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After long careers as atmospheric scientists at the University of Alaska Fairbanks, Gerhard Kramm and his wife, Nicole Mölders, were enjoying their retirement in Alaska. They filled their days with activities they enjoyed together, like continuing their research and ballroom dancing.
But one night in 2023, Gerhard was experiencing sciatica pain — numbness and tingling down his leg — and fell after getting up from bed to use the restroom. Nicole heard a loud bang and found her husband lying on the ground.
“I thought he had hit his head against the bed,” she recalls.
Nicole wanted to go to the emergency room, but Gerhard insisted he was OK.
The next morning, Gerhard woke up with a headache but still maintained that he was fine. Yet, a little more than a month later, Gerhard began forgetting things and asking Nicole to drive instead of him. He stopped doing research because he struggled to hit the right keys on the computer. When Gerhard began losing his ability to walk and talk, Nicole became really concerned.
“Watching his condition worsen and his refusal to see a doctor scared me,” says Nicole. “I thought he might have had a stroke, and I feared that he wouldn’t make it and that I would be a widow at age 60.”
Luckily, Gerhard had an annual wellness exam, where the doctor immediately ordered testing, including a CT scan. In the emergency room, a short time after the scan, Nicole learned Gerhard had a subdural hematoma — a brain bleed likely caused by his fall weeks earlier.
Subdural hematomas: a hidden brain injury
A subdural hematoma occurs when blood vessels rupture between the brain and a layer of protective tissue that surrounds it (called the dura). A clot then forms within the confined space between the brain and the dura, which compresses the brain. This can happen suddenly after a traumatic event or gradually after even a minor bump on the head.
The former, an acute subdural hematoma, is life-threatening and can cause coma, paralysis or death if not treated immediately. The symptoms for the latter, chronic subdural hematoma — which is what Gerhard had — include things like weakness, balance problems, headaches, changes in personality, slurred speech, memory loss and disorientation.
Gerhard’s story isn’t unusual for patients with chronic subdural hematomas, says Richard Ellenbogen, MD, chair of neurological surgery at UW Medicine. Symptoms tend to develop over time as blood accumulates in the brain.
“A lot of times, people hit their heads and don’t relate it to their symptoms because they progress slowly,” he says. “They often don’t realize the connection until weeks later.”
Treating subdural hematoma with surgery
Gerhard needed surgery to remove the clot and relieve pressure on his brain. It would take a specialist with expertise in neurological surgery to perform the procedure. The community hospital in Fairbanks didn’t have such a specialist on staff, so they reached out to Ellenbogen and his team at Harborview Medical Center in Seattle.
Gerhard doesn’t remember much from that summer. He says it dawned on him for the first time in the emergency room, while he waited for a medical plane to arrive and transport him to Seattle, that he had a serious health problem.
“While on the jet, I wondered if I would ever see Nicole again,” Gerhard says.
But once he got to Seattle, he was in good hands. Ellenbogen and his team perform hundreds of surgeries on patients with subdural hematomas each year because of Harborview’s designation as a Level I trauma center — meaning it provides the highest level of comprehensive care for major injuries.
“We have the system in place to care for people with neurological trauma,” he says. “We have a 24/7 operating room, and well-trained doctors, nurses and advanced practice providers who are responsive and who know what to do in these situations.”
Luckily, Gerhard’s condition hadn’t worsened to the point that there was significant damage to the brain. In some cases, a section of the skull needs to be temporarily removed to treat subdural hematomas, but Ellenbogen was able to remove Gerhard’s clot less invasively by drilling holes (called burr holes) through his skull. The procedure lasted about an hour and was successful.
A birthday gift to remember
The first thing Gerhard did after waking up from anesthesia following his surgery was to write his name with his finger on the bedsheet. He quickly gained the ability to do even more.
“He was able to talk, write and walk again,” Nicole says. “Basically, he was his old self, except for feeling tired and weak.”
The day after the surgery was Nicole’s birthday, and she was happy to spend it at Harborview seeing Gerhard’s recovery.
“It was the best birthday gift I could have received,” she says. “At Harborview, the working climate, the collaboration of staff at all levels and the friendliness of all the employees were impressive.”
Ten days later, Gerhard was able to go back home to Fairbanks, where his symptoms improved dramatically. He began accompanying Nicole on walks, and a few months later, he started driving and working on his research again. He and Nicole also resumed ballroom dancing.
“For me, Dr. Ellenbogen is a hero because he not only saved my husband’s life, but he also enabled him to continue doing what he loves,” Nicole says.
