In this piece, I would like to shed light on a story of a 39-year-old young white woman from Brooklyn, New York, who was fortunate enough to get help and thus survive after Sudden Loss of Consciousness. However, the question remains as to what will change her life in the future.
Sarah is divorced and shares a small room in Brooklyn with a friend. On October 14th, 2022, her roommate of two years, Kate, called the emergency responders after finding Sarah unconscious on the floor of their living room.
Upon arrival, Sarah is highly sluggish and unresponsive to verbal communication. According to her roommate Sarah had been complaining of severe headaches. The roommate also recalled mentioning that she vomited profusely as she had never had one like that before.
According to Kate, Sarah related her symptoms to her migraine episode. Yet, this time she described it as long-lasting, not responding to rest and over-the-counter migraine medications, and more severe.
Kate's knowledge of Sarah's medical condition was otherwise close to none, as she describes Sarah as very private and skittish. She often recalls not being unusual for Sarah to lock herself in her room for hours.
The emergency personnel detected a fever of 104.0 F and a rapid heart rate at the scene. Blood pressure and breathing were otherwise normal. Sarah was immediately transferred to the closest emergency room, provided she received basic life support measures, such as oxygen and fluids through her veins.
At the emergency room, the doctor on call performs a quick yet thorough physical examination of the semiconscious lady. The examination findings included rigidity of the neck and swelling of the central section of the Eye retina in both eyes (also called Papilledema).
The physician also finds a palpable bulge on the left side of Sarah's head which seems red and hot, and she grimaces when pressed lightly.
Another revealing physical sign found on examination is the so-called Kernig's sign. Latter primarily points to the inability to straighten Sarah's leg when the hip is flexed to 90 degrees due to severe stiffness in her hamstrings. She also had a few needle puncture marks (some new and others old) in her left groin.
While in the emergency room, Sarah had an episode of seizures associated with repetitive unconscious violent movement and foaming of her mouth. Seizure is something Sarah's roommate denies recalling such episodes at home.
Without a doubt, the limited yet significant findings point to some form of disorder involving Sarah's Brain. For that reason, the doctor immediately orders an MRI.
Since Sarah also had a fever, the doctor sent a blood sample for a culture to find possible bacterial causes of Sarah's problem. Culturing blood not only helps detect severe infection but also assists doctors in making them select the right antibiotics.
Indeed, an MRI of the head enhanced using dye reveals a local abnormality of the left frontal area of Sarah's skull and overlaying brain structures in the exact location.
In association with her signs and symptoms, Sarah's MRI findings strongly suggest localized infection of the covering layers of the brain, called Subdural Empyema, extending to the boney skull.
Subdural empyema is the loculated accumulation of pus between the two layers of the brain's covering tissue. That is the space between the "dura mater and the arachnoid."
Treatment of Subdural empyema consists of emergent surgical intervention by neurosurgeons and long-term antibiotic therapy. And that is precisely what was done for Sarah. Of course, in the initial week after surgery, Sarah was closely monitored and treated in Intensive Care Unit before being downgraded, as tolerated, to a regular ward and discharged home.
Once Sarah regained consciousness after two days, she stated that she was recently laid off from work. She does not drink alcohol or smoke. However, she occasionally injects heroin into her groin vein. She denies any medical condition other than occasional migraines. That includes a history of sinus infection.
Using contaminated needles and heroin products is one of the leading causes of localized central nervous system infection. However, infection among IV drug users often involves their spinal cord. And those who suffer from subdural "infection" of the brain typically also suffer from a long sinus infection history.
Since Sarah does not have a history of sinus infection, it is sure to assume that her IV drug history played a direct role in her recent hospital experience. Later during her stay, blood cultures revealed that the bacteria causing the severe infection was Staphylococcus Areaus. Hence, the treatment was given according to that finding.
Luckily Sarah survived, thanks to her roommate, Kate. Sarah would have rapidly slipped into a coma without timely treatment and died. Her lifestyle with recreational drugs must stop or, at the very least, hygienic practices using clean needles and products observed.