Pathology of the Stars: Gary Coleman
Gary Coleman dies at age 42 from an Intracranial Bleed
Former child actor, Gary Coleman, passed away on May 28th, 2010 from an intracranial hemorrhage. Two days earlier he was rushed to the hospital after suffering a fall where he hit his head. It has been reported that he had an initial lucid interval and then slipped into a coma and he never regained consciousness. He was best know for his role as Arnold on the TV show “Diff’rent Strokes” where his famous catch phrase was “What-“chu” talkin’ ‘bout Willis?” Throughout his life he was plagued by issues with his health, finances, public and personal life. His past medical history includes kidney disease, two renal transplants, heart surgery, pneumonia, and a seizure earlier this year.
Anyone willing to take a guess which kind of intracranial hemorrhage he had?
Tags: Gary Coleman
Copyright 2010 John Barone MD. All rights reserved.
Comments (11)
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written by PJ , May 31, 10
Dr. Bharadwaj,
For sub-arachnoid, there will be a "thunder-clap" headache, or the worst headache the patient has EVER experienced. On CT, there will tree-branch like bleed.
Could you explain the difference between the epidural and subdural hematoma? For epidural hematoma, there is also a lucid interval and on CT, there will be bi-convex shaped bleed. Excluding CT findings, how would you differentiate epidural and subdural bleed?
Sincerely,
PJ
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written by Pramanik Bharadwaj, M.D. , June 02, 10
I had to look it up again to refresh my own memory...
Correction in my earlier posts - 15 minute lucid period after head trauma followed by headache, focal neurologic signs, progressive obtundation, hemiparesis, and ultimately blown pupil (dilated and fixed) - thats an EPIDURAL (my apologies)... the lucid period cannot be used alone to diagnosis epidurals from subdurals in real life... but for the boards, epidurals have shorter lucid periods (minutes to hours) - subdurals would be longer lucid periods (days to weeks).
If we dont have results from CT scan the only to distinguish the two on the exam would be through the history.. Subdurals occur with rupturing of the bridgin veins - so look for elderly (>65 year old) or history of alcohol abuse, demented... Subdurals symmptoms include headache, mental status changes - contralateral hemiparesis and/or other focal changes...
Next Step - CT of head without contrast
Epidural - Convex shaped
Subdural - crescent shaped
Subarachnoid - blood in subarachnoid space at the base of the brain... sometimes this is osbcure - so next step is to do a lumbar puncture to see if theres presence of xanthochromia.. SAH are more interesting for the board to test...
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written by vraj , June 04, 10
Ya I also thought it as an Epidural Hemorrhage.Thank you Dr. Bharadwaj for the detailed explanation.
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written by Danielle , June 14, 10
--- How much cooler would it have been if it was a subarachnoid hemorrhage with the whole circle of "Willis" thing????...but
"Talk and Die", Fall on the head-->Epidural
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written by Groover , May 05, 11
Subdural hemorrhages are caused by rupture of the bridging veins due to shearing force of the brain shifting within the cranium (especially when the brain is atrophied). Saggital plane impact (straight from the front or back) is more likely to cause bridging vein rupture. Lateral impact produces less shearing force on bridging veins since the falx cerebri prevents some of the brain's lateral movement within the cranium. Bleeding occurs between the meningeal layer of dura and the subarachnoid mater and appears crescent shaped on CT.
Epidural hemorrhages are more likely to occur w/ trauma to the lateral cranium, especially at the pterion (junction of the frontal, temporal, parietal, and sphenoid bones due to rupture of the middle meningeal artery. Blood accumulates between the skull and the pericranial layer of dura w/ a convex shape on CT.
Remember that the middle meningeal artery is the main blood supply to the meninges and is a branch of the maxillary artery, entering the cranium via the foramen spinosum.
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