Teamwork and speed of response restore patient’s ability to move after suffering epidural hematoma

Jacqueline Bergan in her studio

(Note: this story was prepared before the COVID-19 pandemic.)

Wisconsin resident Jacqueline Bergan, 82, went into the hospital late in 2019 for a routine steroid injection in her neck to help her manage pain. The injection caused an extremely rare epidural hematoma – bleeding between the tough outer membrane covering the brain (dura mater) and the skull.

According to a case study published by Neurosurgery Department Head Clark C. Chen, MD, PhD; and U of M anesthesiologist Ratan Banik, MD, PhD, in the December 2019 journal, Anesthesiology, thirty minutes after the epidural injection, Jacqueline suddenly developed localized neck pain, quadriplegia, loss of reflexes, and numbness, which signified that the blood clot was exerting pressure on her spinal cord. “I felt a wave of paralysis move up from my feet to my sternum,” Jacqueline said.

She was taken to the University of Minnesota Medical Center into the care of a surgical team led by Chen. “Understandably, there is a great deal of preparatory work involved before a patient can undergo neurosurgery; different preparatory work is required of the nursing team, the anesthesia team, and the surgical team,” he said. “Yet, the patient underwent surgery within 30 minutes of presentation. All team members reacted with a remarkable sense of urgency.”

Clark C. Chen, MD, PhDTricky balance
It was essential that the team remove the clot as quickly as possible. “It extended all the way from the top of the cervical spine to mid-thoracic spine,” said Chen (pictured at left). “Time was of the essence if we were to have a chance of restoring her function – we had to quickly evacuate the clot to remove the pressure on her spinal cord, while maintaining her spine’s stability.”

The surgery lasted well into the wee hours of the morning.  After the procedure, Jacqueline woke up in intensive care. “I remember Dr. Chen and his team coming to my room,” she said. “I told them, ‘I just want to walk and type.’” During her recovery in the ICU, Chen would ask Jacqueline every day to lift her legs. “Around the fourth day, I was able to move my right leg and hand,” she said. “My left side was completely unresponsive.”

You will walk
On the sixth day, Jacqueline was able to lift her left leg a tiny bit off the mattress. “Dr. Chen did a little dance and joyously said, ‘You will walk; you will walk.’” she said.

Chen noted that Jacqueline regained the ability to move shortly after the surgery and was eventually able to recover most of her neurological function. “This outcome couldn’t have been achieved by a single individual,” he added. “The OR nurses who are on standby and ready to go, the anesthesiologist who can work quickly, the surgeon ready and able to do the surgery without compromising the spine. It was truly a team effort.”

Expectations surpassed
Jacqueline spent 16 days recovering in an M Health Fairview rehabilitation facility. “The level of skill and care I received there surpassed all possible expectations,” she said. “They even taught me how to get up after a fall. The staff’s devotion to their patients was evident.” Using Chen’s words, “You will walk; you will walk.” as her mantra, Jacqueline dedicated herself to recovering.

Although she still deals with limitations such as occasional fatigue, Jacqueline feels her recovery is “amazing,” and is incredibly grateful to Chen and the entire team for the “exceptionally kind and skillful care” she received.

“Jacqueline’s recovery is a miracle of modern neurosurgery,” said Chen. “It is the culmination of years of clinical experience and laboratory research. It reflects what we, as a team, can do for our patients against overwhelming odds. It is the type of miracle that we have come to expect at the University of Minnesota.”

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