100-Year-Old Patient Has More Living to Do After Brain Surgery

Adorned with a sparkling tiara and surrounded by family, friends, and local notables, Eloise Brown celebrated her 100th birthday in November 2022.

Weeks later, her life almost ended – but thanks to Penn Medicine, the South Philly resident was given the chance to keep on living.

Something’s Wrong

One evening in early December, Brown’s daughter, Joan, still in town from the party, noticed her mother acting peculiar. Brown seemed disoriented and unusually tentative with her movements. The next day, Joan cancelled her trip home to California and, on the advice of her mother’s doctor, took her to the Emergency Department (ED) at Pennsylvania Hospital.

Tests revealed Brown had a subdural hematoma, which is usually caused by a head injury. Blood from a torn vessel was pooling in the space between her skull and brain. Subdural hematomas can compress the brain, resulting in cognitive dysfunction and symptoms like difficulty speaking, breathing, or walking. When a severe bleed is left untreated, it can be fatal.

It turned out Brown had fallen about a month prior and hit her head, but she never told her family until questioned that night in the ED. Based on the severity of the bleed and the pressure on the patient’s brain, her neurosurgeon recommended immediate surgery to drain the fluid.

Expertise Across Multiple Entities

The neurosurgeon on duty that night in the ED was Zarina Ali, MD, now chief of Neurosurgery at Penn Presbyterian Medical Center (PPMC).

“Most cases like these are routed to PPMC’s Level 1 Trauma Center; however, if a patient is very compromised and unstable for transport, we’ll take care of them where they are,” Ali said. In Brown’s case, Ali and her team felt treatment couldn’t wait.

Joan appreciated how Ali explained her thinking, answered the family’s questions, and allowed Joan to remain with her mom for support. “Dr. Ali told us exactly what the surgery would entail, how the drainage would work, and what to expect. The team was genuinely in our corner and they were truthful about [my mother’s] situation,” Joan said.

More Life Ahead

Subdural hematomas are not uncommon, especially in elderly populations in which falls are an everyday risk. What’s rare is seeing a 100-year-old patient who can undergo successful brain surgery for that type of condition. Ali explained that any type of cranial surgery is significant, more so in an elderly patient.

“As neurosurgeons, we are constantly weighing the risks and benefits of the interventions we offer patients. Part of that shared decision-making that we do with families is considering the physiological, as well as biological, age of the patient,” Ali said.

Until her injury, Eloise Brown lived independently with few medical issues. Physiologically, she was younger than her 100 years. Not every surgeon faced with a centenarian patient would consider surgery, but Ali believed she could get Brown through the surgery safely and help her return to a functional, high-quality life.

A Supportive Team

After surgery on December 5, Brown spent five days in the Neuro Intensive Care Unit and five more in recovery. Given her advanced age, her family felt she would do better receiving therapy at home instead of being moved to an inpatient rehabilitation facility. The family worked closely with the social worker, who arranged for medical equipment to be delivered to Brown’s home and helped coordinate her discharge.

Thanks to Penn Medicine At Home, Brown has received several months of in-home physical, occupational, and speech therapy, and continues to progress in her recovery. She adores her therapists and her family expressed gratitude as well for the compassionate care provided by her home health aide.

“Everyone has been as nice as they could be – thoughtful, caring. They have been my rocks,” Joan said.

By March, Brown was able to get out of bed on her own, and was working on building strength to transition from a wheelchair to a walker and to safely get into a car. Ali said she was pleased with her patient’s remarkable outcome.

“It’s the decision making and the relationship I build with patients in their most vulnerable hours that make my job meaningful,” Ali said. “What’s most important to me as a doctor and neurosurgeon is asking, ‘Am I going to help this person – in this case, this 100-year-old patient – get to a point in her life that she and her family will be pleased with?’ That is what drives the way I think about the care I can deliver to patients and what makes it challenging and at the same time, purposeful and rewarding.”