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  1. #1
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    When is a head bump dangerous?

    This was buried in the Natasha Richardson thread, and I'm interested to hear what the medical guys have to say, so ...

    Quote Originally Posted by Jim S View Post
    Second, I'm guessing she had a 'lucid interval' commonly associated with epidural hematomas. They are produced by arterial bleeding and can be very nasty and often fatal. Fatal and nasty I guess can go in the same sentence. A common injury is the site of the head with rupture of the MMA (middle meningeal artery).

    Subdural hematomas are far more common and with a lower fatality rate but not associate with a lucid interval.
    Quote Originally Posted by Neurodoc View Post
    It's possible to have a "lucid interval" with a SDH as well as a EDH.
    Quote Originally Posted by woodstocksez View Post
    So, what to do, then? I've banged my head pretty good several times in the last couple of years, but felt OK (had a little tingling in some part of my body one time) and just continued skiing. It seems overkill to end the day and go to the hospital every time you bang your head. So, are you just at the mercy of the fates? Or are there signs that indicate that something serious might be happening (e.g., if a headache comes on, go to the hospital)?
    Quote Originally Posted by splat View Post
    Slurred speech is a telltale sign that there is something going on.
    Quote Originally Posted by booner View Post
    My question too. I mean this is just scary shit. Who DOESN'T hit their head hard every once in a while.
    Slurred speech. Headache. (Is it already too late if you're experiencing those?) Any signs to look for after you bang your head that would indicate something seriously bad is happening?
    Quote Originally Posted by Tippster View Post
    Sometimes I think you guys are some of the smartest people on the web, other times I wonder if you were shaken as babies.

  2. #2
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    I haven't read the other thread, but my dad a a similar accident last year. Blood clot on the brain, passed out - 2 brain surgeries, 3 weeks in the ICU. 3 months recovery

    The staff at the brekshire medical center RULES!!! he hit his head boarding at Catamount and yes he had a helmet... then several hours later, he collapsed. heis 65, good shape, etc...

    BUT HERE IS THE KEY - his cardio doc had him on an asprin a day - a blood thinner - and that with a concussion caused the blood clot. the docs said if he had not had surgeries within his another hour or 2 he would be dead.

    I do not know is Natasha was on any meds, but it seems very close to my father's situation.

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    Surely a blood thinner would limit the possibilites of a clot?

  4. #4
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    Quote Originally Posted by miketheskier View Post
    Surely a blood thinner would limit the possibilites of a clot?
    But they would increase the chances that a microtear in the vasculature of the brain would lead to leakage of blood, as apirin inhibits platelet aggregation VERY WELL (and thus increases bleeding time/capacity). I think the issue with this is that leakage of blood causes hematomas (blood clots) in the extravascular space once it finally does clot (which it eventually will). This could be a bit (a crapload) of a problem in certain areas of the brain.

    To the original poster, here's my opinion: If you must take aspirin or coumadin because of a heart condition, ski with extra caution and buy a racing helmet and impact protection (chest/spine protection vest, hip pads, and perhaps elbow pads).

    But furthermore, most people on this forum ski well above 19 mph (the maximum speed at which helmets prevent serious injury, supposedly). Therefore, everyone who is an advanced/expert skier should buy a racing helmet designed for higher speeds. You only get one brain. Please remember the last sentence every time you step on the hill or go buy a new helmet.

  5. #5
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    Quote Originally Posted by miketheskier View Post
    Surely a blood thinner would limit the possibilites of a clot?
    I understand how you could rationalize this but it's wrong.

    Blood thinners + head trauma = not good

    Of approximatelye 100 CT brains that I read for trauma I'd guestimate that 95 or more have no hemorrhage. I about read ~50 CT brains per week including call (70 hour week).
    Last edited by Jim S; 03-20-2009 at 02:59 PM.
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  6. #6
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    To clarify, my question was irrespective of whether you're wearing a helmet or not, since I assume that some impacts even with a helmet on could leave you in condition like Natasha Richardson apparently was, i.e., seemingly OK at first, but not really as it turns out.
    Last edited by woodstocksez; 03-20-2009 at 03:28 PM.
    Quote Originally Posted by Tippster View Post
    Sometimes I think you guys are some of the smartest people on the web, other times I wonder if you were shaken as babies.

  7. #7
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    Quote Originally Posted by intheWRONGsummitcounty View Post
    But they would increase the chances that a microtear in the vasculature of the brain would lead to leakage of blood, as apirin inhibits platelet aggregation VERY WELL (and thus increases bleeding time/capacity). I think the issue with this is that leakage of blood causes hematomas (blood clots) in the extravascular space once it finally does clot (which it eventually will). This could be a bit (a crapload) of a problem in certain areas of the brain.

    To the original poster, here's my opinion: If you must take aspirin or coumadin because of a heart condition, ski with extra caution and buy a racing helmet and impact protection (chest/spine protection vest, hip pads, and perhaps elbow pads).

    But furthermore, most people on this forum ski well above 19 mph (the maximum speed at which helmets prevent serious injury, supposedly). Therefore, everyone who is an advanced/expert skier should buy a racing helmet designed for higher speeds. You only get one brain. Please remember the last sentence every time you step on the hill or go buy a new helmet.
    That 19mph is a myth that's been around for a long time. It comes from the the way they test them. A ski helmets testing (ASTM and both Snell standards) are tested with a 2m drop. The impact is at 14mph(fyi same as bicycle helmets) so people thing they are designed around this speed, it's not the case.

    Also there are two snell standards for snow helmets...the S-98 and the RS-98 the RS is the tougher standard the ASTM is even tougher for a flat impact, they don't test anvil and edge like snell.

    One last FYI moto helmets are tested usually in a 3m drop so only at 17mph.

  8. #8
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    Signs to look for are mental awareness, does the person know what time it is, day, where they are? Memory... do they know their name, date of birth? Any head aches (usually severe), nausea, vomiting, abnormal pupils...dilated, meiotic (small), different sizes?

    If in doubt have them checked out. As noted this is an uncommon problem, but when it occurs can be disastrous.

    If you have a CAT scan done, be sure to put "Change for a nickel?" on the request form, so JimS knows it's a maggot

    I agree it is a constitutional right for Americans to be assholes...its just too bad that so many take the opportunity...
    iscariot

  9. #9
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    I asked the same question about OTC meds with 'blood-thinning' properties over in the gimp forum a while back. Nerodoc replied something to the effect the lower dosages of NSAIDs and Asprin wouldn't pose a major concern related to a head injury.

    Coumadin is a different story.

    I've also wondered the same question, what point should we seek treatment for TBI. In my line of work we look the things hutash mentioned, but with the classic epidural bleeds and slower subdural bleeds you could feel just fine after the impact. I've also read journals about minor head injuries adding up to a more serious one.

    While we're on this topic of head injuries, I've always wondered if old injuries show up on scans. I've been too embarrassed to ask our trauma services directer at the hospital (she's not always the most tactful, and has lectured me a few times on not getting treatment for head injuries), and when I was shadowing a neurosurgeon for class, I didn't get an appropriate time to ask.

  10. #10
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    Also worth notinig is that depending on the combination of the severity of the impact and the localization of trauma to the brain, there may be no symptoms immediately. For instance, an isolated frontal lobe traumatic injury will affect your long term decision making, your ability to hold a job, judgement, higher order tasks/etc, but while on the ski hill you may not notice any difference. Also, the concrete manisfestations of such an injury may not become apparent until some extended period of time.

    A while it may not sound bad, you DO NOT want to get a frontal lobe injury. The point I'm trying to add is that a head injury that is significant may not even elicit any symptoms. My two cents is if you hit your head hard enough with or without a helmet that you are concerned for one reason or another, go to a clinic ASAP to get evaluated.

    A side note: negotiating a CT scan and/or MRI if you don't fit a certain criteria can be a hassle. If you really want one, tell a physician you bashed your head real hard, and you've been forgetting things, are unable to produce certain words, are having "floaters" in the eyes, and have a throbbing headache.

    But to the OP: if you're that concerned, why the heck wouldn't you wear a helmet?

    And racing helmets are still better than your average head-bucket. I personally think maximizing protection is a must based on how fast I ski. Seth Morrisson must have his reasons for wearing that ginormous thing on his head when he skis (which looks "a little" more durable than a vented Giro).

  11. #11
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    Quote Originally Posted by emtnate View Post
    While we're on this topic of head injuries, I've always wondered if old injuries show up on scans. I've been too embarrassed to ask our trauma services directer at the hospital (she's not always the most tactful, and has lectured me a few times on not getting treatment for head injuries), and when I was shadowing a neurosurgeon for class, I didn't get an appropriate time to ask.
    The blond woman? Alfeld or something like that? She intimidated the hell out of my neighbor who's a nurse.
    It's 5 o'clock somewhere.

  12. #12
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    Quote Originally Posted by intheWRONGsummitcounty View Post
    But to the OP: if you're that concerned, why the heck wouldn't you wear a helmet?
    I do wear a helmet (though I don't when I ski with my son on the very shallow greens on which he is just learning). But, as I indicated in the post above, I assume that some impacts even with a helmet on could leave you in condition like Natasha Richardson apparently was.
    Quote Originally Posted by Tippster View Post
    Sometimes I think you guys are some of the smartest people on the web, other times I wonder if you were shaken as babies.

  13. #13
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    Assuming that by "head bump" you mean "terrorist head jab," the answer is: always.
    In the long run, we're all dead.- John Maynard Keynes

  14. #14
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    Quote Originally Posted by Steven S. Dallas View Post
    Assuming that by "head bump" you mean "terrorist head jab," the answer is: always.
    For those I never wear a helmet. Diminishes the solidarity.
    Quote Originally Posted by Tippster View Post
    Sometimes I think you guys are some of the smartest people on the web, other times I wonder if you were shaken as babies.

  15. #15
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    Hutash is right on: if I read your scan and you mention "Change", I'm definitely nabbing you shit and putting it on Gear Swap.

    Quote Originally Posted by emtnate View Post
    I asked the same question about OTC meds with 'blood-thinning' properties over in the gimp forum a while back. Nerodoc replied something to the effect the lower dosages of NSAIDs and Asprin wouldn't pose a major concern related to a head injury. Coumadin is a different story.
    True to a degree. Coumadin at therapeutic levels with a head injury is not the future you hope for. However, chronic NSAID or aspirin inhibits clottting and will make for a worse hemorrhage anywhere in the body.

    While we're on this topic of head injuries, I've always wondered if old injuries show up on scans.
    Few but not all will show up. MRI is far more senstive and specific than CT.



    Quote Originally Posted by intheWRONGsummitcounty View Post
    Also worth notinig is that depending on the combination of the severity of the impact and the localization of trauma to the brain, there may be no symptoms immediately. For instance, an isolated frontal lobe traumatic injury will affect your long term decision making, your ability to hold a job, judgement, higher order tasks/etc, but while on the ski hill you may not notice any difference. Also, the concrete manisfestations of such an injury may not become apparent until some extended period of time.A while it may not sound bad, you DO NOT want to get a frontal lobe injury.
    Umm...I think any 'lobe' injury makes for bit of down day to say the least.
    On the other hand, how has thread made it this far without a NSFW post about "getting a little head?"


    A side note: negotiating a CT scan and/or MRI if you don't fit a certain criteria can be a hassle. If you really want one, tell a physician you bashed your head real hard, and you've been forgetting things, are unable to produce certain words, are having "floaters" in the eyes, and have a throbbing headache.
    OK: you are an idiot. Or maybe you have frontal lobe injuries.....bilaterally.

    One, "if you really want one?" Let the medical staff decide. For god's sake, don't fucking make up symptoms to get a test. Your signs and symptoms and lack thereof will crucial in ordering and interpreting the correct studies and treatment.

    Two, "negotiating a CAT scan or MRI?" Is this Bernie's Used Car Sale or Gear Swap or some hooker by the train tracks? Contrarily, it's almost impossible to not get a CAT scan these days. I can't believe the trivial reasons people get scanned for. Stop into the hospital and ask where the men's room is. They'll think you are confused and scan you in a second.

    Seth Morrisson must have his reasons for wearing that ginormous thing on his head when he skis (which looks "a little" more durable than a vented Giro).
    Throwing 3s and flips in the backcountry off 100 footers. Good reasons.
    Last edited by Jim S; 03-20-2009 at 10:00 PM.
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  16. #16
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    Getting a CT scan increases your risk of getting cancer, they're not something you want to have done unless its really necessary.

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    Quote Originally Posted by Patches View Post
    Getting a CT scan increases your risk of getting cancer, they're not something you want to have done unless its really necessary.
    I was also going to mention this. And the effects of serial CT scans are cumulative, so unless it is absolutely warranted, you should try to avoid them, especially at a young age.
    "Ah, beer, my one weakness. My Achille's heel, if you will." -Homer Simpson

  18. #18
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    Quote Originally Posted by coolstine View Post
    I was also going to mention this. And the effects of serial CT scans are cumulative, so unless it is absolutely warranted, you should try to avoid them, especially at a young age.
    True but exaggerated. You get more risk from living in NYC with it's granite base than you do from a CT scan. Basically, if you truly need a CT, the benefits far far outweigh the risks. It's not even an issue once you know the facts. However, MRI has no ionizing radiation.
    Every man dies. Not every man lives.
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  19. #19
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    Quote Originally Posted by Jim S View Post
    OK: you are an idiot. Or maybe you have frontal lobe injuries.....bilaterally.

    One, "if you really want one?" Let the medical staff decide. For god's sake, don't fucking make up symptoms to get a test. Your signs and symptoms and lack thereof will crucial in ordering and interpreting the correct studies and treatment.

    Two, "negotiating a CAT scan or MRI?" Is this Bernie's Used Car Sale or Gear Swap or some hooker by the train tracks? Contrarily, it's almost impossible to not get a CAT scan these days. I can't believe the trivial reasons people get scanned for. Stop into the hospital and ask where the men's room is. They'll think you are confused and scan you in a second.
    My point is that presenting to your local primary care physician and asking to get a CT scan because you "want one" or are "concerned" will not be good enough reason for many physicians to order one. Some quacks would, but some may have a hard time justifying a CT scan b/c the patient "wanted" one when they document the patient's visit in the SOAP note.

    I only brought this up because someone asked about getting scans for potentially old traumatic injuries.

    Contrarily, it's almost impossible to not get a CAT scan these days.
    I don't blame you for thinking that, since you are a radiologist and read 50 a week.

    Two, "negotiating a CAT scan or MRI?" Is this Bernie's Used Car Sale or Gear Swap or some hooker by the train tracks?
    Patients need to advocate for themselves. If physicians were "right" all the time then most people would never be diagnosed with stage 2,3, or 4 cancer, because the excellent physicians would diagnose everything early and order every appropriate test to do so

    If I am an "idiot," let me remind you that medicine is just a business and you are just a businessman. Just like used car salesmen, physicians show up to work and do what they have to to not get sued, and to make their living.

    So reconsider taking offense to what you perceive to be a tainting of your profession by the usage the word "negotiating" in a previous post.

  20. #20
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    Quote Originally Posted by Jim S View Post
    True but exaggerated. You get more risk from living in NYC with it's granite base than you do from a CT scan. Basically, if you truly need a CT, the benefits far far outweigh the risks. It's not even an issue once you know the facts. However, MRI has no ionizing radiation.
    Apparently "background radiation" exposure for three years exposes you to the same radiation as one CT scan (Time magazine). So does this mean three years in Manhattan equals one CT scan? Or are you saying in Manhattan maybe only one year there equals one CT scan?

    MRIs are better at diagnosing a wider range of conditions dealing with the brain. Can our radiologist Jim S tell us if they are better for diagnosing TBI after head trauma? (several physicians I shadowed told me that in most cases CT scans are ordered first and MRI scans are only ordered if abnormal CT scans are found).

  21. #21
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    Quote Originally Posted by intheWRONGsummitcounty View Post
    Apparently "background radiation" exposure for three years exposes you to the same radiation as one CT scan (Time magazine). So does this mean three years in Manhattan equals one CT scan? Or are you saying in Manhattan maybe only one year there equals one CT scan?

    MRIs are better at diagnosing a wider range of conditions dealing with the brain. Can our radiologist Jim S tell us if they are better for diagnosing TBI after head trauma? (several physicians I shadowed told me that in most cases CT scans are ordered first and MRI scans are only ordered if abnormal CT scans are found).
    Actually, I'm a doctor and not a businessman. No let me rephrase that:

    "Damn it Jim, I'm a doctor and not a businessman!"



    I don't order studies, I don't negotiate our shitty contracts, etc. I can see where you are you coming from but your conclusions are wrong and really coming across as stupid and ignorant, full of fodder from the lay press.


    CT vs MRI:
    I could type a small book on this but basically in a trauma setting you want the answer sooner than soon or STAT:

    1. CT is faster than MRI so you get the images quicker for a faster result.

    2. Because the CT scan is faster, an uncooperative (stuporous, drunk, etc) trauma patient has less time to move and blurr the CT image than MRI image.

    3. If there is no radiologist around, then most ER docs can evaulate a CT brain and pick up most but not all hemorrhages; most are not comfortable with MRI interpretation.

    4. Patients don't need to be 'screened' for a noncontrast CT of the brain. Even if it's a pregnant woman, you need to know if her brain is OK or not. She's going in the CT scanner. For an MRI you have make sure they don't have pacemakers, aneursym clips, metal fragments in the eyes eg metal workers, ski boots on, etc.
    Last edited by Jim S; 03-21-2009 at 08:12 AM.
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  22. #22
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    Earlier this year I caught an edge in cement on a pair of lotus 138 and experienced a violent, single rotation, barrel role.

    My head never hit anything but I was slammed sideways into the snow and stopped abruptly and it was the most violent event Iíve experienced while skiing. Not that I would ever stop wearing one, but in this case the helmet was a heavy Bern hardhat (since replaced with a lighter model) and I believe the added weight increased the moment of inertia which resulted in dizziness and nausea that lasted maybe five minutes and mild concussion symptoms that lasted for a couple of days.

    I never had it checked out because I never hit anything so in the absence of a diagnosis thereís not much of a point other than to say head injuries are weird. We can walk away from some nasty stuff (Iíve been cosmetically mangled pretty badly in Mtn. bike crashes) but otherwise unexceptional crashes can have wicked consequences.

  23. #23
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    Quote Originally Posted by intheWRONGsummitcounty View Post
    I only brought this up because someone asked about getting scans for potentially old traumatic injuries.
    Why would you want a head scan for an old traumatic injury?

  24. #24
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    Ask Powstash.

    Here.


    And the surgery following a 3 week manifestation of a subdural bleed complete with midline shift and all the goodies.

  25. #25
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    Ah, different definitions of "old". I was thinking of something, say, a year old. Not one month with persistent symptoms.

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