Coma and Surgical Options for Brain Hemorrhage Patients

Cerebral hemorrhage with a hematoma, undergoing drainage surgery, with a Glasgow Coma Scale score of 3?

Hello, I apologize for disturbing the doctor during work and rest hours.
My younger brother, who is 46 years old and was born in the Year of the Snake, had a family gathering on the night of November 1st.
While I was preparing for bed, my mother noticed that his sleeping pattern was unusual.
He exhibited signs of unconsciousness and vomiting while asleep.
The family tried to wake him up, but he could not regain consciousness.
He lost consciousness in the ambulance after we called for help at 12:20 AM.
He arrived at the emergency room of Chang Gung Memorial Hospital in Keelung at 12:40 AM without consciousness.
The emergency physicians performed a CT scan of his brain and administered medication to lower his blood pressure.
They informed the family that he had hypertension, a ruptured blood vessel, and a blood clot in the central nervous system, which was surrounded by blood.
The first step was to manage his hypertension.
He was placed on a ventilator, and his Glasgow Coma Scale (GCS) score was only 3 while waiting for a hospital bed.
On November 2nd, he was waiting for an ICU bed at Chang Gung Memorial Hospital in Keelung.
At 2 PM, he finally got a surgical ICU bed.
The doctors informed the family that his GCS score was still only 3 and advised them to be mentally prepared.
On November 6th, the surgeon called the family around 6 PM to discuss the need for a drainage procedure.
The surgery was scheduled for 7 PM, and the family had to make a quick decision.
My brother and I decided to proceed with the drainage surgery to remove fluid from his brain.
The surgery went smoothly, but he remains in a coma to this day.
On November 7th and 8th, the internal medicine and surgical doctors informed the family that he would need a tracheostomy, having already undergone one drainage procedure.
We are uncertain about what to do next.
Doctor, when is my brother likely to regain consciousness? What are the chances of him waking up? Should we proceed with the tracheostomy? Is it possible to consider traditional Chinese medicine in conjunction with Western treatment? I sincerely hope my brother wakes up soon! I kindly ask for your guidance.
Thank you.

Yumei, 40~49 year old female. Ask Date: 2023/11/13

Dr. Zhang Junwei reply Neurosurgery

Without a detailed neurological examination and computed tomography assessment, it is difficult to provide an accurate answer.
However, if the coma scale is indeed 3, the chances of recovery are very low, and even if recovery occurs, there will likely be severe neurological deficits.

Reply Date: 2023/11/13

More Info

I'm sorry to hear about your brother's condition. It sounds like a very challenging and distressing situation for you and your family. Understanding coma and the surgical options available for patients with brain hemorrhage is crucial in navigating this difficult time.

Firstly, a coma is a state of prolonged unconsciousness where a person cannot be awakened and fails to respond to stimuli. The Glasgow Coma Scale (GCS) is often used to assess the level of consciousness in patients with brain injuries. A GCS score of 3 indicates a deep coma, which is concerning. The causes of coma can vary, but in your brother's case, it appears to be related to a brain hemorrhage, likely due to the rupture of a blood vessel, which can lead to increased intracranial pressure and damage to brain tissue.

In terms of surgical options, the decision to perform surgery, such as a drainage procedure, is typically based on the size and location of the hemorrhage, the patient's overall health, and the potential for recovery. The goal of surgery is often to relieve pressure on the brain and to remove any accumulated blood or fluid that could be causing further damage. It’s important to understand that while surgery can be beneficial, it also carries risks, especially in patients with pre-existing conditions like hypertension or other cardiovascular issues.

Regarding your brother's situation, he underwent a drainage procedure, which is a common approach to manage intracranial hemorrhage. However, the fact that he remains in a coma is understandably concerning. The duration of a coma can vary significantly from patient to patient, and predicting when or if someone will wake up is challenging. Factors influencing recovery include the extent of the brain injury, the patient's age, overall health, and the promptness of medical intervention.

As for the tracheostomy (气切), this procedure is often performed to assist with breathing, especially if a patient is unable to breathe adequately on their own. It can be a necessary step for patients who require prolonged mechanical ventilation. The decision to proceed with a tracheostomy is typically made by the medical team based on the patient's respiratory status and the likelihood of recovery.

In terms of treatment options, many families explore complementary therapies, including traditional Chinese medicine (TCM). While some patients may benefit from such treatments, it’s essential to discuss these options with the medical team to ensure they do not interfere with ongoing care. Integrating Western and Eastern medicine can sometimes provide a holistic approach to treatment, but it should be done under professional guidance.

Finally, the emotional toll of having a loved one in a coma can be immense. It’s important to seek support for yourself and your family during this time. Many hospitals offer counseling services, and support groups can also be beneficial.

In conclusion, while the situation is undoubtedly difficult, maintaining open communication with your brother's medical team is crucial. They can provide the most accurate information regarding his condition and the potential for recovery. It’s also important to take care of your own well-being as you navigate this challenging time.

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