This weekend, after a few (~4) drinks at happy hour, and, I believe, too much marijuana (maybe 6-8 inhalations from a water pipe) my husband fell down about 8 steps in our home. He didn't lose consciousness before the fall.
He did hurt his back and was unsure if he hit his head. He sat on the steps for about 4 minutes to make sure nothing was broken. When he got up and attempted to come downstairs, he made it about 8 more steps, then fainted, with eyes open and a slower fall to the floor. His eyes remained open while he was out; he regained consciousness after about one minute. He stood up again, and, again, about 30 seconds later, fainted. Again, the same situation, eyes open, for about one minute.
I had called EMT. They arrived quickly and checked vitals, but kind of dismissed it as attributable to the marijuana and drinking. Of course, he minimized the incident as lightheadedness and said he could hear what was happening while he was "out." Of note, he occasionally talks in his sleep (maybe once a month and briefly), but that night he talked throughout the night, which is unusual.
The incident was terrifying to me. My question is would the trauma of a hard fall, without hitting the head, combined with double intoxication be a likely explanation for the loss of consciousness? Would a bump on the head that did not cause lasting pain be enough to cause syncope or seizure or subdural hematoma or concussion? Might the double intoxication itself have caused syncope or seizure, even? Would a scan be necessary in this situation? Any opinion or elucidation would be greatly appreciated. I have him scheduled for an appointment to be checked out day after tomorrow.
Loss of consciousness should result in hospital admission and 24 hour observation, his blood pressure closely monitored every 30 minutes, and an MRI taken. Do not pass go. Do not collect two hundred dollars. If the EMT's discouraged transport they should have their EMT's revoked. Last year I was escorting a friend for a medical appointment when he fell on the ice. He denied having hit his head. I insisted on a hospital admission and sure enough - subdural hematoma. There was retrograde amnesia. Obviously the alcohol and drugs could have caused the fainting episode, but whenever there is a fall, "Rule out Subdural Hematoma" is the rule of the reasonable and prudent physician.
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Any injury resulting in loss of consciousness irrespective of whether the patient was under intoxication or not should be followed up by complete observation for 24 hours and a CT scan or MRI of the brain as deemed fit. It is difficult to comment beyond this at this stage. Do follow up with the appointment you have taken and insist on a MRI/CT scan of the brain and cervical spine. Please let me know if there is any thing else and do keep me posted. Take care!
Thank you so much for your replies. Well, I accompanied my husband to the doctor's appointment yesterday. He gave him a full neurological clinical exam and didn't order any scans. He didn't seem to have any concerns and seemed to think my husband didn't hit his head, and, instead, that the rush of blood flow to the back injury, combined with sudden standing and intoxication resulted in the loss of consciousness.
I really hesitate to second guess a physician, but MRI's these days are relatively inexpensive, and they are definitive. Decades ago I worked in an emergency room where the senior physician was a very conscientious female. One of the first to spdecialize in emergency medicine. She fell, and "poo-pooed" the possibility of damage. She denied she hit her head. There was loss of consciousness. Six weeks later she had headaches and a CT revealed a hairline fracture C3. She did hit her head. The chances are the doctor who examined your husband is PROBABLY correct, but I would not let this go. There is always the possibility that "something else" is going on. On one side we want to eliminate unnecessary tests. On the other hand....
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