Post-Surgery Confusion After Brain Hemorrhage Drainage

Altered consciousness after drainage of a cerebral hemorrhage?

Hello, doctor! My father was sent to the hospital three weeks after a fall due to headaches.
After examination, he was found to have a subdural hematoma.
The physician recommended drainage for quicker recovery (and he also underwent embolization at his own expense).
After the surgery (which had some complications), he improved in a few days.
However, he developed a fever before discharge, indicating an infection, and after a few days of antibiotics, his infection markers decreased, allowing him to be discharged.

Four days later, my father suddenly became disoriented and experienced incontinence.
After being taken to the emergency room, the drainage site had a purulent discharge.
(CT and MRI scans were performed in the emergency department) and the neurosurgery team had to perform debridement again.
He is currently receiving treatment in a general ward, and antibiotics are expected to be administered for four to six weeks.
During visits, he mostly does not respond to questions or conversation, his eyes wander, and he does not recognize his children well, but he has good strength in his limbs and can lift his legs, etc.
(The CT scan taken post-surgery showed no issues).

Now, after four weeks of antibiotic treatment, he still has not regained consciousness.
When I ask the doctors, they cannot pinpoint the problem and only say to give him time to recover.
(The infection was caused by Staphylococcus aureus) and the antibiotic treatment has reduced the infection markers to zero, but his consciousness remains unclear.
They plan to discharge my father in two weeks, (the doctors say all tests show no problems), but they have not clearly explained the reason for his lack of consciousness.
Should we wait for him to regain consciousness on his own? I would like to ask:
1.
How much longer is it typically expected for him to regain consciousness?
2.
If the CT and MRI show no issues and there is no stroke, what is the situation that the doctors cannot clearly explain? (Currently, my father is restrained because they are afraid he will pull out the nasogastric tube.)
3.
What should we do if he remains unconscious before discharge? They only mentioned switching to oral antibiotics at home.
4.
The doctor said that drainage is a minor procedure and would not harm the brain, yet it has led to this situation (my father had no dementia issues and was normal before the surgery).
5.
Will the doctors stop monitoring him after discharge? Is it just a matter of waiting for him to wake up on his own?

Huang, 50~59 year old female. Ask Date: 2022/12/27

Dr. Zhang Junwei reply Neurosurgery

Without detailed computed tomography and examinations, it is not possible to provide an interpretation or prognosis based on specific medical conditions.

Reply Date: 2022/12/27

More Info

I'm sorry to hear about your father's condition following his brain hemorrhage and subsequent surgery. It's understandable to feel anxious and confused about the situation, especially when dealing with such complex medical issues. Let's break down your concerns and provide some clarity based on the information you've shared.

1. Recovery of Consciousness: After a brain hemorrhage and surgery, recovery can be highly variable. Factors such as the extent of the hemorrhage, the location of the injury, and the overall health of the patient prior to the incident all play significant roles in recovery time. In many cases, patients may take weeks or even months to regain full consciousness. The fact that your father is responsive in some ways—such as moving his limbs—can be a positive sign, but it doesn't guarantee a timeline for recovery. Each patient's brain heals at its own pace, and while some may show improvement in days, others may take longer.

2. Imaging Results: It's reassuring that both CT and MRI scans have not shown any new issues like strokes or significant complications. However, the brain can still be affected by factors that imaging may not fully capture, such as diffuse axonal injury or metabolic changes that can occur after trauma. These conditions can lead to altered consciousness and cognitive function without clear structural abnormalities visible on scans. The medical team may be monitoring for signs of these less visible issues.

3. Discharge Planning: If your father is discharged while still not fully conscious, it is crucial to have a clear plan in place. This may include follow-up appointments with a neurologist or rehabilitation specialist who can provide ongoing assessment and support. Home care may also be necessary, especially if he requires assistance with daily activities or monitoring for any changes in his condition.

4. Surgical Impact: While the drainage procedure is considered minor, any surgery involving the brain carries risks, including infection or complications that may not be immediately apparent. The fact that your father developed an infection post-surgery could have contributed to his current state. It's important to discuss with his medical team how they believe the surgery may have impacted his recovery and what steps can be taken to mitigate any long-term effects.

5. Post-Discharge Care: After discharge, it is common for patients to continue receiving care from their primary physician or a specialist. If your father remains unresponsive, it is essential to advocate for ongoing evaluations and possibly rehabilitation services. Rehabilitation can include physical therapy, occupational therapy, and speech therapy, which may help improve his cognitive function and overall recovery.

In summary, while it is difficult to predict exactly when your father will regain full consciousness, it is essential to stay in close communication with his healthcare providers. They can offer guidance on what to expect and how to best support his recovery. If you have concerns about his care plan or the lack of clear answers, don't hesitate to seek a second opinion or ask for a more detailed explanation from his medical team. Your father's recovery is a priority, and ensuring he receives appropriate follow-up care is crucial.

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