Post-Surgery Cognitive Decline: Navigating Life After Brain Tumor Removal

Cognitive and behavioral dysfunction after brain surgery, leading to an inability to perform activities of daily living?

Hello Doctor, my father experienced symptoms such as tremors, fainting, and general weakness in January, leading to multiple hospital visits.
Initially, an EEG showed no abnormalities, but the neurology department referred him to neurosurgery after noting issues with gait stability and narrowed vision.
MRI scans revealed a pituitary tumor, and he underwent surgery on January 25.
Due to the tumor's size (approximately 6 cm) and its adhesion to the optic nerve and surrounding blood vessels, the surgeon indicated that they had done their best to remove it.
He spent time in the intensive care unit and began his recovery until early March, gradually regaining the ability to walk independently and manage simple daily tasks.
However, he exhibited confusion in conversations and could not recognize people.
During a follow-up visit, the doctor noted hydrocephalus and performed a second surgery on March 19 to place a shunt between the brain and abdominal cavity.
Unfortunately, his condition seemed to worsen post-surgery; he became unable to speak, completely lost the ability to walk, and displayed poor mental status, sleeping throughout the day.
The doctor prescribed relevant medications for epilepsy, thyroid issues, and stimulants like Ritalin to improve his mental state.
However, my father only opened his eyes for a few hours after taking the medication, and he could not engage in any verbal communication, writing, walking, standing, or self-care activities (such as brushing his teeth, washing his face, or eating) as he did before the surgeries.
His condition appears to be worse than after the first surgery.
The neurosurgeon believes that his inability to walk is due to muscle atrophy from prolonged bed rest, while the other abnormalities are attributed to the time needed for recovery from major brain surgery.
Rehabilitation sessions have been scheduled, but my father has been unable to participate due to his poor mental state, falling into sleep after brief movements.
He also cannot follow commands due to his inability to communicate, making rehabilitation ineffective.
I would like to ask the doctor if this post-operative condition is considered normal (if it is normal, what steps should we prioritize to help my father return to a normal life), or if further evaluations are needed to check for other underlying issues.
Thank you for your guidance, and I wish you well.

Miss Zhou, 20~29 year old female. Ask Date: 2021/04/11

Dr. Zhang Junwei reply Neurosurgery

First, I'm not sure how old your father is, but many elderly individuals who have undergone brain surgery may experience symptoms similar to dementia and stroke.
Your father's condition is complex, and it is advisable to follow up with a neurologist for treatment.

Reply Date: 2021/04/11

More Info

Post-surgery cognitive decline, especially after a significant procedure like brain tumor removal, can be a complex and challenging issue for both patients and their families. Your father's situation, following the removal of a large pituitary tumor, is not uncommon, and there are several factors to consider regarding his recovery and rehabilitation.

Firstly, it is essential to understand that cognitive decline after brain surgery can manifest in various ways, including confusion, difficulty with speech, and challenges in recognizing familiar people. These symptoms can be exacerbated by factors such as brain swelling, infection, or the effects of anesthesia and medications used during and after surgery. The fact that your father experienced complications such as hydrocephalus (accumulation of cerebrospinal fluid) and required a second surgery to address this issue indicates that his recovery is indeed complicated.

The cognitive recovery process can be quite variable. Some patients may show improvement in cognitive function over weeks or months, while others may experience fluctuations in their abilities, as you have described. It is not unusual for patients to have good days and bad days, where they may be able to recall information or perform tasks one day but struggle significantly the next. This variability can be frustrating and concerning for families, but it is often part of the recovery trajectory.

In terms of rehabilitation, it is crucial to have a multidisciplinary approach. Since your father is currently unable to participate actively in rehabilitation due to his low energy levels and cognitive confusion, it may be beneficial to focus on supportive care initially. This could include:
1. Physical Therapy: Even if he is not able to engage fully, gentle physical therapy can help prevent muscle atrophy and improve circulation. A physical therapist can work with him to perform passive range-of-motion exercises.

2. Speech Therapy: A speech-language pathologist can assess his communication abilities and provide strategies to improve his speech and cognitive-communication skills. They can also work on swallowing if that becomes an issue.

3. Occupational Therapy: An occupational therapist can help with activities of daily living (ADLs) and suggest adaptive strategies or tools to assist him in regaining independence.

4. Cognitive Rehabilitation: Once he is more stable, cognitive rehabilitation can help him regain cognitive functions. This may include memory exercises, attention tasks, and other cognitive challenges tailored to his abilities.

5. Medication Management: It’s essential to ensure that his medications are optimized. Sometimes, medications for mood or cognition can have side effects that may contribute to confusion or lethargy. Regular follow-ups with his healthcare team to adjust medications as needed can be beneficial.

6. Family Support and Education: Educating family members about the recovery process and what to expect can help manage expectations and provide emotional support. Engaging in supportive conversations and providing a calm environment can also aid in his recovery.

As for the question of whether his current state is "normal," it is essential to recognize that recovery from brain surgery is highly individualized. While some degree of cognitive impairment can be expected, the extent and duration can vary widely. Continuous monitoring by his healthcare team is crucial to assess his progress and make necessary adjustments to his treatment plan.

In conclusion, while your father's situation is undoubtedly challenging, there are avenues for support and rehabilitation that can aid in his recovery. It is essential to maintain open communication with his medical team, advocate for his needs, and ensure he receives comprehensive care that addresses both his physical and cognitive rehabilitation. With time, patience, and appropriate interventions, there is potential for improvement in his quality of life.

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