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Abscess or Blood Clot? Please help.
Please forgive the length of this post, I want to make sure I give you all of the information. Also, my wife is a neuro nurse, so I know just enough to be dangerous.
4 weeks ago, my friend Larry complained to his wife that he thought he had the flu. Over the next two days, he got worse and complained of a headache. The next day, his wife found him collapsed and took him to the hospital. They immediately suspected spinal meningitis and began treating with antibiotics. After an hour, he was able to talk and in interviewing him, they discovered he had been taking antibiotics for a tooth infection and they determined he had an abscess that went from his tooth to his brain. They performed CAT scans and MRI's over the next four weeks while treating with antibiotics and meds to reduce swelling in his brain.
Larry improved, though he had problems with speech, memory, etc. However, through all of the tests, the abscess never changed size. Eventually, after nearly 3 weeks, he was moved from intensive care to a regular unit, still being treated with antibiotics but not the med for brain swelling. While on the other unit, he developed an infection from his pic line and was taken back to ICU. Differrent antibiotics were used and the brain swelling med was reinstated and he quickly improved to where he had been.
The doctor, after another MRI, stated that the ventricule was filling with fluid and needed drained. He recommended surgically inserting a catheter to the ventricule for drainage.
The doctor stated it wold take about 2 hours to perform the surgery. After 3 hours, he came out and stated there was a problem. He stated that as soon as they drilled the hole in his skull, they ruptured a blood vessell on the outside of his brain. They eventually stopped the bleed, but the blood clotted and there was a huge clot they neededx to remove. After nearly 7 hours, he was taken back to ICU in grave condition. At first, he responded to pain and light stimuli, but throughout the night his pupils have ceased reacting to light. This morning, they ran a CAT scan and the doctor told us that his brain stem has filled with blood.
My questions:
Can the blood clot that quickly during surgery, especially considering he had been on blood thinners up until a couple of days before surgery?
Shouldn't the MRI used to map the surgery have seen the blood vessel?
If the ruptured blood vessel was on the outside wall of his brain, how could the brain stem fill with blood?
Is it possible it was a misdiagnosis? Do blood clots and abscesses look similar in an MRI and CAT scan (especially since they were looking for an abscess)? Could he had had a small aneurysm which created the clot, and then when they went in, it opened it back up?
Please answer these questions and help us to understand what has happened.
Thank you.
Answer:
Abscess or Blood Clot? Please help.
Thanks for your question. The answer is here:
Hope it helps.
Dr Sinuhe