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He had a stroke during a speech. Now Sen. Van Hollen is back to work.

Sen. Chris Van Hollen (D-Md.) in the Hart Senate Office Building in D.C. on June 7. Van Hollen is back at work after suffering a stroke during a speech at a Democratic event last month. (Bonnie Jo Mount/The Washington Post)
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He was about two minutes into a speech at a Democratic summit in Western Maryland when his neck began throbbing. He felt lightheaded. His ears started popping like he was on an airplane.

So Sen. Chris Van Hollen (D-Md.) asked himself: Should he tell the audience he wasn’t feeling well and walk off the stage? Or stick it out? “So I powered through,” Van Hollen said in his office Tuesday, his first interview since he suffered a stroke last month at the Western Maryland Democratic Summit.

Van Hollen, who returned to the Senate to vote Monday, spent a week in the hospital last month after the stroke. His doctor, Dimitri Sigounas, an associate professor of neurosurgery at George Washington University School of Medicine, said the stroke was due to a small venous bleed in his head. Sigounas described Van Hollen’s prognosis as “excellent.” Van Hollen, 63, said Tuesday he was feeling fine, noting his only lingering side effect is some recurring neck pain, for which he is taking Tylenol. He is also on a temporary blood-pressure medication.

But while he was relieved to learn that doctors did not identify any risk of long-term damage, the caveat was they also couldn’t identify the underlying cause of the stroke, leaving Van Hollen with a lingering unanswered question.

“That’s the big unknown,” Van Hollen said. “The good news is, when they look at the CT scans, they don’t see any sign of risk for recurrence. I don’t know if it’s fair to say this can happen to anybody — but that’s the big unknown. They really don’t know.”

Van Hollen was one of several high-profile Democratic politicians to have a stroke around the same time, including North Carolina’s attorney general and John Fetterman, the lieutenant governor of Pennsylvania who had a stroke right before winning the state’s Democratic nomination for Senate. It later emerged that Fetterman’s situation was more serious than initially revealed and that he had not been taking a prescribed heart medication.

Inside John Fetterman’s changing health scare story

Van Hollen and his doctor said that in his case, the senator did not have any known risk factors and there were no doctor’s orders that he was ignoring.

Van Hollen said that after delivering his speech at the Rocky Gap Casino Resort on May 16 — rousing the crowd about the impact of the American Rescue Plan, among other things — he decided to go sit outside to take a breather, hoping his symptoms would subside. But lightheadedness persisted, so after about a half-hour Van Hollen decided to go home.

In the car came nausea, and at home, vomiting — an unusual combination with the neck pain that made Van Hollen realize something more was going on. “So we called the attending physician” at the U.S. Capitol, Van Hollen said. After hearing his symptoms, the doctor suggested Van Hollen go to the emergency room.

Doctors at George Washington University Hospital ordered an angiogram for Van Hollen, then brought him the results. The good news: It was not an aneurysm, Sigounas said. The bad news: Blood was leaking next to his brain.

Sigounas said Van Hollen experienced what’s called a “perimesencephalic subarachnoid hemorrhage” — essentially, he said, a small tear in a vein near the midbrain.

That can be caused by a benign buildup of pressure or exertion in the abdomen — think: sneezing, coughing, even doing crunches, he said — which can back up blood flow in veins in the brain. If one vein is flimsy by chance, Sigounas said, it could break and spill blood. Sigounas said Van Hollen could not identify any kind of exertion before giving his speech that could have caused the venous tear.

But Signouas said this type of stroke is the “best-case scenario” compared with other more serious causes, such as a burst artery. He said there is no chance of recurring bleeding, and that Van Hollen “should be in good shape for years to come in terms of brain health.”

“When you hear stroke, usually you’re concerned about something much scarier,” Sigounas said. “So this is one of those rare cases where it’s classified as a stroke, but it doesn’t have the long-term effects that a stroke would typically have.”

Van Hollen did not undergo any procedures, Sigounas said, noting the bleeding stopped on its own. He stayed hospitalized until he could undergo another angiogram one week later to make sure a different source of bleeding or any other “vascular abnormality” didn’t emerge, and none did, the doctor said.

Both President Biden and Vice President Harris called while he was recovering in the hospital, Van Hollen said. Biden had two back-to-back life-threatening aneurysms in 1988, so serious that at one point a Catholic priest came to his bedside to deliver final rites. Biden’s doctors said during his presidential campaign that he had fully recovered.

“He called and said, ‘You know, I’ve been there, buddy,’ ” Van Hollen recounted. “His main advice was: ‘Listen to your doctor.’ I’m not very good at taking orders, but my wife, Katherine, is also enforcing this. She’s been my major caretaker through this time.”

Since returning home, Van Hollen has been trying to take it easy, taking his chocolate lab on long walks through Rock Creek Park, and said he will be avoiding large campaign-stumping events like the Western Maryland Democratic Summit for a while — pursuant to doctor’s orders.

He is up for reelection this year, but Van Hollen said because there are no foreseeable long-term effects, the stroke did not cause him to reconsider his campaign and that, save for the temporary pause on big events, he is fully committed to another six-year term.

“I do plan to share with my colleagues, if you’re not feeling great, get checked out,” Van Hollen said. “None of us ever know, and a lot of us can be reluctant — if I hadn’t been urged by the attending physician to go to the emergency room, who knows?”

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