Hemorrhagic Stroke: A Family's Journey Through Crisis - Neurosurgery

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Hemorrhagic stroke


Dear Dr.
Ding,
My mother suffered a hemorrhagic stroke on February 14.
At the nursing station, I saw my father signing the physician's critical condition notice.
My father mentioned that she was still asking him for tissue when she arrived at the hospital, but suddenly she became unresponsive and fell into a coma, with tubes inserted all over her body.
She did not respond when called.
Later, the attending physician showed us her CT scan and indicated that there were two bleeding points, one of which was quite large (in the right hemisphere) and was continuously bleeding.
He said that if we did not perform surgery to stop the bleeding, it would be life-threatening, and the success rate of the surgery was only 30%.
I couldn't bear to hear more; I just wanted to save my mother quickly.
After signing a pile of consent forms, she was taken to the operating room at 9:26.
She had undergone two previous heart surgeries (the first was valve repair and the second was valve replacement).
At 2:40 PM, they announced my mother's name, and the physician came out holding a jar of blood clots, saying that there was brain tissue and some necrotic material possibly due to vascular embolism.
They initially addressed one of the bleeding points, and the skull was not sutured back temporarily to relieve pressure.
On February 13, my mother had mentioned that her vision on the right side was blurry and that she couldn't see, so we took her to an ophthalmologist, who said everything was normal and scheduled a follow-up for February 27.
The next morning, while having breakfast, she complained of weakness in her left limbs and had a drooping mouth when speaking, so we took her to the emergency room.
On the first day after surgery, while waiting at the entrance of the ICU, I encountered the surgeon who operated on my mother.
He said she was more stable and her condition was better than the previous day.
Dr.
Hsu from cardiothoracic surgery also came to adjust her medication since she couldn't take oral anticoagulants and switched to injections.
When I went in to see my mother, I asked the nurse about her coma scale, which was "7." Her right limbs would move on their own, but the left side was less responsive.
She would react to painful stimuli but did not open her eyes when called.
Today is the fourth day post-surgery.
When I visited this morning, the nurse said my mother's coma scale had dropped to "5," and she did not respond to painful stimuli.
In the afternoon, the nurse reported it was "7." Currently, she cannot move her left limbs, and while her right limbs had shown some movement on the first day post-surgery, their activity has decreased over the past couple of days.
Her ability to open her eyes is also very limited.
She is on a ventilator, and the feeding tube is set up for digestion.
There is a drainage tube at the head wound site, and a urinary catheter is in place.
I would like to ask Dr.
Ding, based on your years of clinical experience, what do you think are the chances of my mother waking up? What further medical interventions can the doctors provide? We have two young children at home who need their mother.
Is there anything we, as family members, can do for her? Thank you very much for taking the time to respond.
I am deeply grateful.

Daughter Waiting for Mom to Recover, 20~29 year old female. Ask Date: 2007/02/20

Dr. Ding Xianwei reply Neurosurgery


Hello: If a patient can survive the critical period of one week after a hemorrhagic stroke, generally speaking, the chances of survival are higher.
Your mother may have experienced an intracranial hemorrhage due to anticoagulant therapy, which is inherently a double-edged sword.
Sincerely, Dr.
Ding Hsien-Wei, Neurosurgery.

Reply Date: 2007/02/20

More Info


I'm sorry to hear about your mother's condition. It sounds like a very challenging and distressing situation for your family. Hemorrhagic strokes, particularly those involving significant bleeding in the brain, can lead to serious complications and require immediate medical intervention.
From your description, it appears that your mother experienced a hemorrhagic stroke, which is characterized by bleeding in the brain due to the rupture of a blood vessel. The presence of two bleeding points, especially one that is large, indicates a critical situation that necessitates surgical intervention to prevent further damage and to relieve pressure on the brain. The fact that the surgeon mentioned a 30% success rate for the surgery reflects the high risks associated with such procedures, particularly in patients with pre-existing conditions like heart disease.

Post-surgery, your mother's fluctuating Glasgow Coma Scale (GCS) scores indicate varying levels of consciousness. A GCS score of 7 suggests a moderate level of impairment, while a score of 5 indicates a more severe level of unresponsiveness. The fact that she is showing some movement in her right side but not in her left is a common sign of neurological impairment, often indicating damage to the opposite side of the brain from where the symptoms are manifesting.

In terms of recovery, the prognosis for patients who have undergone surgery for hemorrhagic stroke can vary widely based on several factors, including the extent of the brain injury, the patient's overall health, and the speed of medical intervention. While some patients may regain significant function, others may experience long-term disabilities. The presence of children at home adds an emotional layer to your concerns, as you wish for your mother to recover and return to her role in the family.

As for what can be done, it's essential to maintain open communication with the medical team. Ask about the specific rehabilitation options available, as early intervention can significantly impact recovery outcomes. Physical therapy, occupational therapy, and speech therapy may be beneficial, depending on her needs.
Additionally, providing emotional support to your mother, even if she is not fully responsive, can be beneficial. Familiar voices and gentle touch can sometimes stimulate responses in patients who are in a coma or semi-conscious state.
In summary, while the situation is undoubtedly serious, there is still hope for recovery. The medical team will continue to monitor her condition closely, and as a family member, your support and involvement in her care can make a difference. Stay engaged with her treatment plan, and don't hesitate to seek second opinions or additional resources if you feel it's necessary. Your mother's journey is a difficult one, but with the right care and support, there is potential for improvement.

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