Blood Clots in the Brain: Clinton Clot Confusion

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Clinton Clot Confusion: Mystery Solved and Lessons Learned (I Assume)

Article about the clot Hillary Clinton really had—and why it would be easy to misdiagnose. | The Survival Doctor

Normal veins in the brain.

by James Hubbard, MD, MPH

The Clintons confused me this week. Oh, it’s not the first time, but this time it was Secretary Hillary and her blood clot in her brain. Well, it wasn’t really in her brain. It was … you’ll see.

As opposed to President Bill and what the meaning of “is” is, this time the key word was “clot.” I assumed, and shouldn’t have, that I knew what “clot” meant here. Fortunately, my wrong assumptions have lead to some The Survival Doctor teachable moments.

First Round of Reports and Wrong Assumptions

I read that Secretary Clinton had a clot in her leg. I assumed she had deep vein thrombosis (DVT). It seemed reasonable. She had the risk factors for it. I’ve actually written a little on DVT.

Her risk factors were:

  • An episode of deep vein thrombosis several years ago. If you’ve had it once, you’re at risk to get it again.
  • Possible prolonged bed rest or sitting. During a recent bout of vomiting and diarrhea, she apparently got so dehydrated that she fainted, hit her head, and got a concussion. In my post on concussions I explain that part of the treatment is rest. A major risk factor for DVT is lying around or sitting for prolonged periods of time.
Second Round of Reports

Next, I read that Secretary Clinton’s blood clot was not in her leg but between her brain and her skull. Okay, that made sense.

Her risk factors were:

  • Recent head trauma. She’d hit her head and injured a vein in her dura mater. That’s the outer of three membranes that cover the brain. The fact that her head injury had been a couple of weeks earlier didn’t matter. The symptoms of a subdural (below the dura mater) or epidural (above the dura) hematoma (clot) can come on immediately, or there can be no symptoms until weeks afterwards. The symptoms include increasingly severe headaches, vision disturbances, dizziness, confusion, and increasing drowsiness, to name a few.
  • Her age. These types of clots are more common in older people. (She’s 65, folks.)

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Third Round of Reports

But then, I read the doctors put her on blood thinners. Well, that didn’t make any sense. Subdural/epidural hematomas develop from an injured, bleeding blood vessel. The treatment for a subdural, which is the one she reportedly had, is to bore a tiny hole in the skull over the blood collection and drain out the blood. That takes the pressure off the brain. Taking a blood thinner would make the bleeding worse. Some writer got the facts wrong again, I guessed.

Finally, the Truth (Or I Assume)

And then, I read that Mrs. Clinton actually has a cerebral vein thrombosis. The cerebral veins run through the dura mater. These are the veins that leak and cause the subdural hematomas. But hers didn’t leak. Instead, a clot formed in one. That’s much more rare.

If the clot had been in a cerebral artery, she would have had a stroke. But the veins drain the blood away from the brain rather than to it. To clog one up with a clot is still dangerous, even life threatening. The dura mater holds in cerebrospinal fluid. A vein clot there backs up the fluid, causing increased pressure on the brain.

Fortunately, it was one of Mrs. Clinton’s side veins that clotted, and she has a duplicate on the other side of her head that can do double duty. Still, if not treat with blood thinners and medicines to try to dissolve the clot, only about twenty-five percent of people with cerebral vein thrombosis recover without at least minimal brain damage. With treatment, about sixty percent recover fully.

Final Lessons
  1. Take any change in head symptoms seriously, especially if the symptoms are getting worse. Apparently, Secretary Clinton was doing pretty well. Then, two weeks after her head injury, she began having increasingly severe headaches, vision disturbances, and nausea. It doesn’t matter if the symptoms occur in two years or even if you can’t recall any trauma, see a doctor ASAP for increasing headaches or problems with speech, sight, feeling, or muscle strength. When you can’t see a doctor? Well, that’s a big problem. There’s not much you can do but rest, and pray you’re one of the lucky ones who’ll recover without treatment.
  2. Don’t assume head symptoms are a stroke or from bleeding. If I’d seen a case like Mrs. Clinton’s in a disaster situation with no medical facility, I would have assumed a subdural and that she needed to have pressure taken off her brain. I would have assumed wrongly. Getting the person with any neurological symptoms to a medical facility and getting the needed diagnostic tests are essential to make a proper diagnosis.

The doctors are saying Secretary Clinton will make a full recovery. I wish her the best, but wouldn’t dare assume anything.

Has anyone had experience with anything like this? Something abnormal related to the brain? What were the symptoms? The diagnosis? Treatment?


Image by Reigh LeBlanc on Flickr.

  • Annette Brown

    I am; just in the process of recovering from exactly this same thing. My clot is in the right transverse sinus. I presented with an unimaginable headache and am now home beginning the recovery process, I still have a constant headache, light and sound sensitivity and hope they will slowly become a non issue. I am thankful for the 3 ER doctor and radiologist who found what several others didn’t. I am taking life one day at a time.

    • James Hubbard, MD, MPH

      Thanks for sharing. I wish you a speedy recovery.

  • Jamie

    In 2006 my husband had a brain aneurysm on Christmas Eve. It didn’t burst, but instead developed a slow leak. He was really lucky! He passed out in the bathroom and came back to and had our 3 year old come get me. He had brain surgery, where they put a clamp on the vessel. 5 days in the hospital and he came home. There were a lot of questions for months about various funny feelings, personality changes, memory issues, etc… The best our neurologist could tell us was, “from the neck down we know almost everything about how things work medically, but from the neck up, we really know very little.” Not very helpful to say the least, but he’s very healthy today, and most of his issues have leveled themselves out. 3 months later a man he had gone to school with had one and he will be in a nursing home for the rest of his life. Anytime I hear about someone with brain injuries or illnesses I immediately say a prayer, no one knows until it’s all said and done, how it will end up.

    • James Hubbard, M.D., M.P.H.

      Jamie, how true. I wish your husband well.

  • http://facebook Shirley Ferguson

    Thank you for thoroughly explaining about what happens & walking me/us thru the steps. Your explanation made more sense than any media article I had read or listened to. Keep up the good work.

    • James Hubbard, M.D., M.P.H.

      Thanks, Shirley. I appreciate that.

  • gin

    my husband has two conditions: arteriovenous malformation AVM and cavernous angioma –basically, a tangle of enlarged blood vessels in his brain that have hemorrhoids that over time have calcified. the neurosurgeon told him that it’s possible that they aren’t going to be a problem unless they start bleeding. they’re going to ‘watch’ him with periodic scans and MRIs. he was told that they were there for a long time possibly all his life and are likely genetic.

    • James Hubbard, M.D., M.P.H.

      Gin, I wish him the best. At least you know to be on the outlook.

  • Trace

    Good way to put together an interesting teaching post. Head injuries, when/if there is not doctor, will pretty much just come down to rest and hope for the best…

    • James Hubbard, M.D., M.P.H.

      Yes they will. thanks

  • Chad

    I believe what she has is called.. BSitis
    That from combining my medical knowledge and Political info.

    • James Hubbard, M.D., M.P.H.

      Thanks, Chad.

  • http://Surprise! John Gardner

    In 1993, I took a little fall; well, I slammed my head against a boulder, opening up a supraorbital artery. I did see a Physician.
    Exactly one week later, my head exploded (felt like it, anyway). Worst headache I could imagine. After I called 911, I had a personal experience with projectile vomiting.
    Grade 4 subarachnoid hemorrage…
    I was placed in a narcotic coma. My intercrannial pressures were so high that they didn’t drill me for fear of killing me. By the time the pressure started dropping, it self-corrected.
    With four, 4 vessel cerebral angiograms, the bleed was never found.
    I had no symptoms until about 10 minutes before the “explosion”.
    With about as good tertiary medical care as one could hope for, we never did know exactly what happened.
    It took four months to get back to a normal work schedule.
    This stuff is very complicated.

    • James Hubbard, M.D., M.P.H.

      John, thanks for sharing. Yes, it is very complicated, for doctors and patients alike.

  • James Hubbard, M.D., M.P.H.

    Chris, who knows. I don’t try to speculate on anything but the medical teaching aspects.

  • Chris

    I heard rumors that she’s in The Hague together with other big names because they were sued for treason, so maybe her medical condition is just an excuse to hide this supposed fact…