Challenges and Hope: Navigating Post-Surgery Hydrocephalus Recovery

Recurrence after hydrocephalus surgery?

Hello, doctor.
My father is 84 years old.
He was in a car accident at the age of 79, which resulted in a brain injury and a Glasgow Coma Scale score of 8.
At that time, his language abilities were impaired, and he could only speak a maximum of three words.
After recovery, his consciousness and memory were relatively clear, and he could interact with others.
Two years ago, he began experiencing issues with consciousness, becoming increasingly drowsy and losing motor function.
He underwent surgeries for cerebral hemorrhage drainage and the implantation of a shunt for hydrocephalus.
After the hydrocephalus surgery, he regained some consciousness and motor function.
However, a year ago, he gradually started to lose motor function again, finding it difficult to perform any movements.
This time, it has become more severe, as even producing sounds has become very laborious and challenging, and his balance has deteriorated significantly.

The shunt I installed for his hydrocephalus is adjustable in pressure.
A CT scan shows that there is still ventricular enlargement, but my attending physician believes that there are still signs of bleeding in the area where the previous hemorrhage occurred.
Adjusting the pressure of the shunt might lead to increased bleeding, which the doctor attributes to aging.
Currently, my father is in a state better than a vegetative state; he is not completely paralyzed but cannot do anything, cannot speak, and it is difficult for him to understand what we say.
I would like to ask the doctor if this is truly the end of the road.
I hope to hear a different opinion, as I genuinely wish for my father to recover.

Here are the recent CT scans: https://photos.app.goo.gl/hYDoZnWxbkYCyCv88
This is my father's current condition: https://photos.app.goo.gl/tNxER2KMhvfiEeHu8
Abnormal movements in the wheelchair: https://photos.app.goo.gl/UDZfQ4sJLXok7tcX6
Unsuccessful rehabilitation: https://photos.app.goo.gl/JyLLvZu8pgmMzzHH7 https://photos.app.goo.gl/4bbYGBNAPhvLXjkc6
Abnormal hand curling while in bed: https://photos.app.goo.gl/rp98yPMBJPRyAEcL8
Loss of body awareness, hands and feet not in natural positions: https://photos.app.goo.gl/AnMNiQAsNGwbydFW8 https://photos.app.goo.gl/neRuYSuAN3SeAXw6A

A-Wen, 80~89 year old female. Ask Date: 2020/06/18

Dr. Zhao Shaoqing reply Neurosurgery

In the case of the father, his condition requires ongoing rehabilitation therapy for improvement.
The situation regarding the hydrocephalus can be reassessed, or adjustments to the hydrocephalus shunt valve may be necessary, which should be evaluated in an outpatient setting before any recommendations are made.
Keep it up!

Reply Date: 2020/06/18

More Info

Navigating the recovery process after surgeries related to hydrocephalus, especially in elderly patients, can be incredibly challenging. Your father's situation, marked by a history of traumatic brain injury, multiple surgeries, and fluctuating levels of consciousness and physical ability, is indeed complex.
Firstly, it’s important to understand that hydrocephalus, characterized by an accumulation of cerebrospinal fluid (CSF) in the brain's ventricles, can lead to increased intracranial pressure and various neurological symptoms. The fact that your father has undergone procedures such as ventricular-peritoneal shunt placement indicates that the medical team is actively managing his condition. However, the persistence of symptoms like decreased mobility, difficulty in speech, and balance issues suggests that there may be ongoing challenges in his recovery.

In older adults, the brain’s ability to recover from injury or surgery can be significantly diminished due to factors such as age-related neurodegeneration, pre-existing medical conditions, and the cumulative effects of previous injuries. The fact that your father has experienced episodes of improved consciousness and activity after surgeries indicates that there is still potential for recovery, albeit limited.

Regarding the concerns about the adjustable pressure valve in the shunt, it is crucial to maintain a balance between managing intracranial pressure and avoiding complications such as further bleeding. The decision to adjust the shunt pressure should be made cautiously, considering the risks and benefits. Continuous monitoring through imaging studies, such as CT scans, is essential to assess the status of the ventricles and any potential complications.

As for rehabilitation, it is vital to engage in a comprehensive approach that includes physical therapy, occupational therapy, and speech therapy. While it may seem that progress is slow or stagnant, consistent and tailored rehabilitation efforts can sometimes yield improvements over time. Therapists can work on exercises to enhance mobility, strength, and coordination, as well as strategies to improve communication skills.
Additionally, it may be beneficial to explore alternative therapies that can complement traditional rehabilitation. These might include:
1. Neurostimulation Techniques: Some patients benefit from therapies that involve electrical stimulation to enhance motor function and communication abilities.

2. Hydrotherapy: Water-based therapies can provide a supportive environment for movement and may help improve muscle strength and coordination.

3. Cognitive Rehabilitation: Engaging in activities that stimulate cognitive function can also be beneficial, even if your father is currently having difficulty with communication.

4. Nutritional Support: Ensuring that your father has a balanced diet can support overall health and recovery.

5. Family Involvement: Encouraging family members to participate in therapy sessions can provide emotional support and motivation for your father.

It’s understandable to feel disheartened by the current state of your father’s health, but it’s crucial to maintain hope and continue advocating for his care. Regular consultations with his healthcare team, including neurologists and rehabilitation specialists, can provide insights into potential adjustments in his treatment plan.
Lastly, consider seeking a second opinion if you feel uncertain about the current management plan. Different specialists may offer new perspectives or treatment options that could be beneficial. Recovery from brain injuries and conditions like hydrocephalus is often non-linear, and while some days may seem bleak, there can still be opportunities for improvement.

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