HDIB? Neuroscience Grand Rounds: Epidural Hematoma

So by now many/most of you have seen the Brandon McCarthy incident that occurred during Wednesday’s game against the Los Angeles Angels of Anaheim, the Inland Empire, Barstow, and High Desert of Kern and LA Counties, and parts of San Diego. Scary stuff, life threatening stuff. Stuff of nightmares, and stuff that conjures up flashbacks to Juan Nicasio, even Ray Chapman.

As a neuroscientist by trade, I feel compelled to have a teaching moment, and hopefully shed some light on the medical aspects of the incident, in hopes of arming folks with a little extra knowledge of this type of injury, and perhaps add some additional gravity to the situation, while also alleviating some of the mystery, and concern over the epidural hematoma Brandon sustained.

Excuse me while I change into my white coat — mine’s flannel lined, and super comfy.

Ahh, that’s better; gotta love the LL Bean Health Care catalog.

While he didn’t quite dodge the ball coming off of Erick Aybar‘s bat, McCarthy did dodge a huge bullet in terms of his long-term health; he was quickly seen, and the physicians involved with his initial care did him a great service by getting a CT scan of his head. With the help of my crack staff of interns here at HDIB?, here’s a ‘nice’ CT image of what an epidural hematoma looks like:

Guhhhh

See the bright white crescent on the left? That’s the hematoma, which is simply an area of blood that has pooled outside of blood vessels due to trauma. As you can image, a baseball to the noggin at over 120 miles per hour will create enough trauma for the tiny capillaries and vessels of the head to get a little leaky, shall we say. For this type of injury, the blood pools between the tough, layered outer covering of the brain – collectively called the dura – and the skull. As more blood seeps out of blood vessels, the greater the pooling between the dura, and skull. More pooling, more intracranial pressure – the skull doesn’t have much ‘give’, as you can imagine, to flex against the swelling – which in turn, pushes the hematoma into the brain.

From here, the brain gets smooshed (medical term there, folks), and depending upon which part of the brain gets smooshed the most, you can see a number of symptoms, arising from what that smooshed brain area is responsible for – language, vision, movement, what have you. More severe hematomas can smoosh all the way down to more basic areas of brain that are responsible for things like, say, breathing. This can happen over a matter of hours, or a matter of days, which is why the CT scan, as well as keeping a person with this in the hospital for observation, is a crucial aspect of diagnosis, and treatment of this injury.

OK, my impromptu neurosurgery residents, what do we need to do, and how do we do it. Yes, you with all of the tattoos, playing Fruit Ninja on your phone – whatcha got?

…reduce intracranial pressure is the first step? Excellent! What’s a quick, and mildly barbaric way to do that?

You, the one with the bowtie, picking your earwax and smelling it, you’re up.

… a craniotomy? What you lack in social skills, you add in sheer neuroscience genius. While you are correct in wanting to do this, there are other methods of reducing the pressure from the hematoma, but the craniotomy is arguably the quickest, and most thorough way to get this resolved.

OK, so off we go to the OR to drill a hole in poor Brandon’s skull, to ‘evacuate’ the hematoma, and reduce that brain smooshing. You can find more in-depth information about the procedure here.

There we have it, in a nutshell – for those scoring at home, it’s a Brazil nut. While a somewhat common injury, especially in falls, and car accidents, it’s exceedingly rare within the realm of baseball injuries. McCarthy’s prognosis is quite good, given the speed in which the medical staff treated this, from the team trainer, down to the neurosurgeon.

Isn’t neuroscience great?

The answer is yes. Yes it is.

…and even more awesome is that Brandon is going to be OK, and hopefully back on the mound soon, albeit not this season, I would imagine.

I hope you enjoyed my teaching moment, and that it adds to your enjoyment of the game, and to your amazement of the human body, at rest, and in motion.

Is Brandon McCarthy awesome?

Yes. Yes he is. And with the help of modern medicine, he will continue to be.

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