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Cedars-Sinai Neurosurgeon Explains Former President Jimmy Carter's Brain Injury

Neurosurgeon Explains President Carter's Brain Surgery

Former President Jimmy Carter is recovering after a surgery this week to relieve pressure on his brain caused by a subdural hematoma, according to a statement released by The Carter Center, a nonprofit organization founded by Carter and his wife, Rosalynn.

Cedars-Sinai neurosurgeon Adam Mamelak, MD, is an expert in treating subdural hematoma and, while he did not treat Carter, offered insight into the potentially life-threatening condition and its treatment.

"A subdural hematoma is an abnormal collection of blood, often mixed with fluid, that is in the space between the brain and the membrane that covers the brain, which is called the dura, inside the skull," Mamelak said.

Most subdural hematomas are caused by head trauma, Mamelak explained, and a third of them occur in older adults. In younger patients, the condition is more likely to be caused by head trauma due to an accident, violence or high-impact sports. In infants, subdural hematomas are often from shaken baby syndrome.

"It can, in some cases, be very minor trauma, such as hitting your head against a cabinet, or even in some cases a strong sneeze," he said. "More commonly that's seen in older people, because their brains have a little more atrophy, so there's a little more space in there. Typically, a vein or some other blood vessel will tear, and the fluid will collect in the space between the brain and the skull."

Subdural hematomas are dangerous because as extra fluid builds up it is confined by the skull, has nowhere to go and causes pressure on the brain. This can cause neurological symptoms such as confusion, dizziness, headache, nausea, seizures or problems with balance.

If not treated quickly, symptoms can worsen, potentially leading to coma or death.

Fortunately, neurosurgeons can relieve this pressure on the brain by creating a hole in the patient's skull and draining the fluid.

"In some cases, we do a craniotomy, which is where we open a larger window of bone and wash out the blood and fluid that way, and in other cases, smaller holes, what are called burr holes, can be used if the hematoma has become all liquid," Mamelak said.

Recovery from the surgery varies based on many factors, Mamelak said. Those factors include the patient's condition and symptoms before the surgery, the size of the hematoma, how rapidly the hematoma developed and the patient's individual response to the surgery.

"Some patients can leave the hospital within a few days," he said. "Other patients will end up being in the hospital for weeks and sometimes require long-term rehabilitation."

Read more on the Cedars-Sinai Blog: Understanding Traumatic Brain Injury