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Like I Need a Hole in My Head

Strangely enough, last week, 2 of our patients needed holes in their heads…  More about that in just a bit.  Throughout the ages, different civilizations have employed various versions of making holes in the skulls of humans (while still alive) in the attempt to alleviate various infirmities.

Often, it was for things like ‘letting the bad spirits out,’ or other pagan rituals.  Sometimes it was appropriate, for reasons such as increased pressure in the brain caused by blood.  In these cases, anthropologists can see that the patients actually survived, and the surgery was appropriate and successful.  Today, there is a very (very) small and disturbed faction of people (not doctors) who believe in the medical benefits of self-trepanation (drilling a hole in your own skull).  So anyways…

This brings me to Don Rodolofo, who came to the emergency department one day with his lovely family, because of his weakness and change in mental function.  He is 72, and they told me that he just started to act funny for the past week, and that he couldn’t walk anymore.  Previously he had been very functional, even working at times.

We did some tests to make sure he didn’t have an infection, heart attack, or problems with his kidneys and liver.  All of these were normal.  I asked the family about anything weird that might have happened in the last month or so;  Had he fallen or hit his head?  ‘Why, yes, he had,’ they replied, ‘about 5 weeks ago…’

Since he was stable, he was able to go to the city to get a Cat Scan of his brain, which you can see below.  They returned with it shortly, and it was clear what the diagnosis was:  Subdural Hematoma.  Otherwise known as ‘blood in the brain.’

What happened was that when he had his fall, he must have set off a tiny, slow bleed in his brain which accumulated over time.  Once it reached a critical volume, it pushed against the brain, and ‘squashed it,’ causing symptoms that looked very much like a stroke.  This is the reason doctors often tell you to watch a person closely after they’ve had a bad fall, or concussion.

Well, I wasn’t too optimistic that we were going to be able to help him, since he had been having the symptoms for quite awhile. But after a discussion with Dr. Jeff, and some consultation with a neurosurgeon who visits us occasionally (Thanks Dr. Doug!), It was decided to move forward with drillin’ some holes in his head (known as ‘Burr Holes’).

I wasn’t there for the actual surgery, so I can neither confirm or deny whether Dr. Jeff used a hand cranked drill like the one pictured above.  But what I can tell you was that the next morning, Don Ronaldo was talking, was moving the right side of his body normally, was thinking clearly, and I even think he completed the New York Times Sunday edition Crossword puzzle (in Mandarin Chinese, to boot).  Ok, that’s not true.  They don’t actually sell the New York times in this part of the Honduran jungle…  We sent him home a couple days after.

Below is the CT of his brain.  you can see where the blood has formed and is compressing part of his brain (the ventricle, fellow doctor nerds…)

Not here, or here so much, but right here…

Ironically, we had a second patient arrive at the hospital at roughly the same time, with similar symptoms. Dr. Peter quickly diagnosed “something bad in his brain.”  It was unclear whether he, too, had a subdural hematoma, or whether he had a Goomba in there (this is a technical term used by doctors for tumors, and other badnesses that might be found on a cat scan;  apparently, as I google the term ‘goomba‘ it’s also a derogatory term for Italian Americans that have links to the mob, as well as one of the wussy bad guys on the Nintendo Super Mario Bros video game).

Dr. Peter, Dr. Jeff, and Dr. Doug (consulting again, from the states) wrestled with what to do next.  As his condition started to deteriorate, they eventually decided they had to do some digging.  In his case, they used a more aggressive procedure, called a craniotomy.  This is where Dr. Jeff had to actually cut a triangle of skull away, to expose his brain and ‘suck out all the bad stuff.’  It was not a tumor that they found (Gracias a Dios), just blood, which they cleaned out.  Now normally this guy would be in the ICU for days, with tight monitoring, and a slow rehab.  But, as Dr. Peter says, the next morning he was ‘sitting up eating corn flakes.’  He went home soon after, as well, and continues to do great.

These 2 guys are a reminder to us here at Loma de Luz that our patients do ‘better than we deserve,’ and that ‘Dios Obra Aqui,’ –God works here.

Originally posted by the Moultray’s on March 05, 2018

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