A negative CT (CAT) scan after hitting your head doesn’t guarantee that bleeding in the brain won’t eventually result.
It still might, and when it does, it’s called chronic subdural hematoma (cSDH).
This happened to my mother who hit her head on a bathtub after passing out while standing.
You can imagine how hard she hit her head, since she wasn’t conscious to try to break the fall a little.
Several hours later she had a CT scan that looked perfectly normal.
She was kept for overnight observation. I was told that if her brain began bleeding, there would be neurological signs of this, that would be evident when nurses would give her neurological checks every so often.
Next morning she had another CT scan, and it was perfectly normal.
I asked the doctor about the possibility of bleeding still occurring in her brain, at some point down the road, since I had read reports in the past that getting hit in the head can cause delayed bleeding in the brain …
… up to two months later.
The doctor said there was a very tiny chance of this occurring, but that chances are, it wouldn’t, since the second CAT scan was completely normal.
My mother was discharged and I forgot about the possibility of delayed bleeding in the brain.
Six weeks later she awakened with a blazing headache and profound weakness in her legs, which I thought was a stroke.
I didn’t even think about that she had struck her head six weeks prior.
I kept thinking stroke because she had been taken off a blood thinner, Coumadin, which was prescribed for stroke prevention as a result of undergoing mitral valve replacement. The Coumadin prescription was for 90 days.
Shortly after hitting her head in the bathroom, the surgeon recommended that she cease the blood thinner because she was at risk for falling, due to unexplained orthostatic hypotensive episodes.
So she ceased the Coumadin after only 60 days. The morning she awakened with the headache and weakness was day 90 from the valve replacement surgery.
So I thought that the mitral valve replacement, in the absence of the 90-day Coumadin treatment, had resulted in a minor stroke.
The ER doctor assessed my mother and concluded that it was probably a small stroke.
Interestingly, the ER doctor never thought to ask if my mother had recently hit her head!
Because a stroke was suspected, my mother underwent a CT scan with contrast dye.
The ER doctor came back with the results and admitted being surprised at the findings: no stroke, but … bleeding in the brain.
Only then did the ER doctor ask if my mother had hit her head recently, and I was flabbergasted that all this time, I had etched the bathtub incident out of my mind.
Some of the blood in her brain was “old,” and some was “fresh.”
The diagnosis was a chronic subdural hematoma – a slow brain bleed whose primary cause is getting hit in the head.
“Elderly have weaker everything due to age,” says Danielle DonDiego, DO, a family physician with SteadyMD, an online program where patients can call, text or video chat with their doctor anytime.
“They are much more likely to have a brain bleed due to fragility from age.
“Also, many elderly are taking aspirin or a stronger blood thinner for health purposes, and this alone puts anyone at a higher risk.”
At the time my mother had hit her head, she was on the Coumadin as well as a daily aspirin.
The takeaway message here is that if you hit your head, record the date this happened, even if you’re young.
Not being elderly does not make you immune to bleeding in the brain after striking your head.
The other two types of subdural hematoma are “sub-acute” and “acute.”
Sub-acute is when the bleeding in the brain occurs three to 21 days after getting hit in, or falling on, one’s head.
The acute form has a very high mortality rate.
A normal CT scan shortly after hitting your head is always reassuring, but it doesn’t mean you’re out of the woods.