Clinton’s Blood Clot Is Near The Brain
Doctors treating Secretary of State Clinton have released some details about her condition:
(Reuters) – U.S. Secretary of State Hillary Clinton suffered a blood clot in a vein between her brain and skull behind her right ear but is expected to make a full recovery, her doctors said on Monday in a statement released by the State Department.
Clinton did not suffer a stroke or neurological damage as a result of the clot, the doctors said, adding that “she is in good spirits, engaging with her doctors, her family and her staff.”
The U.S. secretary of state, who has not been seen in public since December 7, was revealed on Sunday evening to be in a New York hospital under treatment for a blood clot that stemmed from a concussion she suffered in mid-December.
The concussion was itself the result of an earlier illness, described by the State Department as a stomach virus she had picked up during a trip to Europe and that led to her becoming dehydrated and fainting after she returned to the United States.
“In the course of a routine follow-up MRI on Sunday, the scan revealed that a right transverse sinus venous thrombosis had formed. This is a clot in the vein that is situated in the space between the brain and the skull behind the right ear,” Clinton’s doctors, Drs. Lisa Bardack and Gigi El-Bayoumi said in the statement released by the State Department.
“To help dissolve this clot, her medical team began treating the Secretary with blood thinners. She will be released once the medication dose has been established,” the doctors said. “In all other aspects of her recovery, the Secretary is making excellent progress and we are confident she will make a full recovery.”
At The Atlantic Dr. Richard Shenelick, a neurologist, explains what’s at stake:
A blood clot on top of the brain after trauma is a subdural or epidural hematoma and usually requires surgery to remove the blood clot. These are very dangerous — Natasha Richardson, Liam Neeson’s wife, died from an epidural hematoma after a mild head injury skiing in Canada. But, Secretary Clinton’s venous sinus thrombosis is very rare and quite uncommon after a mild head injury.
Blood is carried from the heart to the brain under high pressure in four main arteries. Just like elsewhere in the body, the blood returns to the heart through a series of low pressure veins. What is different in the brain, is that there are a number of small lakes or “sinuses” where are similar to rivers feeding a lake, the small veins returning the blood. One of these, called the transverse sinus, is located behind the ear (where press releases have said her clot was), inside the skull and is vulnerable to trauma. Under normal conditions the blood would slowly flow through the sinus, but it can clot (thrombosis) for a number of reasons, including pregnancy, cancer, infection, head injury, and certain medications.
It is best to try and dissolve the clot or at least to keep it from increasing in size. This is done by using the same medicines that we use to treat blood clots in the veins in the legs, thrombophlebitis. Depending on the individual patient and her doctor, they may choose different ways to “thin” the blood or keep it from clotting. The most common is to administer heparin into a vein the arm by an intravenous drip. The degree of blood thinning or anticoagulation can be carefully monitored by regular blood tests. Once everything is stable, an oral medication, warfarin, is started and eventually the IV drip of heparin can be discontinued. Although it may vary, most patients will remain on an oral anticoagulant for 3-6 months.
Hopefully the treatment will be successful, the blood clot dissolved and complications averted. As we enter the New Year we wish Secretary Clinton a speedy and full recovery
Clinton is being treated in the same hospital where her husband had his bypass operation more than ten years ago and is quite obviously in the best of medical hands at the moment. Hopefully this will just be a passing episode and she’ll recover fully in a short period of time. Incidentally, a story like this is a good reason why head trauma of any kind should always been taken seriously.