Blunt Trauma With Parenchymal Bleed. Doing Great After 3 Months.

Brief Answer:
Headache induced by alcohol use

Detailed Answer:
Good morning.

I've read through your question as well as other consults you've put on this network including one where you described having fallen and suffered a brain bleed. Your question revolved around asking for an opinion on how well you'd be expected to do if you were able to stick to certain parameters mainly in the context of living a "clean" life by taking care of yourself.

On this particular occasion you state that you've been doing GREAT after 3 months with a CT scan that did not show any further active bleeding or other problem but that you had a "few" drinks and got a moderate headache that lasted several days. You've not really described the intensity of the headache or other symptoms associated so I am not clear on whether this could be a "hangover" headache which is possible since in my experience when patients relay the information of "a few drinks" it's usually at least enough so that they'd likely blow over the limit and shouldn't be driving. In that setting a hangover headache is certainly possible even if the rest of the hangover doesn't necessarily follow (i.e. vomiting, sweating, talking to God on the ceramic telephone, etc. etc.)....

That being said, if you received blunt trauma on your brain bleed of 3 months ago and if in fact there was aenough blood on the scan to warrant a recommendation that you see both a NEUROLOGIST as well as NEUROSURGEON then, there is also a pretty good likelihood that some of that blood remains in the brain....and it shall for some time....that's normal for brain bleeds of the type you describe. When they give you a CLEAN CT XXXXXXX of health it is unusual for there to be absolutely no trace of any prior bleeding because it takes blood a VERY VERY VERY long time to fully resorb....there's always a little residual....it's just that the radiologist may not have read it out if he was being asked to look for ACUTE or ACTIVE bleeding (which would've stopped almost immediately following the trauma).

So, the presence of blood itself in the brain may be a risk factor for headaches and the addition of a "few" drinks may have amplified or exacerbated the tendency toward these headaches you're having for the past few days. I do not suspect you are suffering from a rebleed since you're not referring any new neurological symptoms and are not having any UNEXPLAINED nausea, vomiting, or changes in mental status....just the headache.

Therefore, I don't see the necessity to go back to the ER.

However, my concern is that the few drinks you did have- if uncontrolled in the future could lead to drinking more than you really should and this could lead to problems of balance and equilibrium (especially since you'd just had this other blunt trauma to the head...probably a concussion) which then, can result in a fall where you may strike your head again, and now the 2nd concussion and brain bleed scenario becomes a real possibility.

You also take prescription medications from another consult I saw you submitted online a few weeks ago and it appears that you also have alcohol around the same time as you take the pills. This is not a good habit to be in and I'm sure someone's told you along the way that you should not be drinking any alcohol while taking drugs such as Xanax. The combination makes it more likely that you could injure yourself and again suffer a concussion and resultant brain bleed.

Remember this fact when you suffer a concussion your brain becomes 3x more likely to suffer a 2nd concussion (even from a minor blow which most people can withstand) and after a 2nd concusson the risk rises to about 9x to have the 3rd conussion....get the picture? The same numbers and risks for brain bleeds can be said to hold true. After a first brain bleed from a concussion, future brain bleeds are more easily triggered and they also can become more extensive.

Therefore, if your intent is to lead a "clean" life with activities that do not place you at risk for future concussions you really must seriously consider giving up alcohol altogether and/or getting help with your anxiety such that you do not require the use of anxiolytics. Otherwise, things may get more complicated in the future.

I hope this opinion was valuable and that you find some information in there to help you make some decisions about how to avoid headaches from alcohol induction because it really can lead to bigger problems down the road. Brains really require a minimum of 1-2 years to fully cool down after even MINOR CONCUSSIONS. You shouldn't do anything that risks a fall, etc.

If I've provided useful or helpful information to your questions could you do me the utmost of favors by CLOSING THE QUERY along with a few positive words of feedback and maybe even a 5-star rating if you feel it is deserving? I am definitely interested in getting updated information on your condition if you'd care to drop me a line at www.bit.ly/drdariushsaghafi and let me know how things turn out.

You can always reach me at the above address for this and other questions. I wish you the best with everything and hope our discussion has aided in your understanding of a few concepts related to your concerns.

Regards,


This query required 40 minutes of professional time to research, assimilate, and file a response.

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Brief Answer:
Headache induced by alcohol use

Detailed Answer:
Good morning.

I've read through your question as well as other consults you've put on this network including one where you described having fallen and suffered a brain bleed. Your question revolved around asking for an opinion on how well you'd be expected to do if you were able to stick to certain parameters mainly in the context of living a "clean" life by taking care of yourself.

On this particular occasion you state that you've been doing GREAT after 3 months with a CT scan that did not show any further active bleeding or other problem but that you had a "few" drinks and got a moderate headache that lasted several days. You've not really described the intensity of the headache or other symptoms associated so I am not clear on whether this could be a "hangover" headache which is possible since in my experience when patients relay the information of "a few drinks" it's usually at least enough so that they'd likely blow over the limit and shouldn't be driving. In that setting a hangover headache is certainly possible even if the rest of the hangover doesn't necessarily follow (i.e. vomiting, sweating, talking to God on the ceramic telephone, etc. etc.)....

That being said, if you received blunt trauma on your brain bleed of 3 months ago and if in fact there was aenough blood on the scan to warrant a recommendation that you see both a NEUROLOGIST as well as NEUROSURGEON then, there is also a pretty good likelihood that some of that blood remains in the brain....and it shall for some time....that's normal for brain bleeds of the type you describe. When they give you a CLEAN CT XXXXXXX of health it is unusual for there to be absolutely no trace of any prior bleeding because it takes blood a VERY VERY VERY long time to fully resorb....there's always a little residual....it's just that the radiologist may not have read it out if he was being asked to look for ACUTE or ACTIVE bleeding (which would've stopped almost immediately following the trauma).

So, the presence of blood itself in the brain may be a risk factor for headaches and the addition of a "few" drinks may have amplified or exacerbated the tendency toward these headaches you're having for the past few days. I do not suspect you are suffering from a rebleed since you're not referring any new neurological symptoms and are not having any UNEXPLAINED nausea, vomiting, or changes in mental status....just the headache.

Therefore, I don't see the necessity to go back to the ER.

However, my concern is that the few drinks you did have- if uncontrolled in the future could lead to drinking more than you really should and this could lead to problems of balance and equilibrium (especially since you'd just had this other blunt trauma to the head...probably a concussion) which then, can result in a fall where you may strike your head again, and now the 2nd concussion and brain bleed scenario becomes a real possibility.

You also take prescription medications from another consult I saw you submitted online a few weeks ago and it appears that you also have alcohol around the same time as you take the pills. This is not a good habit to be in and I'm sure someone's told you along the way that you should not be drinking any alcohol while taking drugs such as Xanax. The combination makes it more likely that you could injure yourself and again suffer a concussion and resultant brain bleed.

Remember this fact when you suffer a concussion your brain becomes 3x more likely to suffer a 2nd concussion (even from a minor blow which most people can withstand) and after a 2nd concusson the risk rises to about 9x to have the 3rd conussion....get the picture? The same numbers and risks for brain bleeds can be said to hold true. After a first brain bleed from a concussion, future brain bleeds are more easily triggered and they also can become more extensive.

Therefore, if your intent is to lead a "clean" life with activities that do not place you at risk for future concussions you really must seriously consider giving up alcohol altogether and/or getting help with your anxiety such that you do not require the use of anxiolytics. Otherwise, things may get more complicated in the future.

I hope this opinion was valuable and that you find some information in there to help you make some decisions about how to avoid headaches from alcohol induction because it really can lead to bigger problems down the road. Brains really require a minimum of 1-2 years to fully cool down after even MINOR CONCUSSIONS. You shouldn't do anything that risks a fall, etc.

If I've provided useful or helpful information to your questions could you do me the utmost of favors by CLOSING THE QUERY along with a few positive words of feedback and maybe even a 5-star rating if you feel it is deserving? I am definitely interested in getting updated information on your condition if you'd care to drop me a line at www.bit.ly/drdariushsaghafi and let me know how things turn out.

You can always reach me at the above address for this and other questions. I wish you the best with everything and hope our discussion has aided in your understanding of a few concepts related to your concerns.

Regards,


This query required 40 minutes of professional time to research, assimilate, and file a response.

---

Brief Answer:
Glad that the headache did not include any of the typical HANGOVER issues

Detailed Answer:
Thank you for the clarifications.

I couldn't begin to hazard a guess on what another physician might tell or not tell his patients with respect to what a scan shows. I think the question is easily answered simply by looking at the original CT scan reports themselves as they are signed off by the reading radiologists.

If they are in English then, it would easy to spot whether or not BLOOD were seen or not in the parenchyma of the brain and what state such as "chronic, hemosiderin, acute" etc. Blood in any organ (before it is fully resorbed) changes into "old" blood first which would be the same as a "chronic" bleed or something along those lines. From there the aging process shows the presence of HEMOSIDERIN which is iron resdiua which cannot be resorbed by the body. So the iron contained within all red blood cells would simply stay in that part of the brain where the bleed occurred. This is detectable on CT scans if the quantity is HIGH ENOUGH or it's concentrated in an area where iron can be picked up more easily due to the lack of iron in the surrounding tissues, make sense?

I'm pretty sure that a radiologist would call the presence of HEMOSIDERIN deposits. They always seem to even if it's not that much. Effectively, this tells the reader that "once upon a time" there was a bleed into the brain. It doesn't say how it happened or anything else but just that there was blood and again, based upon quantity that's a permanent change that will be likely present in that brain.

If on the other hand the radiologist were specifically directed to comment on whether or not any evidence of acute bleeding had occurred it is possible that in the final conclusion or impression of the report he/she may not feel the need to state the presence of any small amounts of iron deposition but rather just if there were any acute bleeds. That would answer the referring physician's question directly without bringing other "unnecessary" information into the equation. Make sense? So is it possible that a report may state the presence of OLD bleeding the brain but that your physician(s) may not report that to you? Sure, since old bleeding is not of any great clinical importance unless you're a research scientist looking for information that nobody else finds particularly interesting! HA! Is it possible that ACTIVE bleeding that could be a reason for your headaches were MISSED or not reported? Hard to believe that one unless someone really were not paying close attention to why a scan was being obtained on a patient with headache. Radiologists HATE making those kinds of mistakes so they pretty much go over scans with such information very thoroughly.

Again, in your case if you had a headache without signs or symptoms of an acute withdrawal or hangover type of headache (i.e. nausea, vomiting, photo/phonosensitivity) and it subsided then, it is not likely due to a silently expanding bleed within the brain because that would not get better....yours did. Ergo, not likely to be a spontaneous bleed (I'm also assuming you didn't hit your head again on anything.....or did you?)

As far as a couple of drinks being OK....that's for your doctors to say who know you and know what you mean by a "a few" drinks to decide upon when counseling you for the future. I'm sure they are taking into consideration your risk for followup blunt trauma episodes and the fact that those can cause rebleeds when they give you their opinions.

I know that I have patients for whom "a few" literally means 1-2, maybe 3 and that's it for months at a time. And then, I have patients (and friends-- I play on a men's rugby league so the boys can put a FEW down with relative ease....HAHA!) for whom "a few" is more on the order of what they can easily remember with the rest being a bit fuzzy if you know what I mean! Then, the pics start getting circulated the next day around the clubhouse and embarrassment ensues! LOLOLOL! So for those types, "a few" is usually more than most people are able to consume without risks! But again, only you and your physicians know what is being said when they tell you a couple of drinks is fine.

My perspective happens to be slightly more conservative in a person who just had a concussion resulting in a parenchymal bleed. I'd prefer they not engage in any behaviors that could place them at risk of another concussion....make sense? At least until the brain has fully cooled down. Then, I know they will be safest so not only would I prefer to see them curtail or even stop their drinking but I'd like to see them not engage in high risk sports (such as RUGBY....which almost never is something you'll see from a true lover of the sport! LOL!), high risk occupations where falls can occur due to being at heights, or the type of work that places their head at risk for being concussed, etc. It is hard in our modern society for every patient with a concusion to just kick their heels up for 1-2 years and completely abstain from everything and anything that could risk another blow to the head or intracranial bleed. But again, I'm operating from a more theoretical level since I'm asked questions more along the lines of "What's BEST for me doctor?".....as opposed to what's most PRACTICAL for me to be doing after having had X, Y, or Z happen to me and what are my risks if I don't observe changes in habits, lifestyles, or working environment in terms of future concussions?"

Make sense?

Also, your headache may be part of something called the POSTCONCUSSIVE SYNDROME (PCS) in which headaches can persist for weeks to months after a traumatic blow to the brain. It gets better over time which usually starts out in the initial days after the incident as being very strong and painful with the need to take strong pain relievers. Then, as time progresses they come and go and hopefully the need to use additional medications for headaches also begins to taper off....don't know if that described your situation. But perhaps these headaches were part of that picture and you're just still in your PCS phase of recovery. That wouldn't be surprising and should not dictate any major changes to your work or recreational activities- again, unless you are a race car driver, a XXXXXXX stuntman, or professional NFL or RUGBY player for the All Blacks (what a monstrous team those guys are from New Zealand!).

Be well, be happy, be careful, and above all, DON'T be worried so long as YOU know you are keeping things on a clean track.

Cheers!

So again, kind sir....If I've provided useful or helpful information to your questions could you do me the favor of CLOSING THE QUERY along with some upbeat words of feedback and a 5-star rating if you feel I deserve a bigger bag of peanuts to munch on as I answer more questions from your comrades in Health? I am definitely interested in updated information on your progress if you'd care to drop me a line at www.bit.ly/drdariushsaghafi and let me know how things turn out.

You can always reach me at the above address for this and other questions. I wish you the best with everything and hope our discussion has aided in your understanding of a few concepts related to your concerns.

Salute as they say in XXXXXXX Italy!


This query required 120 minutes of professional time to research, assimilate, and file a response.

---

Brief Answer:
Glad that the headache did not include any of the typical HANGOVER issues

Detailed Answer:
Thank you for the clarifications.

I couldn't begin to hazard a guess on what another physician might tell or not tell his patients with respect to what a scan shows. I think the question is easily answered simply by looking at the original CT scan reports themselves as they are signed off by the reading radiologists.

If they are in English then, it would easy to spot whether or not BLOOD were seen or not in the parenchyma of the brain and what state such as "chronic, hemosiderin, acute" etc. Blood in any organ (before it is fully resorbed) changes into "old" blood first which would be the same as a "chronic" bleed or something along those lines. From there the aging process shows the presence of HEMOSIDERIN which is iron resdiua which cannot be resorbed by the body. So the iron contained within all red blood cells would simply stay in that part of the brain where the bleed occurred. This is detectable on CT scans if the quantity is HIGH ENOUGH or it's concentrated in an area where iron can be picked up more easily due to the lack of iron in the surrounding tissues, make sense?

I'm pretty sure that a radiologist would call the presence of HEMOSIDERIN deposits. They always seem to even if it's not that much. Effectively, this tells the reader that "once upon a time" there was a bleed into the brain. It doesn't say how it happened or anything else but just that there was blood and again, based upon quantity that's a permanent change that will be likely present in that brain.

If on the other hand the radiologist were specifically directed to comment on whether or not any evidence of acute bleeding had occurred it is possible that in the final conclusion or impression of the report he/she may not feel the need to state the presence of any small amounts of iron deposition but rather just if there were any acute bleeds. That would answer the referring physician's question directly without bringing other "unnecessary" information into the equation. Make sense? So is it possible that a report may state the presence of OLD bleeding the brain but that your physician(s) may not report that to you? Sure, since old bleeding is not of any great clinical importance unless you're a research scientist looking for information that nobody else finds particularly interesting! HA! Is it possible that ACTIVE bleeding that could be a reason for your headaches were MISSED or not reported? Hard to believe that one unless someone really were not paying close attention to why a scan was being obtained on a patient with headache. Radiologists HATE making those kinds of mistakes so they pretty much go over scans with such information very thoroughly.

Again, in your case if you had a headache without signs or symptoms of an acute withdrawal or hangover type of headache (i.e. nausea, vomiting, photo/phonosensitivity) and it subsided then, it is not likely due to a silently expanding bleed within the brain because that would not get better....yours did. Ergo, not likely to be a spontaneous bleed (I'm also assuming you didn't hit your head again on anything.....or did you?)

As far as a couple of drinks being OK....that's for your doctors to say who know you and know what you mean by a "a few" drinks to decide upon when counseling you for the future. I'm sure they are taking into consideration your risk for followup blunt trauma episodes and the fact that those can cause rebleeds when they give you their opinions.

I know that I have patients for whom "a few" literally means 1-2, maybe 3 and that's it for months at a time. And then, I have patients (and friends-- I play on a men's rugby league so the boys can put a FEW down with relative ease....HAHA!) for whom "a few" is more on the order of what they can easily remember with the rest being a bit fuzzy if you know what I mean! Then, the pics start getting circulated the next day around the clubhouse and embarrassment ensues! LOLOLOL! So for those types, "a few" is usually more than most people are able to consume without risks! But again, only you and your physicians know what is being said when they tell you a couple of drinks is fine.

My perspective happens to be slightly more conservative in a person who just had a concussion resulting in a parenchymal bleed. I'd prefer they not engage in any behaviors that could place them at risk of another concussion....make sense? At least until the brain has fully cooled down. Then, I know they will be safest so not only would I prefer to see them curtail or even stop their drinking but I'd like to see them not engage in high risk sports (such as RUGBY....which almost never is something you'll see from a true lover of the sport! LOL!), high risk occupations where falls can occur due to being at heights, or the type of work that places their head at risk for being concussed, etc. It is hard in our modern society for every patient with a concusion to just kick their heels up for 1-2 years and completely abstain from everything and anything that could risk another blow to the head or intracranial bleed. But again, I'm operating from a more theoretical level since I'm asked questions more along the lines of "What's BEST for me doctor?".....as opposed to what's most PRACTICAL for me to be doing after having had X, Y, or Z happen to me and what are my risks if I don't observe changes in habits, lifestyles, or working environment in terms of future concussions?"

Make sense?

Also, your headache may be part of something called the POSTCONCUSSIVE SYNDROME (PCS) in which headaches can persist for weeks to months after a traumatic blow to the brain. It gets better over time which usually starts out in the initial days after the incident as being very strong and painful with the need to take strong pain relievers. Then, as time progresses they come and go and hopefully the need to use additional medications for headaches also begins to taper off....don't know if that described your situation. But perhaps these headaches were part of that picture and you're just still in your PCS phase of recovery. That wouldn't be surprising and should not dictate any major changes to your work or recreational activities- again, unless you are a race car driver, a XXXXXXX stuntman, or professional NFL or RUGBY player for the All Blacks (what a monstrous team those guys are from New Zealand!).

Be well, be happy, be careful, and above all, DON'T be worried so long as YOU know you are keeping things on a clean track.

Cheers!

So again, kind sir....If I've provided useful or helpful information to your questions could you do me the favor of CLOSING THE QUERY along with some upbeat words of feedback and a 5-star rating if you feel I deserve a bigger bag of peanuts to munch on as I answer more questions from your comrades in Health? I am definitely interested in updated information on your progress if you'd care to drop me a line at www.bit.ly/drdariushsaghafi and let me know how things turn out.

You can always reach me at the above address for this and other questions. I wish you the best with everything and hope our discussion has aided in your understanding of a few concepts related to your concerns.

Salute as they say in XXXXXXX Italy!


This query required 120 minutes of professional time to research, assimilate, and file a response.

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