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New Directions - THINC (Again!) Head Injury Patient Benefits from Research Protocol

New Directions Winter 2013

THINC (Again!) Head Injury Patient Benefits from Research Protocol

Date: November 1, 2013

Neurosurgeon David Lin, MD with patient, Richard Suchinsky, MD.
Neurosurgeon David Lin, MD, reviews CT and MRI scans with his patient, Richard Suchinsky, MD.

Retired psychiatrist Richard Suchinsky, M.D., 83, enjoyed a long and distinguished medical career, working well into his 70s. Five years after his retirement, in November 2012, he found himself on the receiving end of health care when he arrived by ambulance at Suburban Hospital’s Trauma Center.

Dr. Suchinsky was walking to his car after a routine medical appointment when he suddenly felt “woozy.” The next thing he remembers, he was being evaluated at Suburban Hospital for a severe head injury. He had fallen in the parking lot and landed on his face, losing consciousness. His traumatic brain injury (TBI) made him a candidate for the THINC study (see sidebar).

“Dr. Suchinsky’s original MRI showed that he had a significant bleed in his brain,” says Mary Jo Rucker, RN, BSN, traumatic brain injury research nurse coordinator. “While he seemed alert and oriented in the Trauma Center, he was experiencing some difficulty with his speech as well as memory problems. We were particularly worried about him because of his age.”

Dr. Suchinsky was admitted to Suburban’s ICU. “I have no recollection of the two weeks following my injury,” he says. His participation in the study, however, meant that he would automatically receive a second MRI while still in the hospital and a third MRI approximately 30 days after his hospital admission.

After his discharge, Dr. Suchinsky spent two weeks at a rehabilitation facility before transferring to an assisted living facility for a short stay before heading home. It was during this stay that he was contacted for his follow-up MRI. By the time he returned to the hospital in late December, his speech and memory had improved and he was walking with the help of a walker. Having made great strides in his recovery, the last thing he expected was to be told that his MRI revealed a problem. “The MRI showed a huge chronic subdural hematoma,” says Rucker. “We immediately took Dr. Suchinsky to the Emergency Department and called in neurosurgeon David Lin, M.D.

“A subdural hematoma is a collection of blood outside the brain, under the skull, which can be life-threatening because of bleeding and increased pressure,” explains Dr. Lin. “This condition is very common in elderly patients. In nearly half of these cases, the patients don’t even remember experiencing head trauma, or they may complain of very non-specific symptoms, such as headaches. Even if they do remember a head trauma, they may not associate that event with their later symptoms. This makes for a very tricky diagnosis. In Dr. Suchinsky’s case, because he was symptom-free, we would not have known about his hematoma had it not been for his participation in the THINC study.”

Dr. Suchinsky was admitted to the hospital for a day of observation. When his neurological status remained intact, Dr. Lin felt it safe to discharge him back to the assisted living facility, with instructions to the facility staff regarding what symptoms to watch for in the future. Within 48 hours after his discharge, Dr. Suchinsky began to experience some of these symptoms and was quickly brought back to Suburban Hospital, where he was immediately scheduled for surgery. Dr. Lin successfully drained the hematoma through two small holes in Dr. Suchinsky’s skull.

“Because subdural hematomas have a recurrence rate of between 10 and 15 percent, we follow these patients rather closely” says Dr. Lin. “I followed Dr. Suchinsky for about five months after the surgery; he has recovered completely and is doing great.”

Dr. Suchinsky is pleased to be back home, living completely independently once again. An avid reader, he also enjoys watching old movies and is looking forward to future visits with his two children and two grandchildren, all of whom live outside the area. “I am about 90 percent of where I was before falling,” he says. “I could have easily experienced problems from the subdural hematoma, and I feel very fortunate to have survived both my TBI as well as the hematoma. I am so happy that I participated in the THINC study, and I am very grateful for the care I received at Suburban Hospital.”

The THINC Study
The Trauma Head Injury Neuroimaging Classification (THINC) study explores the use of early MRI imaging to determine the true extent of a traumatic brain injury as well as the degree to which the initial injury resolves or progresses over time. Suburban Hospital’s role in the study evolved from a unique partnership with the Center for Neuroscience and Regenerative Medicine (CNRM), a collaboration between the Uniformed Services University of the Health Sciences (USU) and NIH (namely, the National Institute of Neurological Disorders and Stroke and the NIH Clinical Center).