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Monday, May 22nd 2006

WHO Head Dies

Director General of the World Health Organization has died in Switzerland.

Dr. Lee fell ill at a luncheon on Saturday in Geneva at the beginning of the weeklong meeting, called the World Health Assembly. He complained of a severe headache, took an analgesic, and later vomited, an official who was present said. Paramedics took him to the Cantonal Hospital in Geneva. Surgeons found that he had a blood clot on the brain known as a subdural hematoma and removed it.

Such clots often follow injuries to the head like those from a fall. But the W.H.O. said Dr. Lee had been in good health and was not known to have had any such injury. The clot also could have resulted from a bleeding artery in his brain.

Almost all subdural hematomas result from a bleeding artery, the vast majority of the time the middle meningeal artery which runs in the dura that encloses the brain just inside the skull. Bleeding from the middle meningeal artery however is almost always associated with some sort of trauma.

Spontaneous subdural hematomas are rare, probably much rarer than the spontaneous causes of epidural hematomas. As well, I suppose they don’t arise from middle meningeal bleeds like the much more common trauma subdural clots. Here’s eMedicine on it.

Spontaneous subdural hematoma is rare. The literature is limited to sporadic case reports. These cases often have an arterial source, because they are usually associated with the same pathology as that involved in subarachnoid or intracerebral hemorrhage. The blood from a ruptured aneurysm may dissect through the brain parenchyma or subarachnoid space into the subdural space. Likewise, the blood released from a “hypertensive” intracerebral hemorrhage can dissect into the subdural space. In fact, a case has been reported of an acute spontaneous subdural hematoma precipitated by cocaine abuse.