Q: My aunt, who is 50, had injured her face (left eye, left side of face and head) in a car accident last month. She also bled from the left eye and was unconscious for two or three days. Later, she started responding and in a week she was well enough to be discharged but the left side of her face and left eye were still swollen and bulging. She was advised medicines for a month and then called for a follow-up. She was improving at home except for the swelling of the left eye. Last week she developed constant headache which was severe and the doctor treated it but on last Wednesday she slept more and the doctor said that she had a blood clot and advised angiography as soon as possible. As the angiography specialist was not present on that day it was postponed. Her face started bulging and on the railway station she got fits and was hospitalised. There we were told that there is a big blood clot and a hole was made to reduce pressure. Till then angiogram was not done. She is now responding when we call her. Please advise on this and let us know about her health condition. What are the steps we need to take?

A:Sometimes a clot which is beneath the bone but outside the brain increases in size either by further bleeding or by absorption of water by a process of osmosis due to degrading blood products. This then requires a hole to be made to remove the blood. The facial swelling may have raised a possibility of a trauma related short circuit of the vessels supplying blood and vessels draining blood from the brain termed medically as a carotico-cavernous fistula. The diagnosis of this condition requires an angiogram.