Blood Clots: Are You at Risk?

Sen. John McCain’s unexpected surgery on July 14 made headlines because it delayed a vote on the U.S. Senate’s health care bill. It also turned attention to a health problem that is common although not well understood: blood clots on the brain.

Blood clots are common in the 50+ population, and it is important to know how dangerous they are and to recognize warning signs.

“The word 'clot' can be confusing,” says Vikram Nayar, a neurosurgeon at MedStar Georgetown University Hospital in Washington, D.C. In the most common cases there isn’t a blockage, he says, but rather “bleeding outside the blood vessels.” The danger is that the clots can put pressure on the brain, causing problems from disorientation to, in severe cases, coma or death.  

The Arizona Republican's clot reportedly was found during a “routine exam,” but clots in or on the brain can be confirmed only through an MRI or CT scan.

In most cases a subdural hematoma, which most experts believe is the type of clot the 80-year-old McCain suffered, is diagnosed after a patient shows some of the typical symptoms. These include headaches, seizures, confusion, weakness involving one side of the body, and problems with speech. A stroke — a blood flow blockage within the brain that begins to kill brain cells — can cause similar symptoms. But not all clots lead to stroke.

The older we get, the higher the risk for a hematoma, Nayar explains, because our brains shrink with time. This causes the veins that bridge the brain to the skull to be more susceptible to tearing. The most minimal trauma can lead to a tear, he adds, “even a shaking of the head without actually hitting the head. So a minor fall could cause it.” In younger people it is typically caused by severe head injuries.

Anyone at risk should see a doctor immediately if symptoms appear, Nayar says. He advises people to take extra care to avoid falls, and to make sure a doctor is carefully monitoring the dosage if they are taking blood thinners.

McCain's doctors report that he is likely to make a full recovery after rest at home.