WESTBOROUGH, MA June 6, 2016 The Bike of the week is drawn by a 86-year old man who is undergoing inpatient rehabilitation for an acquired brain injury and stroke. Actually I rarely publish the drawings made by patients I see unless I am going through a dry spell of interesting clocks. The man who drew this bicycle was independent prior to a fall and driving. In this case, there was a a fall 2 months ago – in April 2016 from which he largely recovered. He underwent lab studies and a C-T scan of his brain being diagnosed with subdural hematoma (SDH). The C-T scan revealed a collection of blood in the frontal part of his brain known as a subdural hematoma (SDH) often associated with brain trauma from a fall or motor vehicle crash. The patient in this case had fallen in his bathroom. He had been prescribed a blood thinner and his atrial fibrillation which was stopped. These levels were supratherapeutic – too high making him at high risk for bleeding – in this case in his brain. He was taken off the blood thinner in the weeks following the traumatic injury to allow the bleeding in his brain to be controlled. In late May, 2016, he was found at home to be slurring his words and demonstrating right hand weakness. He was rushed to Cape Cod Hospital and diagnosed with a left MCA ischemic stroke and he was treated conservatively.
Bleeding on the brain is a life threatening condition that will eventually result in herniation of brain tissue and death unless it is controlled. Trauma can lead to edema or swelling of brain tissue. In many cases, neurosurgery is required to remove subdural blood allowing space in the skull for the brain to swell as much as needed to recover. In some rare cases, the part of the skull is actually removed to allow for brain swelling. By removing a portion of the skull the brain tissue does not efface ipsilateral tissue or cause herniation by crowding out other viable brain tissue.