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View Diary: Hillary Clinton in hospital with blood clot (153 comments)

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  •  Subdural hematoma vs DVT (17+ / 0-)

    There isn't much more information other than the above. I am a physician; here is my speculation, which should be taken with a grain of salt. (I also posted this on TPM)

    The doctors said that her "blood clots" were related to her concussion. The blood clots were being treated with anticoagulants.

    It is possible, but unlikely, that she has a subdural hematoma- a blood clot that forms between the dura mater (the outer lining attached to the skull) and the arachnoid mater (the inner lining adhering to the brain).

    A subdural hematoma is usually caused by relatively minor head trauma which causes a tearing of small veins. The gradual accumulation of blood causes headaches and neurological symptoms.

    I doubt that she has a subdural hematoma because this is NOT treated with anticoagulants. Usual treatment is observation for small clots -or- surgical removal of the clot if the patient has significant neurological symptoms or rapid growth of the clot.

    More likely is a deep venous thrombosis (DVT) in the veins of the leg.

    Secretary Clinton has several risk factors for a "hypercoaguable state;" a situation where her blood is more likely to clot in low-flow blood vessels like the veins her legs.

    Her risks factors include:

    - a recent viral gastroenteritis
    - dehydration
    - bed rest due to the concussion
    - and most importantly, prolonged air travel.

    The treatment for a DVT is anticoagulants.

    If she does indeed have a DVT, the prognosis is good.  The biggest danger is that a large part of the clot would break off and travel to the lungs, where it would block blood flow through the lungs.

    Another danger is the risk of anticoagulation- either not enough, leading to growth of the clot -or- too much causing dangerous bleeding.  With proper monitoring (which I am sure she will get!) the risk is low.

    After several days of an injectable anticoagulant, she would be sent home on an oral anticoagulant.

    An interesting note is that a very similar thing happened to Richard Nixon during his 1960 campaign for the presidency.

    Counting stars by candlelight...

    by frasca on Sun Dec 30, 2012 at 06:21:47 PM PST

    •  Subdurals are not treated with anti-coagulants. (2+ / 0-)
      Recommended by:
      lirtydies, suesue

      So if that part of the story is right (that she is on anti-coagulants) it is not likely to be a subdural. Could be a a deep vein thrombosis in the leg or a cerebral venous thrombosis.

      Praying she is okay and has a speedy recovery.

      "Say little, do much" (Pirkei Avot 1:15)

      by hester on Sun Dec 30, 2012 at 06:55:36 PM PST

      [ Parent ]

    •  Here is why I said to take my speculation with a (0+ / 0-)

      grain of salt!

      Her doctors today said that she had an MRI of her head which showed a blood clot in the right tranverse venous sinus located in the back part of her brain behind the right ear. This is an unusual condition that is easily missed. Kudos to her doctors- this is a major league save!

      The venous sinuses in the brain bring blood back from the brain and return it to the heart via the jugular veins.

      This condition is associated with trauma, infection and anything that increases the blood's coagulability as outlined above. In addition, some other medical and inherited disorders can predispose the blood to clot and cause a venous sinus thrombosis.

      Unlike a subdural hematoma, treatment is indeed blood thinners. Her doctors will also look for those underlying medical and inherited disorders that I mentioned above.

      Like a DVT, a venous sinus thrombosis can be quite dangerous if not diagnosed. It sounds like they picked it up early, so hopefully she will do well.

      Counting stars by candlelight...

      by frasca on Mon Dec 31, 2012 at 02:28:36 PM PST

      [ Parent ]

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