ICH: Recovery Insights for a 65-Year-Old with High Blood Pressure

Intracerebral hemorrhage (ICH) with bleeding on the left side?

Hello, my mother is 65 years old and has a history of hypertension.
She secretly stopped taking her medication.
One night, she reported numbness in her hand, and on the evening of July 30, she was urgently taken to the hospital.
After the first CT scan, the doctor diagnosed her with intracerebral hemorrhage (ICH), with findings indicating a right basal ganglia hematoma measuring 26mm × 13mm × 25mm, with low midline shift and the midline being okay.
At that time, my mother had no sensation on her left side, was speaking unclearly, and experienced vomiting, requiring a nasogastric tube.
Two days later, a follow-up CT scan showed that the hematoma had increased by 5-6mm, but on that day, my mother’s speech had improved slightly.
Her blood pressure remained elevated, ranging from 130-150 mmHg when awake and 120-130 mmHg while asleep.
After the second CT scan, my mother experienced a moment of emotional instability on the third day, with her blood pressure rising to 200 mmHg.
Yesterday was the fifth day, and the doctor stated that the third CT scan showed no significant change from the second.
The nasogastric tube has been removed, and she is now consuming a liquid diet, but she is reluctant to have a bowel movement.
The doctor mentioned that her right side, which is unaffected, is still very strong.
As of today, my mother still has no sensation on her left side.
I tried to get her to smile to see if she could control both sides of her face, and she was able to do so without any noticeable asymmetry.
She can speak slowly, although not very clearly, and her consciousness is good.
The doctor mentioned that her scores have been the best since the third day.
Due to the pandemic, we are unable to visit her and find it difficult to communicate with her attending physician.
1.
Given my mother's condition, is a hematoma larger than 30mm in the left basal ganglia considered severe in the context of intracerebral hemorrhage?
2.
Does the fact that the hematoma did not increase in size on the third CT scan indicate that the bleeding has been controlled?
3.
Is a 30mm hematoma in the left basal ganglia likely to result in permanent disability?
4.
In similar situations, is there a possibility of sudden deterioration in the short term even with controlled blood pressure?
5.
Considering her situation, if she actively engages in treatment and acupuncture, along with aggressive physical therapy, is there a possibility for her to regain her ability to walk and speak? What are the chances? Could her recovery process be better and faster?
There is a lot of information and many questions, and I truly cannot find anyone to ask.
Thank you for your patience, and I appreciate the doctor's responses.
Good people will be rewarded.
Thank you.

HANNA, 30~39 year old female. Ask Date: 2021/08/06

Dr. Jiang Junyi reply Neurology

Dear Ms.
Hanna,
1.
I would like to ask, given my mother's condition, is a blood clot larger than 30mm in the left basal ganglia considered severe in the context of cerebral hemorrhage? A: The severity depends not only on the size of the clot but also on its location.
If there are no sudden worsening clinical symptoms, treatment with medication typically stabilizes the condition.
2.
Regarding my mother's third CT scan, if the blood clot has not increased in size, does that indicate that the bleeding is under control? A: Most acute cerebrovascular diseases (either ischemic or hemorrhagic) show the most significant changes in symptoms within the first three days.
Since it has been seven days, she is gradually entering the rehabilitation phase.
3.
Is a 30mm blood clot in the left basal ganglia certain to result in sequelae leading to disability? A: It is crucial to capitalize on the golden rehabilitation period within 3 to 6 months.
4.
In similar situations, if blood pressure is consistently controlled, is there a possibility of sudden deterioration in the short term? A: The likelihood is low, but it depends on the individual's cerebrovascular condition and the management of comorbidities.
5.
Given her situation, if she actively engages in treatment and acupuncture, along with aggressive physical therapy, is it possible for her to regain her ability to walk and speak? What are the chances? Can her recovery process be somewhat better and faster? A: Rehabilitation is a critical factor influencing the prognosis of recovery.
The first 3 to 6 months post-stroke are the most important for rehabilitation, and there is a greater chance of rapid improvement in neurological function within six months.
If rehabilitation starts after six months, progress may be slower.
Therefore, family members should encourage the patient to actively participate in rehabilitation.
If financially feasible, considering hyperbaric oxygen therapy may enhance rehabilitation outcomes.
Most importantly, controlling risk factors is essential to reduce the likelihood of another stroke.
I recommend discussing the next steps in treatment and management (such as risk factor control and post-stroke rehabilitation plans) with your mother's attending physician.
Thank you for your questions, and feel free to discuss any related issues further!
Wishing you and your mother good health and peace.
Dr.
Jiang Junyi, Department of Neurology, Taoyuan Hospital

Reply Date: 2021/08/06

More Info

Understanding intracerebral hemorrhage (ICH) and its implications for recovery, especially in a 65-year-old patient with a history of hypertension, is crucial for both the patient and their family. Your mother's situation, characterized by a significant hematoma in the right basal ganglia, presents several challenges and considerations for her recovery.

1. Severity of the Hematoma: A hematoma measuring 26mm x 13mm x 25mm is indeed substantial, particularly in the context of ICH. The basal ganglia is a critical area of the brain involved in motor control and coordination. Hemorrhages in this region can lead to significant neurological deficits, including weakness or paralysis on one side of the body, speech difficulties, and cognitive impairments. The fact that the hematoma increased in size by 5-6mm indicates that the situation was initially unstable, which is concerning. However, the absence of further enlargement in subsequent imaging suggests that the bleeding may have stabilized, which is a positive sign.

2. Control of Bleeding: The stabilization of the hematoma size in the third CT scan is encouraging. It indicates that the acute phase of bleeding may have ceased, which is critical for recovery. However, the presence of a hematoma of this size still poses risks for complications, including increased intracranial pressure and potential for further neurological deficits.

3. Risk of Residual Effects: While not all patients with a hematoma of this size will experience permanent disabilities, there is a significant risk of residual effects. Factors influencing recovery include the location and size of the hematoma, the speed of medical intervention, and the patient’s overall health prior to the event. Your mother’s left-sided weakness and speech difficulties are common outcomes of ICH, particularly when the right side of the brain is affected.

4. Potential for Sudden Deterioration: In patients with a history of hypertension, there is always a risk of sudden deterioration, especially if blood pressure is not well controlled. Hypertension can lead to further vascular complications, including additional hemorrhages or ischemic events. Continuous monitoring and management of blood pressure are essential to mitigate these risks.

5. Possibility of Recovery: Recovery from ICH can vary widely among individuals. Factors such as age, the extent of brain damage, and the effectiveness of rehabilitation efforts play significant roles. Engaging in physical therapy, occupational therapy, and speech therapy can significantly enhance recovery prospects. While some patients may regain substantial function, others may experience more limited recovery. The brain has a remarkable ability to adapt, and with dedicated rehabilitation efforts, there is potential for improvement in both mobility and speech.

In summary, your mother’s situation is serious, but there is hope for recovery. It is essential to maintain open communication with her healthcare team, even if in-person visits are limited due to the pandemic. Regular updates on her condition and progress will help you understand her recovery trajectory better. Encourage her to participate actively in her rehabilitation, as this can significantly impact her recovery outcomes. The journey may be challenging, but with support and appropriate medical care, there is potential for improvement.

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