Brain Hemorrhage After Falls: A Case Study

Cerebral hemorrhage caused by a fall?

Dear Deputy Director,
My grandfather is 71 years old and has high blood pressure, but he is physically strong.
On November 4th, he slipped on gravel while trying to catch a dog that had run out of the house and collided with a post.
While waiting for the ambulance, he managed to sit up on his own and was conscious enough to respond.
During this time, he vomited blood.
Upon arrival at the hospital, he underwent a CT scan of the head and X-rays (he continued to vomit blood during this period), but afterward, he lost consciousness and could not respond to questions or open his eyes.
The doctor asked if he could hear his voice, and my grandfather made a faint sound but could not articulate words.
There was also bleeding from his nose and ears, and he underwent immediate surgery, during which a small portion of his right brain was removed due to bleeding on both sides of his brain.
One day post-surgery, on November 5th, when I held my grandfather's hand and spoke to him, he would grip my hand tightly and even continue to hold it.
He had a fever once during the night, but it later subsided.
On the second day post-surgery, November 6th, when I held his hand and spoke to him, he again gripped my hand tightly and even shook it as if we were shaking hands.
He showed responses in both legs, and his right leg could be lifted to show me, although his eyes remained closed, and he had no response in his left hand.
His Glasgow Coma Scale score was 6.
On November 7th, when I spoke to him, I noticed he did not respond at all, and his hands and feet were cold (I had put socks on him).
I asked the nurse, who said his temperature was normal.
During our conversation, his breathing became noticeably louder and more erratic.
The nasogastric tube had not yet been removed, but there was no response from his right hand or legs.
I would like to ask the doctor if this situation is normal, whether he will recover, and if there is any improvement.
I have also informed the attending physician to use the best medications available.
I would appreciate your guidance, as my grandfather cares deeply for me, and I have been crying for several days since this incident.
I know that crying does not solve anything, but seeing the long wound on my grandfather's head is truly heartbreaking.
Thank you for your response.

Wu, 20~29 year old female. Ask Date: 2023/11/07

Dr. Zhang Junwei reply Neurosurgery

I would like to offer my support, but without detailed CT scan reports and neurological examinations, it is difficult to provide accurate advice and prognosis for the patient.
I recommend consulting the original treating physician for further inquiries.

Reply Date: 2023/11/07

More Info

Brain hemorrhage, particularly following a fall, is a serious medical condition that requires immediate attention and careful management. In the case of your grandfather, who is 71 years old and has a history of hypertension, the incident of slipping and hitting his head on a pillar could have significant implications for his health.

Understanding Brain Hemorrhage
Brain hemorrhage refers to bleeding within the brain, which can occur due to various reasons, including trauma, hypertension, or vascular malformations. In older adults, the risk of hemorrhage increases due to age-related changes in blood vessels and the presence of conditions like hypertension. The symptoms can vary widely depending on the location and extent of the bleeding, but common signs include loss of consciousness, confusion, headache, and neurological deficits.

Initial Assessment and Treatment
In your grandfather's case, the initial assessment involved a CT scan and X-rays, which are standard procedures to determine the extent of the injury and any bleeding. The fact that he was initially responsive but later became unresponsive is concerning and may indicate a worsening condition, possibly due to increased intracranial pressure or further bleeding.

The surgical intervention to remove a portion of the brain and address the hemorrhage is a critical step in managing severe cases. This procedure aims to alleviate pressure on the brain and prevent further damage. Post-operative care is equally important, as it involves monitoring for complications such as infection, seizures, or additional bleeding.

Recovery and Prognosis
The recovery process after a brain hemorrhage can be complex and varies significantly among individuals. Factors influencing recovery include the patient's age, overall health, the severity of the hemorrhage, and the effectiveness of the initial treatment. In your grandfather's case, the fact that he was able to respond to stimuli, such as squeezing your hand, is a positive sign. However, the absence of response in his left hand and the fluctuating levels of consciousness are concerning.

It is not uncommon for patients to experience periods of responsiveness followed by unresponsiveness, especially in the early days following a significant brain injury. This can be due to various factors, including sedation, pain management, and the body's natural response to trauma.

Potential Long-term Effects
After a brain hemorrhage, patients may experience a range of long-term effects, including cognitive deficits, physical disabilities, and emotional changes. Rehabilitation is often necessary to help patients regain lost functions and adapt to any changes. The extent of rehabilitation needed will depend on the specific deficits your grandfather may have after recovery.

Next Steps
1. Continuous Monitoring: It is crucial to keep a close watch on your grandfather's vital signs and neurological status. Any changes, such as increased confusion, seizures, or changes in responsiveness, should be reported to the medical team immediately.

2. Rehabilitation: Once stabilized, your grandfather may benefit from physical therapy, occupational therapy, and speech therapy, depending on his needs. These therapies can help improve mobility, daily functioning, and communication skills.

3. Emotional Support: It is also important to provide emotional support to both your grandfather and your family during this challenging time. The psychological impact of such an event can be significant, and counseling may be beneficial.

4. Follow-up Care: Regular follow-up appointments with neurologists and rehabilitation specialists will be essential to monitor recovery and address any ongoing issues.

In conclusion, while the situation is undoubtedly difficult, there is hope for recovery. The medical team will continue to provide the best care possible, and your grandfather's resilience and the support of his family will play a crucial role in his recovery journey.

Similar Q&A

Understanding Brain Hemorrhage Risks After Trauma: Key Insights

Hello, doctor. I apologize for the interruption. In mid-June, my husband was involved in a collision with a woman nearly 60 years old. At that time, the woman only had an abrasion on her elbow, and she was sitting on the ground with her helmet still on. My husband called an ambul...

Dr. Zhang Junwei reply Neurosurgery
It is possible for intracranial hemorrhage to occur after a car accident, even if there were no immediate injuries at the time of the incident. However, the pattern of the hemorrhage observed on a CT scan can help determine whether the bleeding was caused by trauma or if it was a...

Understanding Intracranial Hemorrhage: Treatment and Prognosis After Trauma

My husband fell down the stairs on the night of October 13 and suffered a significant impact. There were no obvious external injuries to the head, but he bled profusely from his ears. He was taken to Linkou Chang Gung Memorial Hospital and was already in a coma, with a Glasgow Co...

Dr. Zhang Junwei reply Neurosurgery
Without a complete medical history and assessment, it is not possible to provide an accurate response. I apologize!

Understanding Post-Intracranial Hemorrhage Symptoms and Rehabilitation

Hello Dr. Zhang! My mother had a motorcycle accident in June two years ago, resulting in a head injury to the right occipital lobe with intracranial hemorrhage. She did not require surgery as the blood clot was absorbed naturally. Her Glasgow Coma Scale score dropped to 3, but sh...

Dr. Zhang Junwei reply Neurosurgery
The issue is somewhat complex, and each physician has a different explanation. This means that even the doctors are unsure how to explain it; they can only say it is a consequence of brain injury.

Understanding Intracranial Hemorrhage: Risks and Monitoring After Trauma

I would like to ask the doctor: A patient in their 60s had a car accident and was in good mental condition afterward. An evening CT scan of the brain revealed intracranial hemorrhage, but the patient's mental status remained stable for 2-3 days. On the fourth day, another CT...

Dr. Xu Kaixi reply Surgery
According to your description, after the car accident, intracranial hemorrhage was observed. A follow-up CT scan of the brain four days later showed an increase in the volume of bleeding. Although the mental status is stable, the hemorrhage may still be ongoing, indicating an uns...