Hemorrhagic Stroke: A Father's Journey Through Emergency Care

Dad has a hemorrhagic stroke?

Hello Doctor, my father (51 years old, in good health, with a history of hypertension) fainted on the evening of November 22nd around 8:30 PM.
After fainting, he was unconscious and was urgently taken to the hospital.
The doctor performed the first CT scan at 9 PM, which showed bleeding in the left basal ganglia, with a hematoma size of 5x3 cm.
The doctor assessed that the hematoma could be absorbed on its own, so no surgery was performed.
At 11 PM, my father vomited, and his blood pressure rose to 244 (still unconscious).
A second CT scan was done, revealing that the hematoma had enlarged to 7x5 cm.
The doctor stated that emergency surgery was necessary to prevent life-threatening complications.
After the surgery, intracranial pressure stabilized.
However, on the morning of November 23rd at 7 AM, the intracranial pressure increased again, and a third CT scan showed further bleeding in the same area, leading to a second surgery.
In the following days, the intracranial pressure gradually stabilized.
During his hospitalization, the hospital continuously administered sedatives to prevent agitation that could raise intracranial pressure, and on the morning of November 27th, the sedatives were stopped.
The doctor mentioned that the sedative had a strong effect, so it would take 2-3 days for the effects to wear off before there was a greater chance of awakening.
On the evening of November 28th, the day after stopping the sedatives, my father's eyes slightly opened, and his eyeballs were moving as if he were looking at something.
When spoken to, his chin slightly lifted (a gesture suggesting he wanted to speak).
I would like to ask the doctor: 1.
Does my father's eye movement indicate awareness? The doctor previously mentioned that since the bleeding was in the left hemisphere, which controls consciousness, he might not awaken.
2.
The intracranial pressure monitor has been removed; is there a possibility that the intracranial pressure could rise again? If it does, how can we detect it? Thank you, doctor.

Shen Xiaojie, 20~29 year old female. Ask Date: 2017/11/28

Dr. Zhang Junwei reply Neurosurgery

This issue is complex and not suitable for online response without complete medical history information.

Reply Date: 2017/11/28

More Info

Understanding hemorrhagic stroke, especially in the context of your father's recent medical journey, is crucial for both family members and healthcare providers. Hemorrhagic strokes occur when a blood vessel in the brain ruptures, leading to bleeding within or around the brain. This can result in increased intracranial pressure, which can be life-threatening if not managed promptly and effectively.

In your father's case, the initial CT scan revealed bleeding in the left basal ganglia, which is a critical area of the brain involved in motor control and other functions. The size of the hematoma (5x3 cm initially, expanding to 7x5 cm) indicated a significant risk of further complications, necessitating surgical intervention. The decision to operate was based on the need to relieve pressure and prevent further damage to brain tissue.

After the first surgery, it is common for patients to be placed on sedatives to manage agitation and prevent spikes in intracranial pressure. The use of sedatives can complicate the assessment of consciousness, as they may mask the patient's ability to respond. The fact that your father began to show signs of responsiveness—such as opening his eyes and moving his jaw—after the sedatives were discontinued is a positive sign. However, it is essential to understand that these movements do not necessarily indicate full awareness or understanding; they could be reflexive or involuntary.

1. Does the eye movement indicate consciousness?
Eye movements can be a sign of awareness, but they do not definitively indicate that a person is fully conscious or able to comprehend their surroundings. The brain's ability to process information can be severely impaired after a hemorrhagic stroke, especially if the left hemisphere is affected, as it is responsible for language and cognitive functions. Continuous monitoring and evaluation by healthcare professionals will provide a clearer picture of your father's neurological status.

2. Can intracranial pressure rise again?
Yes, intracranial pressure can rise again, especially after a hemorrhagic event. Factors such as swelling (edema), additional bleeding, or complications from surgery can contribute to this. Healthcare providers typically monitor intracranial pressure closely, especially in the immediate postoperative period. Signs of increased intracranial pressure may include changes in consciousness, worsening headache, nausea, vomiting, or changes in pupil size and reaction.

3. How can we detect if the pressure increases?
Monitoring for signs of increased intracranial pressure is critical. Healthcare providers will often use clinical assessments, including neurological exams, to evaluate changes in consciousness and responsiveness. If there are concerns about rising pressure, imaging studies like CT scans may be repeated to assess for any new bleeding or swelling.
In summary, your father's journey through emergency care following a hemorrhagic stroke has been complex and challenging. The initial management involved critical decisions regarding surgery and sedation, and the subsequent recovery will require careful observation and rehabilitation. It is essential to maintain open communication with the medical team, ask questions, and seek clarity on any concerns you may have regarding your father's condition. Understanding the nature of his injury and the potential for recovery can help you and your family navigate this difficult time.

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