Subdural Hematoma: Cause & Cure

By G. Jeffrey MacDonald

As Episcopalians awaited word Tuesday about Presiding Bishop Michael Curry’s urgent brain surgery in Richmond, Virginia, two medical-school professors explained the risks and outlook associated with draining a chronic subdural hematoma.

Dr. Alex Valadka, chair of the Department of Neurosurgery at Virginia Commonwealth University Medical School, said the procedure involves drilling a hole in the skull and draining built-up pools of blood in the wake of a head injury.

“I would call it brain surgery because that’s the whole goal: to take the pressure off the brain,” Valadka said. “You don’t want to go into the brain. You want to stay out of it. But the brain is right there. You of course have to be very, very careful not to cause any injury.”

Patients will sometimes suffer a stroke as they’re waking up from the operation, he said, although stroke risk is low. They also run a low to moderate risk of experiencing epileptic seizures in the days to follow, he said.

Overall, the long-term odds bode well for Bishop Curry’s recovery. About 80 percent of those treated for his condition return to their pre-hematomal level of function, according to John Higgins, a sports cardiologist at McGovern Medical School at the University of Texas Health Science Center at Houston. A month after surgery, the chances of dying from hematoma hover around 5 percent.

Yet because the condition can recur and the surgery can disrupt brain function, the mortality rate is 10 to 30 percent within 30 days of surgery, according to Higgins. It’s a period that necessarily involves close observation, follow-up CT scans, and lots of rest before gradually increasing activity.

“They can try to seal off the blood vessel, but it may continue to ooze,” Higgins said. “If the stitches don’t hold, it could rapidly accumulate again. So there are definitely issues following the actual surgery in terms of how long it’s going to be before he’s out of the woods.”

Doctors scheduled Curry, 62, for urgent surgery after a Sunday visit to Bruton Parish in Colonial Williamsburg, where he was helping celebrate the congregation’s 300th anniversary. He had difficulty finding words, according to his nurse, Roland Anderson, and was diagnosed at a local hospital before being transferred to a Richmond tier-one medical center for treatment.

Subdural hematoma occurs with greatest frequency in older people who have suffered head injuries, which can seem minor if they involve merely bumping one’s head on a cabinet or car door. What can ensue, however, is effectively a one-way valve in which blood from a damaged vein or artery pools up with nowhere to drain. Pressure in turn mounts on parts of the brain and can become life-threatening if it’s not relieved.

The surgery can take anywhere from less than an hour to several hours, Valadka said, depending on how much of the pooled blood can be drained through the first drill hole. Sometimes a larger portion of the skull needs to be removed to access all the affected areas. Afterward, a patient generally needs a day or two in intensive care for close monitoring and then several more days in the hospital before being sent home.

In Curry’s case, the prognosis calls for a full recovery, according to a statement issued from the Episcopal Church before his surgery. From his bedside, he was alert enough to record a brief video with his nurse and the Rev. Canon Michael Hunn, canon to the presiding bishop for ministry within the Episcopal Church. He probably did not suffer any brain damage from the hematoma, according to Anderson.

Following discharge, Curry will need to function on a reduced schedule, at least for the first few weeks. Most surgeons will advise their patients not to fly for a month after this procedure, Higgins said, while they monitor for a hematoma’s possible recurrence.

Depending on how the recovery proceeds, Curry’s schedule might need adjusting in the long term to accommodate diminished stamina. Even months and years after a hematoma-draining procedure, patients who are accustomed to putting in long, busy days often find they can no longer maintain the same schedule.

“What patients often report after the brain surgery is that they seem to feel fatigued,” Valadka said. “People may notice that it’s a little bit harder once they get to the 10th, 11th, 12th, 13th hour of their days.”

Still, if Curry can steer clear of stroke, seizure, and recurrent hematoma for 30 days, he stands a good chance of returning to his usual schedule, which he’s been carving out since his Nov. 1 installation as presiding bishop. Long hours and frequent air travel have for decades been staples of Episcopal primacy. Whether Curry will need to modify those standards in light of his health, time will tell.

“In the new year, start low and go slow,” Higgins said, by way of advice for Curry. “I wouldn’t go from zero to 100 percent of his activity. I would start at maybe 20 percent and, every couple of weeks, add a little bit more.”

Contact | Covenant | Facebook | RSS | Subscribe | Twitter


Online Archives