Diminished Responses in Brain Injury Patients

The mother's reactions are becoming increasingly diminished?

My mother, who is 58 years old, was diagnosed with breast cancer metastasis to the brain at the end of April this year.
On November 13, she fell at home, hitting the left side of her head, resulting in a wound with significant bleeding.
At the time, she was able to respond but was not fully conscious.
After being taken to the hospital, her wound was sutured, and it was confirmed that she had intracranial bleeding, leading to her admission to the intensive care unit for observation.
The emergency room physician informed me that the amount of intracranial bleeding was not significant, so there was no immediate life threat, but she needed to stay in the ICU.
During her time in the ICU, my mother's responses were normal, although her speech was unclear.
On November 16, she was transferred to a general ward for further observation.
However, by November 19, her responsiveness had decreased significantly.
Initially, she could answer questions about who she was and where she was, but on the 19th, I and the nurse called her for 30 minutes without her saying anything; she just stared at us with wide-open eyes.
Despite normal results from EEG and blood tests, the medical team suggested that she could be discharged.

I am deeply concerned as I clearly perceive that my mother's condition is deteriorating.
I even questioned whether she had become a vegetative state.
I fear that if the doctor recommends her discharge, she may not have much time left.
Doctor, do you think her current condition is normal? If this is a sequela, is there a chance for her to improve gradually?

Chen, 20~29 year old female. Ask Date: 2020/11/20

Dr. Zhang Junwei reply Neurosurgery

Based solely on your description and without seeing the brain CT scan, I cannot answer your question!

Reply Date: 2020/11/20

More Info

I'm sorry to hear about your mother's condition. It sounds like a very challenging situation for both her and your family. Understanding diminished responses in brain injury patients can be complex, especially when there are multiple factors at play, such as a history of cancer and recent trauma.

When a patient experiences a brain injury, the extent of the injury can significantly influence their cognitive and physical responses. In your mother's case, the fall and subsequent head injury may have exacerbated any existing vulnerabilities due to her previous medical history. The brain is a highly intricate organ, and even minor injuries can lead to significant changes in behavior, cognition, and responsiveness.

The fact that your mother was initially responsive and then began to show diminished responses could indicate a few possibilities. One common phenomenon in brain injury patients is the fluctuation of consciousness and responsiveness. This can be due to various factors, including swelling in the brain, changes in intracranial pressure, or even metabolic imbalances. It's not uncommon for patients to exhibit periods of lucidity followed by times of confusion or unresponsiveness.

The medical team’s decision to discharge your mother after observing normal results from EEG and blood tests suggests that they did not find any immediate life-threatening issues. However, your observations of her declining responsiveness are valid concerns. It’s essential to communicate these changes to her healthcare providers. They can perform further assessments to determine if there are underlying issues that need to be addressed, such as potential complications from the head injury or the progression of her cancer.

Regarding the possibility of recovery, brain injuries can lead to a range of outcomes. Some patients experience significant recovery over time, while others may have lasting effects. The brain has a remarkable ability to adapt and reorganize itself, a phenomenon known as neuroplasticity. Rehabilitation efforts, including physical therapy, occupational therapy, and speech therapy, can play a crucial role in recovery. These therapies can help stimulate brain function and improve communication skills, mobility, and daily living activities.

In terms of your mother's current state, it is essential to monitor her closely. If you notice any further decline or if she becomes unresponsive for extended periods, it is crucial to seek immediate medical attention. Additionally, if she is discharged, ensure that you have a clear plan for follow-up care, including outpatient rehabilitation services.

In summary, while fluctuations in responsiveness can occur after a brain injury, it is vital to remain vigilant and proactive in seeking medical advice. Recovery is possible, but it often requires time, patience, and appropriate therapeutic interventions. Your concerns are valid, and advocating for your mother's health is crucial during this challenging time.

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