to keep it ‘alive’ while brain is given room to swell and recover without compression complications. This is only done when pressures in cranial vault exceed acepted levels and almost a hail-mary type of attempt to keep person alive, fwiw. Eerie to do a bandage change on person with ‘open skull’ wound. Later on, if pt’s condition improves (basically, doesn’t die) the bone ‘plate’/pieces is re-installed to cranium and regrowth occurs, similar to a healing fracture, so to speak.
First time I saw this was when I was doing a follow-up belly scan and there was this weird big/flat bony ‘artifact’ anterior to bowels down low in abd. Thought machine was effing up, so I got Radiologist to look at it and he called Neuro Team who told of what they were now doing to preserve cranial bone(s) in extreme situations. The last follow up scan showed excellent fusion of bony edges of the formerly removed surgically parts of cranium. Pretty cool stuff to see - kinda head-up-ass looking thing
Its also not unusual for cranial-trauma persons to simply go home missing parts of cranium that are easily palpable as ‘soft spots (like in infants’ heads, per se). Usually not largish area, maybe a few inches across on average. Usually in such cases, the pieces left after their trauma were unusable for reimplant or destroyed during the trauma, etc, but brain activity was normal for the most part in many of these folks who survived their initial insult to brain. They just had to be extra careful to avoid forceful point-pressure with that portion of head, of course. HTH
Blood from a subdural hematoma large enough to be picked up on CT is not typically likely to resolve within 2 or 3 days. If a traumatic subdural was considered highly likely at presentation , a delay of 2 or 3 days for the next scan is a long time to wait to see how the subdural is evolving.
CT scanning is dependent upon the quality of the scanner and a few other factors for the degree of sensitivity and specificity.
If your first scan was done in an emergency situation along with many other tests, and the purpose is to find potentially dangerous conditions, the reading will lean toward high sensitivity. Several days later, when the patient appears more stable, a follow-up study can be read with less need for sensitivity and a higher confidence that what might have mimicked a small bleed was artifact of some kind. The second reading will reflect the first if the radiologist has access to the first, so look for that.
It’s likely the first reading, in the context of the scan, reflected a possibility raised that was not actually there. While it’s not impossible a tiny bleed was seen the first time, and not seen the second time because the tiny amount of blood dispersed, that is not likely.
An MRI would have been a more sensitive followup test, but unnecessary if a second CT did not show any blood at all.
No; it does not appear you were anywhere near needing a steel plate. Those are put in if part of your skull needs to be removed and cannot be salvaged.
In Grandma’s defense, I’m sure that it was a very stressful time for her. We use all kinds of mental tricks to manage and compartmentalize new and complex information even in the best of times. “Steel plate in the head” is a not uncommon Hollywood trope (i.e. “Biloxi Blues”, “Christmas Vacation”), so it’s possible that she equated something the surgeon said with that. It’s even possible that the surgeon actually said it, rather than go into details about plastic reconstruction or autografting.
