Last week I was busy taking care of some patients. I reviewed the chart on a patient who recently had some falls and bleeding in the brain. She had a “subdural hematoma”.
This CT shows a medium size hematoma noted by the red arrows
What is a Subdural Hematoma?
Subdural hematoma is a medical term for bleeding between the brain and the skull. The bleeding can be a small or large amount and is easily seen on CT scan of the brain. The bleeding is due to bursting of veins on the surface of the brain. This is usually related to an injury to the head although the injury may be minor. Subdural hematomas happen more often in the very old. Another risk factor is brain injury such as dementia. Blood thinners also increase the risk for bleeding. As a result, sometimes doctors avoid blood thinners in patients in whom the risk of falling is very high.
A patient may not even feel anything abnormal despite the finding of a subdural hematoma. This is because the bleeding was slow, not large and has stopped. In these cases, surgery isn’t needed. Sometimes, follow-up CT’s are done to see if there is a change in the size of the bleed. Over a number of months, the blood disappears or can appear as an old “clot” on a follow-up CT scan. Subdural hematomas may not cause serious injury. However, they are an important sign of increased injury and frailty of the brain
A large, fast, or dangerously located bleed is much more serious. It can cause a severe headache, nausea, loss of strength, confusion, and coma. In this case a neurosurgeon is needed.
I’m frustrated at how “unGeriatric” care continues to be.
This patient has been cared for in multiple hospital systems in the past year. Care has been episodic. This means that she had appointments and then irregular gaps in follow up. She has Parkinson’s Disease. It was felt that she was falling because of her Parkinson’s Disease. But, when I saw the patient, it was immediately obvious how thin she is. She is 74 pounds. This was not highlighted as a problem. My guess is that this is assumed to be her baseline weight. I had to look carefully and read many notes to find out that one year earlier, she was 89 pounds. Such a large loss of weight in an underweight woman is an obvious risk factor for falls. Could her falls have been prevented?
November is family caregiver month.
The caregiver is the day-to-day eyes and ears to a patient. I wish that the healthcare system had contacted the caregiver regularly. I wish that the caregiver was asked how well the patient was eating. I wish that the caregiver had been given some guidance about weight loss. I want a future in which the caregiver is recognized as an important member of the health care team. The patient will benefit, the caregiver will benefit, and the healthcare system will benefit.
A friend asked me what I’m trying to do with GeriatricswithAloha.com. I have several goals. One goal is to put together a caregiver guidebook for care of frail older seniors. The patient I described above illustrates a very basic caregiving point. Appetite and weight must be monitored regularly. A more ambitious goal is to develop a support tool that caregivers turn to for 5 minutes a day. Caregivers would use it for a daily lift and some guidance. All this is very ambitious and will need hard work. Please wish me luck.
In my next post I will talk about weight loss in frail elderly patients.