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Medical Forum / General / General / June 2005Head bang, Nasal blood?
Hi 24hrs ago I slammed the front-top of my head into the side of the doorway. No loss of consciousness or amnesia, and no cut just a bump. A couple hours ago when I woke up and blew my nose there was blood mixed with the mucus. Is the blood just a coincidence? I did a search and read about this double ring if it is CSF when put on filter paper, but can't find any pictures. Mine has blood in the center, an off-white color surrounding it, and a thin outline of red at the edges. Like an egg in a frying pan or coffee stain. Probably just nasal blood and nothing to worry about right? If it was from the head whack will it heal on it's own? Thnx > Hi > 24hrs ago I slammed the front-top of my head into the side of the [quoted text clipped - 10 lines] > Probably just nasal blood and nothing to worry about right? If it was > from the head whack will it heal on it's own? Hmm...in the spectrum of traumatic brain injury, your positive double-ring sign, and epistaxis don't fit very well with the fact that there was no LOC, no focal defecits, no altered mental state, normal GCS. In the event you're not trolling, I'd have to recommend that someone drive you to the nearest ER. Sounds like you need a CT scan. HMc Is what I described really a positive double-ring? I've had blood on the nose tissue before in the past, as has everyone I know... does nasal blood absolutely not spread out as I described on the paper? It's not like I was in a car accident, just kind of fast walked into the side of the doorway. I was hoping to hear, "Don't worry about it." What could a CT scan show? Is it not okay to just give it time and monitor for any other unusual symptoms? Thank you > Is what I described really a positive double-ring? I've had blood on > the nose tissue before in the past, as has everyone I know... does > nasal blood absolutely not spread out as I described on the paper? > > It's not like I was in a car accident, just kind of fast walked into > the side of the doorway. I was hoping to hear, "Don't worry about it." What you described is consistent with a double-ring sign, and you reported a nose bleed from a blow to the top front of your head (nose not injured). Can't just shrug that off. My interpretation depends on the accuracy of your description, since I can't see it. It's possible that it could be just mucus, but since I can't tell from here if your drainage contains polysaccharides, and since CSF rhinorrhea carries the very significant risk of bacteria from the sinus infecting your brain, then yes, go to the ER. > What could a CT scan show? It *might* show a sinus full of blood, or it might show a fracture, or it might show a tumor in your frontal sinus. It might show nothing. > Is it not okay to just give it time and > monitor for any other unusual symptoms? You asked for advice over the internet, where a proper history is unlikely and a physical exam is impossible. I'm giving you the same advice you'd likely get if you called the ER doctor on the phone.....clear nasal drainage mixed with blood after a blow to the head *might* be nothing, but it *might* be CSF rhinorrhea. Since it's impossible to tell over the internet or over the phone, go to the ER. Here's the deal...you've presented a set of facts, now, readers here have to guess what's going on. The consequences of guessing "go for examination" and being wrong are wasted time for you. The consequences of guessing "Don't worry about it" and being wrong might result a your death. HMc > > Is it not okay to just give it time and > > monitor for any other unusual symptoms? [quoted text clipped - 12 lines] > > HMc Yes, I appreciate your advice very much. It is always a gamble I guess. :) I will wait a bit and if there is more blood/discharge, or other signs I will go to the ER. Thanks > Yes, I appreciate your advice very much. It is always a gamble I guess. > :) I will wait a bit and if there is more blood/discharge, or other > signs I will go to the ER. In the absence of altered mental state or other focal neurological signs, I can't say that that's unreasonable. CSF rhinorrhea is likely to be persistant and ongoing, not episodic. HMc >Here's the deal...you've presented a set of facts, now, readers here have to >guess what's going on. The consequences of guessing "go for examination" and >being wrong are wasted time for you. The consequences of guessing "Don't >worry about it" and being wrong might result a your death. I'm going to go out on a limb here and pronounce his death highly unlikely based solely on the fact that it's been several hours and he's still posting messages to this newsgroup. Call me bold and rash. >>Here's the deal...you've presented a set of facts, now, readers here have >>to [quoted text clipped - 9 lines] > > Call me bold and rash. I don't disagree, but my advice to patients with potentially life-threatening problems that I can't evaluate tends to err on the side of caution. Going out on a limb is generally discouraged as a concept. HMc >>>Here's the deal...you've presented a set of facts, now, readers here have >>>to [quoted text clipped - 15 lines] > >HMc I agree with Dr. McCollister. While the odds of this being a serious injury are small, there is a chance that a life-threatening problem exists. I would go to the ER and a CT scan sounds good to me, also. Best, Bob Robert A. Fink, M. D. Neurological Surgery 2500 Milvia Street Suite 222 Berkeley, CA 94704-2636 USA 510-849-2555 ********************************** NOTE: The material above is not "medical advice". Medical advice can only be given after an in-person contact between doctor and patient. ********************************** I understand why you guys err on the side of caution, but sometimes I wish physicians gave two opinions; one as a professional, and the other in a lighter, 'off the record' tone. Once in the past I tried to get a quick appointment but everyone was out, and I was told to go to the ER over the phone. When I went there it turned out to be nothing. Here I was healthy surrounded by serious injuries, and I felt stupid. I wish I wasn't told to go. The doctor hid it, but I could tell he was laughing at me inside like, "what a waste of time". The other thing besides a waste of a visit is the anxiety. A physician's word can be intimidating and when they speak strongly, including the word death, it can be very scary. It's been around 60 hours since my incident, and I haven't had a repeat of nose discharge, it is quite dry. Last night my neck was rather stiff, but today it is improved and I feel mostly fine. I appreciate Howard, and now your advice Robert, but I would be lying if I said it didn't cause stress. Sometimes I wonder if the stress caused by a doctor stating the possibility of a serious issue ever causes one, or prevents something from what would have otherwise healed. I did some reading about the CSF rhinorrhea and minor head trauma. The stats I read said that most leaks close up within a week or two on their own, and only a fraction get things like meningitis, and only a small number of those die. It looked like if the CT scan showed such that the first treatment would be simply bed rest, and surgery as a last resort. But it doesn't sound like something that is so critical to the hour. I can take it easy at home for a week or two until things fully heal, but the odds are that it was no big deal and I would've wasted a bed at the ER. Anyways I do appreciate the advice... and who knows, maybe I'll still need a CT scan since Howard said it is persistent. But I wanted you guys to know that hearing these things can cause anxiety, and sometimes maybe you can offer some reassurance along with the advice to soothe the nerves. If you have to go to the ER, and might die, it would be nice to be relaxed in the process and have some words of hope to hold onto. Thanks again >I understand why you guys err on the side of caution, but sometimes I > wish physicians gave two opinions; one as a professional, and the other [quoted text clipped - 38 lines] > nice to be relaxed in the process and have some words of hope to hold > onto. I am not unmindful of the stress and anxiety that a physician's advice can sometimes cause, and like most physicians, my ongoing goals for my patients include not causeing such stress unnecessarily. However, I've been doing this long enough to be aware of the disasters that can come from not being cautious enough. When people play the odds, it's important to for them to know what they're betting relative to what the cost is. I advise you to go to the ER, and the worst case scenario is that it's a wasted trip and you get some unnecessary anxiety. So, in this, as in many other cases in my career, I balance the risks vs the benefits -- an unnecessary trip to the ER vs a timely discovery of a potentially lethal medical condition. What to choose... I'm sorry about your anxiety. I'd have been a lot sorrier if I'd advised you to shrug it off and you had died of septic meningitis. HMc Okay I wasn't entirely sure how mindful physicians tended to be. From the face of it they can appear to be cold. But I thought about what you said and I think that physicians shouldn't have to candy coat advice. Me and many others were brought up regarding doctors as borderline gods... since they are the first faces you see when born in this country, and often the ones who either save your life or tell you that you will be losing it shortly. It is not your fault, and I need to remember that it is a profession, and a technical one at that. How we deal with the pain and fear involved in losing health is better left to the individual rather than making physicians have to worry about it. So, don't feel bad about any anxiety you might cause. >I agree with Dr. McCollister. While the odds of this being a serious >injury are small, there is a chance that a life-threatening problem >exists. I would go to the ER and a CT scan sounds good to me, also. Of course I agree with both of you in the "real world" but I have to take issue with the idea of advising him to visit an ER for this. I would say calling his doc in the morning and dealing with it then would be adequate advice. Even if he really is leaking CSF, I doubt it will kill him before then. And if it will, odds are he'll never see our replies anyway. Usenet just isn't a very good emergency advice medium. >Date: 22 May 2005 07:22:30 -0700 > >24hrs ago Going on 3 days now. Still got that clear fluid? Hi. I don't think there's any clear fluid that isn't normal, at least nothing that drips out on it's own. Definitely no blood, so I guess I'm good. I have no idea what the blood was from, but I'm glad I'm not dead... can you imagine being known for dying by running into a doorway? :) Thanks for your first reply, "his death highly unlikely"... you'd be surprised how a few simple words can help bring back focus on reality. >can you imagine being known for dying by running into a >doorway? :) Oh, yes. Definitely. Trust me, there are dumber, far more embarrassing ways to die. Happens all the time. >Thanks for your first reply, "his death highly unlikely"... >you'd be surprised how a few simple words can help bring back focus on >reality. You're quite welcome, even if two highly respected individuals with far more training than I have both disagreed with my advice. You got lucky -- I happened to be right (as they expected)... or at least so it seems. Next time just do us all a favor and don't ask here, okay? Emergency questions just don't work on the internet. Call your doctor, call 911, visit a walk-in clinic, or whatever works where you are. Don't wait for answers here. Oh, and watch out for doors.... "Agent Canary Knows, too." ~ Folly >>can you imagine being known for dying by running into a >>doorway? :) [quoted text clipped - 17 lines] > > Oh, and watch out for doors.... Let me put it this way, Carey...if it had been ME that had the OP's symptoms after such an accident, I would NOT have gone to the hospital ER or had a CT scan. But I don't figure that I can take that kind of liberty with other people's lives. HMc "Let me put it this way, Carey...if it had been ME That had the OP's symptoms After such abuse, I would NOT have gone to the hospital ER Or had a CT scan. But I don't figure I can take that kind of liberty with other people's lives." ~ HMc Riddle ~ If you're catapulted to Channel Z And all you hear or see R Hickory Dickory Dock & Tocks Tick Tocking & Tocks Tick Tocking & Tocks Tick Tocking & Tocks Tick Tocking & Tocks Tick Tocking & Tocks Tick Tocking & Tocks Tick Tocking & Tocks Tick Tocking & Tocks Tick Tocking What do you do? You swim blincdly to the first familiar known authority figure Who'll answer your calls ... Any port in a storm. Even if that port turns out to be Enemy Territory. You survive the First Storm. You are sunk by The Second Storm, Additional torture And distortion added to kill the voice, To bury the Living Witness, aka, The Victim. Burn at the stake, Or burial at sea? Buzzard's bait, or self ~ hate & humilation fighting other's lies? A Child Is A Child Is A Child. I Was A Child. My Memory Is Accurate. But My Voice Choked. A Child Is A Child Is A Child. I Was A Child. My Memory Is Accurate. But My Voice Choked. A Child Is A Child Is A Child. I Was A Child. My Memory Is Accurate. But My Voice Choked. A Child Is A Child Is A Child. I Was A Child. My Memory Is Accurate. But My Voice Choked. A Child Is A Child Is A Child. I Was A Child. My Memory Is Accurate. But My Voice Choked. I almost died. That's someone's fault." ~ Twittering "My Memory Is Accurate. But My Voice, Choked. I almost died. That's someone's fault. I almost died. I lost something else instead. I almost died. My suffering's denied. I almost died. Part of my mind's dead. I almost died. My brain blood red. I almost died. I am alive. I almost died. I am a burning fire of rage. I almost died. I need this written on The Law's Page. I almost died. I might be dead. I almost died. I lived for months thinking I was dead. I almost died. Others witnessed my death consume to me. I almost died. I am still alive. I almost died. This should not have happened to me. I almost died. This was evil, this was wrong. I almost died. Evil is very real. I almost died. What happned to me is not justified. I almost died. I will make something good of it anyway. I almost died. Listen to me. Don't let this happen again To anyone again. Learn from me, I tell you my story. If you do listen to me, I talk to myself. I listen to me, One who loves me. I lonely. Me loves me." ~ Twittering ~ Twittering broken I lonely. Me loves me." ~ Twittering ~ Twittering Broken, but Twittering Spoken "I alone, But I hold me. & Folly knows me, too. Folly follows & protects me. & I, her. We fly The Ether Patrol Making wrongs right, that others refuse to hear or right. We write, too. We want everything alright for everyone, Else, too." ~ Twittering LSTOO & Folly IAG "Twittering, Work in the world is very important." ~ Capsicum "Yes, Capsicum, I know. Work in the world matters very much." ~ Twittering "Capsicum, Each and every day, I try to do my best. Tomorrow, I try harder, too." ~ Twittering "Me, too." ~ Folly "Very good goose, Folly. Very wise, indeed. Very brave goose, You, too, all spruced up today. So pretty, you, too." ~ Capsicum >>>can you imagine being known for dying by running into a >>>doorway? :) [quoted text clipped - 24 lines] > > HMc I would guess though that this has less to do with a lower level of concern than it does with actually being able to directly assess the rhinorrhea. ;-) Steve  SignatureMark & Steven Bornfeld DDS http://www.dentaltwins.com Brooklyn, NY 718-258-5001 Okay so I might've been wrong... sorry. I thought it was my imagination, but now I see that almost every time I eat my nose runs. We're not talking gallons or anything, but maybe a drop or two escape the nostrils on their own. The fluid is clear, slightly clouded with white particles. It has an average glucose level of lower 20's mg/dL (thought I read this info isn't very accurate for determining CSF), and when dried on brown paper disappears (I read mucus dries shiny). I've been more aware lately, but I'm pretty sure my nose didn't run before when I'd eat. It's been like 10 days and for most of it I prevented myself from coughing/sneezing just in case. I also haven't done any exercise, which is pretty irritating since I want to. A quick search shows, 'gustatory rhinorrhea', which doesn't right away mention CSF or head trauma... So is this just becoming aware of something that was always there because now I'm watching for it? Or? Before I was thinking 1-2 weeks, but I just read, "Series from the first half of the century indicate that two-thirds of post-traumatic CSF leaks will resolve spontaneously by one month". So maybe I just need to give it more time just in case? |
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