Article about the clot Hillary Clinton really had—and why it would be easy to misdiagnose. | The Survival Doctor

Normal veins in the brain.

by James Hubbard, MD, MPH

The Clintons confused me this week. Oh, it’s not the first time, but this time it was Secretary Hillary and her blood clot in her brain. Well, it wasn’t really in her brain. It was … you’ll see.

As opposed to President Bill and what the meaning of “is” is, this time the key word was “clot.” I assumed, and shouldn’t have, that I knew what “clot” meant here. Fortunately, my wrong assumptions have lead to some The Survival Doctor teachable moments.

First Round of Reports and Wrong Assumptions

I read that Secretary Clinton had a clot in her leg. I assumed she had deep vein thrombosis (DVT). It seemed reasonable. She had the risk factors for it. I’ve actually written a little on DVT.

Her risk factors were:

  • An episode of deep vein thrombosis several years ago. If you’ve had it once, you’re at risk to get it again.
  • Possible prolonged bed rest or sitting. During a recent bout of vomiting and diarrhea, she apparently got so dehydrated that she fainted, hit her head, and got a concussion. In my post on concussions I explain that part of the treatment is rest. A major risk factor for DVT is lying around or sitting for prolonged periods of time.
Second Round of Reports

Next, I read that Secretary Clinton’s blood clot was not in her leg but between her brain and her skull. Okay, that made sense.

Her risk factors were:

  • Recent head trauma. She’d hit her head and injured a vein in her dura mater. That’s the outer of three membranes that cover the brain. The fact that her head injury had been a couple of weeks earlier didn’t matter. The symptoms of a subdural (below the dura mater) or epidural (above the dura) hematoma (clot) can come on immediately, or there can be no symptoms until weeks afterwards. The symptoms include increasingly severe headaches, vision disturbances, dizziness, confusion, and increasing drowsiness, to name a few.
  • Her age. These types of clots are more common in older people. (She’s 65, folks.)

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Third Round of Reports

But then, I read the doctors put her on blood thinners. Well, that didn’t make any sense. Subdural/epidural hematomas develop from an injured, bleeding blood vessel. The treatment for a subdural, which is the one she reportedly had, is to bore a tiny hole in the skull over the blood collection and drain out the blood. That takes the pressure off the brain. Taking a blood thinner would make the bleeding worse. Some writer got the facts wrong again, I guessed.

Finally, the Truth (Or I Assume)

And then, I read that Mrs. Clinton actually has a cerebral vein thrombosis. The cerebral veins run through the dura mater. These are the veins that leak and cause the subdural hematomas. But hers didn’t leak. Instead, a clot formed in one. That’s much more rare.

If the clot had been in a cerebral artery, she would have had a stroke. But the veins drain the blood away from the brain rather than to it. To clog one up with a clot is still dangerous, even life threatening. The dura mater holds in cerebrospinal fluid. A vein clot there backs up the fluid, causing increased pressure on the brain.

Fortunately, it was one of Mrs. Clinton’s side veins that clotted, and she has a duplicate on the other side of her head that can do double duty. Still, if not treat with blood thinners and medicines to try to dissolve the clot, only about twenty-five percent of people with cerebral vein thrombosis recover without at least minimal brain damage. With treatment, about sixty percent recover fully.

Final Lessons
  1. Take any change in head symptoms seriously, especially if the symptoms are getting worse. Apparently, Secretary Clinton was doing pretty well. Then, two weeks after her head injury, she began having increasingly severe headaches, vision disturbances, and nausea. It doesn’t matter if the symptoms occur in two years or even if you can’t recall any trauma, see a doctor ASAP for increasing headaches or problems with speech, sight, feeling, or muscle strength. When you can’t see a doctor? Well, that’s a big problem. There’s not much you can do but rest, and pray you’re one of the lucky ones who’ll recover without treatment.
  2. Don’t assume head symptoms are a stroke or from bleeding. If I’d seen a case like Mrs. Clinton’s in a disaster situation with no medical facility, I would have assumed a subdural and that she needed to have pressure taken off her brain. I would have assumed wrongly. Getting the person with any neurological symptoms to a medical facility and getting the needed diagnostic tests are essential to make a proper diagnosis.

The doctors are saying Secretary Clinton will make a full recovery. I wish her the best, but wouldn’t dare assume anything.

Has anyone had experience with anything like this? Something abnormal related to the brain? What were the symptoms? The diagnosis? Treatment?

 

Image by Reigh LeBlanc on Flickr.