Brain injuries, like the one President Jimmy Carter suffered, are on the rise

Local neurologist says he's seeing more subdural hematomas every day

Fred Bodimer
November 14, 2019 - 2:36 am
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ST. LOUIS (KMOX) — Former President Jimmy Carter is recovering from surgery to relieve pressure on his brain from bleeding linked to recent falls.  The injury is called a subdural hematoma.

"Subdural hematomas are usually caused by any form of traumatic injury to the brain -- falling can be a common cause," said Dr. Jeroen Coppens, a SLU Care neurosurgeon at SSM Health Saint Louis University Hospital.  "It can also be linked to the fact that more and more of the population is on blood thinners today and so the risk goes up as you age with a combination of blood thinners and some form of mechanical hit to the head."

Mr. Carter's bleeding was related to two recent falls he had in his home.

Related: Former U.S. President Jimmy Carter injured in fall

"It's very common," said Dr. Coppens.  "We see patients every day coming into the hospital with subdural hematomas.  It's actually increasing in frequency just because life expectancy is increasing and because much of the population now due to either stroke prevention or underlying cardiac disease has to be on blood thinners.  That exacerbates the problem because now it may not even take a very significant injury to your head and it be just something in day to day life where you just hit our head on a door or a cupboard.  In the moment, it may not be that obvious to you -- but we end up seeing patients when these things escalate into eventually becoming a subdural hematoma that may need to be drained."

Treatment options depend on how bad the bleeding has become.  There are a variety of techniques that can be used to treat subdural hematomas.  

  1. Burr hole trephination.  That's where a hole is drilled into the skull where the subdural hematoma is located and the blood is suctioned out.
  2. Craniotomy.  This technique involves temporarily removing a larger sections of the skull to allow better access to the bleeding so pressure can be reduced.
  3. Craniectomy.   This is the most rare procedure where a section of the skull is taken out for a longer amount of time to allow the injured brain to recover. 

"They vary from having to do a bigger operation to actually drain the blood," Dr. Coppens tells KMOX.  "Once the blood becomes a little more liquid, then there are options of doing things that are a little bit smaller -- like drilling a small hole in the skull and putting a catheter in the fluid space between the brain and the skull to drain the blood."

So what are the symptoms?

"Chronic subdural hematoma is something that will slowly kind of come up where you will have some headaches, you may be a little bit confused over time," said Dr. Coppens.  "If you start having things like nausea or vomiting, those are warning signs that the pressure in your head is increasing.  Occasionally it can give you a seizure, but that's less common.  If your symptoms continue to grow, you may start to have some weakness on one side of your body.  And if you have that progression where just from one day to the next, or every couple of days, you realize you are getting worse -- with that underlying headache there -- then that's a reason to go to the hospital to get a CT scan.  

Dr. Coppens says the recovery process depends on the type and extent of surgery the patient undergoes....and the age of the patient, as well.

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