Post-Surgery Memory Confusion: Behavioral Changes After Hydrocephalus Surgery

Q: Post-Surgery Memory Confusion: Behavioral Changes After Hydrocephalus Surgery

Hello： I would like to answer your question directly, but your records indicate that the surgeries were performed at other hospitals, so I cannot provide you with a definitive answer. <br>Wishing you all the best.

After the surgery for hydrocephalus, there is confusion and a constant desire to go home?

Hello Dr.
Lai,
My father suffered a head injury due to a work accident in late October last year, resulting in a skull fracture, intracranial hemorrhage, subarachnoid hemorrhage, and frontal lobe injury.
His Glasgow Coma Scale score was 11, and he did not undergo surgery.
After spending 7 days in the intensive care unit, he was transferred to a regular ward.
During his hospitalization, his behavioral abilities improved significantly; he was able to recognize his work colleagues when they visited him (though this recognition was limited to identifying people).

After being discharged, he exhibited repetitive behaviors at home but continued to follow his usual routines.
A little over a month post-discharge, we discovered that he had developed hydrocephalus and required surgery at a medical center.
After the surgery, once the anesthesia wore off, he was agitated throughout the night, repeatedly expressing a desire to find people and talking incessantly.

Since his discharge, he has been irritable, stating every morning that he wants to go to work, but by the afternoon, around three or four o'clock, he becomes calmer and more composed.
Initially, when he was injured, the doctors mentioned that his personality might change, and at that time, we thought it was reflected in his more humorous speech.

Due to his uncontrollable behavior, the doctor prescribed sedatives, which have significantly improved his emotional state.
It has been about three weeks since the surgery, and in the past week, he has started expressing a desire to go out again in the afternoons, and at dinner time, he insists on wanting to go home (even though he is already at home).

Dr.
Lai, I understand that brain injury recovery is unpredictable in terms of the behaviors that may emerge.
However, his inability to recognize his own home seems similar to symptoms of dementia.
Is this also part of the recovery process? If my father continues to exhibit these behaviors, how long should we observe him before consulting a doctor to assess the likelihood of dementia?
Thank you for your hard work, and I wish you a Happy New Year.

Yu, 30~39 year old female. Ask Date: 2018/02/14

Dr. Lai Zhaokang reply Neurosurgery

Hello: I would like to answer your question directly, but your records indicate that the surgeries were performed at other hospitals, so I cannot provide you with a definitive answer.
Wishing you all the best.

Reply Date: 2018/02/14

More Info

Post-surgery memory confusion and behavioral changes, particularly after significant brain injuries such as those resulting from hydrocephalus surgery, are not uncommon. Your father's case illustrates a complex interplay of neurological recovery and behavioral adjustments following his traumatic brain injury (TBI) and subsequent surgical intervention.

Firstly, it's essential to understand that the brain is a remarkably adaptable organ, but it can also be sensitive to trauma and surgical changes. After a brain injury, individuals may experience a range of cognitive and emotional changes, including memory confusion, personality shifts, and altered behavior. These changes can be attributed to several factors, including the location and extent of the injury, the type of surgery performed, and the individual's pre-existing health conditions.

In your father's situation, the initial trauma led to significant brain injuries, including skull fractures and intracranial bleeding. Following surgery for hydrocephalus, it is common for patients to exhibit heightened agitation or confusion as they recover from anesthesia and adjust to the changes in their brain's structure and function. The excitement and restlessness you observed post-surgery can be a result of the brain's temporary dysregulation as it begins to heal.

The behavioral changes you describe—such as irritability, confusion about his surroundings, and fluctuating moods—can be indicative of a condition known as post-traumatic confusional state or post-traumatic amnesia. This state can manifest as disorientation, memory lapses, and difficulty recognizing familiar places or people, which may resemble early signs of dementia but is often a part of the recovery process following a TBI.

It is also worth noting that the brain's recovery trajectory can vary significantly from one individual to another. While some patients may show rapid improvements, others may take longer to regain cognitive functions and emotional stability. The fact that your father can recognize people but struggles with spatial awareness and memory of his home suggests that his cognitive recovery is still ongoing.

Regarding your concerns about potential dementia, it is crucial to differentiate between temporary post-traumatic symptoms and more chronic conditions. The presence of confusion and memory issues shortly after surgery does not necessarily indicate the onset of dementia. However, if these symptoms persist or worsen over time, it would be prudent to consult with a neurologist or a neuropsychologist for a comprehensive evaluation. They can conduct cognitive assessments to determine the extent of your father's memory issues and provide guidance on the best course of action.

In the meantime, there are several supportive measures you can take to assist your father's recovery:
1. Structured Environment: Create a predictable daily routine to help him feel more secure and reduce confusion. Familiarity can aid in cognitive processing.

2. Cognitive Rehabilitation: Engage him in memory exercises and cognitive activities that stimulate his brain without overwhelming him. Simple puzzles, memory games, or even reminiscing about past events can be beneficial.

3. Emotional Support: Encourage open communication about his feelings and frustrations. Emotional support from family can significantly impact recovery.

4. Medication Management: Continue to work closely with his healthcare providers regarding any medications prescribed for agitation or mood stabilization. Adjustments may be necessary as he progresses.

5. Regular Follow-ups: Keep up with regular medical appointments to monitor his recovery and address any emerging concerns promptly.

In conclusion, while your father's behavioral changes post-surgery are concerning, they may be part of the normal recovery process following a significant brain injury. Close observation and ongoing communication with healthcare professionals will be key in navigating his recovery journey. If you notice persistent or worsening symptoms, do not hesitate to seek further evaluation. Wishing you and your family strength and support during this challenging time.

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