Stroke and Decompressive Surgery: What to Expect

Q: Stroke and Decompressive Surgery: What to Expect

Hello： An acute cerebral infarction occurring in the major blood vessels of the brain can lead to significant neuronal cell death. <br>During the third to fifth day, brain swelling may become severe, and if the swelling compresses the brainstem, it could result in the loss of vit

Cerebral stroke, craniotomy?

Hello, doctor.
A few days ago, my grandmother fainted at home.
After being taken to the hospital, it was discovered that she had a stroke and missed the critical treatment window.
A CT scan revealed that two-thirds of the major artery in her right brain was blocked.
She was only awake for one day before slipping into a coma, with a lowest Glasgow Coma Scale score of 6.
Due to pressure on the left brain, the doctors decided to perform a decompressive craniectomy.
However, she remains in a comatose state after the surgery.
I would like to ask if it is normal for her to be in a coma, and if the blocked area does not improve, will it become more severe?

Ru Ru Ru, 30~39 year old female. Ask Date: 2019/01/02

Dr. Jiang Junyi reply Neurology

Hello: An acute cerebral infarction occurring in the major blood vessels of the brain can lead to significant neuronal cell death.
During the third to fifth day, brain swelling may become severe, and if the swelling compresses the brainstem, it could result in the loss of vital functions, leading to coma or even death.
Decompressive craniectomy is primarily performed to relieve the pressure from the swollen brain cells and prevent brainstem compression.
This is a life-saving procedure.
However, the damage to the brain has already occurred, and the swelling typically begins to improve gradually over 1 to 2 weeks, which may lead to increased alertness.
The neuronal cell death caused by a stroke does not regenerate; therefore, active rehabilitation is necessary to facilitate the connections of surviving brain cells.
The effectiveness of rehabilitation is greatest during the first month, with limited improvement after three months, marking the golden period for rehabilitation.
It is usually encouraged for family members to invest more effort during this time.
The rehabilitation process can be challenging, and I recommend discussing the subsequent treatment and management (such as risk factor control, post-stroke rehabilitation plans, etc.) with your grandmother's attending physician.
Wishing you and your grandmother good health, safety, and happiness.
Dr.
Jiang, Department of Neurology, Taoyuan Hospital, cares for you.

Reply Date: 2019/01/02

More Info

I'm sorry to hear about your grandmother's condition. Stroke, particularly when it involves significant blockage in the brain, can lead to serious complications, including prolonged unconsciousness or coma. Understanding what to expect after a stroke and decompressive surgery is crucial for both patients and their families.

When a stroke occurs, especially an ischemic stroke where blood flow to a part of the brain is blocked, the affected brain tissue can become damaged due to lack of oxygen. This can lead to various neurological deficits, depending on which part of the brain is affected. In your grandmother's case, with a significant blockage in the right hemisphere, it is likely that she may experience weakness or paralysis on the left side of her body, as well as potential cognitive and speech difficulties.

The decision to perform decompressive surgery is often made when there is significant swelling in the brain (cerebral edema) that threatens to increase intracranial pressure. The goal of this surgery is to relieve pressure on the brain, which can help prevent further damage. However, even after such surgery, it is not uncommon for patients to remain in a state of reduced consciousness or coma for an extended period. This can be due to several factors, including the extent of the initial brain injury, the duration of the blockage before treatment, and the overall health of the patient prior to the stroke.

Regarding your question about whether it is normal for her to remain in a coma after surgery, it is important to understand that recovery from a stroke can be highly variable. Some patients may regain consciousness within days, while others may take weeks or even months. The Glasgow Coma Scale (GCS) score you mentioned (6) indicates a severe level of impairment, and unfortunately, this level of consciousness can be associated with a poor prognosis. However, it is essential to have ongoing assessments by medical professionals who can monitor her condition and provide updates on her potential for recovery.

If the blockage in the right hemisphere does not improve, it could lead to further complications. The brain tissue that is deprived of blood flow may continue to die, leading to more extensive brain damage. This is why timely intervention is critical in stroke management. If the blockage persists, it could also exacerbate the existing neurological deficits and complicate recovery efforts.

In terms of what to expect moving forward, it is crucial to maintain open communication with the healthcare team. They can provide insights into her specific condition, potential for recovery, and what rehabilitation options may be available. Rehabilitation can be a long and challenging process, but it is essential for maximizing recovery and improving quality of life.

In summary, while it is not uncommon for patients to remain in a coma after decompressive surgery for a stroke, the situation is complex and requires careful monitoring and assessment. The prognosis can vary widely based on individual circumstances, and ongoing support from healthcare providers is vital. I encourage you to ask questions and seek clarity from her medical team as they are best positioned to provide guidance tailored to her specific situation.

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