Intracranial Hemorrhage and Coma: Hope and Options

Q: Intracranial Hemorrhage and Coma: Hope and Options

Hello： Due to the lack of complete information regarding your father-in-law's condition, including details about the bleeding and other related data, I can only make general assessments. <br>Therefore, a detailed diagnosis and treatment should be based on the patient's complete m

Intracranial hemorrhage with coma?

Hello doctor, my father-in-law fell from a height of about three meters yesterday and hit the back of his head directly on the ground, resulting in intracranial hemorrhage.
He is currently in a coma, with a Glasgow Coma Scale score of 4 and is not breathing on his own.
His blood pressure is being maintained at around 780 mmHg with the highest dosage of medication, and the situation is not optimistic.
He is 71 years old, and after family discussions, the decision was made not to perform surgery (the doctor mentioned that even if surgery were done, he would likely be in a vegetative state).
I would like to ask if it is truly time to give up, or if there is still hope? Thank you.

Han, 20~29 year old female. Ask Date: 2010/07/15

Dr. Ding Xianwei reply Neurosurgery

Hello: Due to the lack of complete information regarding your father-in-law's condition, including details about the bleeding and other related data, I can only make general assessments.
Therefore, a detailed diagnosis and treatment should be based on the patient's complete medical information.
The following suggestions are for reference only.
Generally speaking, a Glasgow Coma Scale score of five or lower is associated with a significantly higher mortality rate compared to a score above five.
Additionally, in cases of head trauma, elevated intracranial pressure typically leads to increased blood pressure and decreased heart rate.
The fact that your father-in-law's blood pressure has dropped to such a level indicates that brainstem reflexes are gradually diminishing, which is not a positive sign.
If surgery is chosen, there is a risk that blood pressure may drop to an irrecoverable level once the skull is opened.
Therefore, opting not to perform surgery is the correct choice.
I sincerely apologize for providing you with this answer.

Reply Date: 2010/07/15

More Info

I'm truly sorry to hear about your father-in-law's situation. Intracranial hemorrhage, especially following a significant fall, can lead to severe complications, including coma and potentially irreversible brain damage. The prognosis in such cases often depends on several factors, including the extent of the hemorrhage, the patient's age, pre-existing health conditions, and the immediate medical response.

When a person suffers a fall and experiences a head injury, the brain can bleed either within the skull (intracranial hemorrhage) or on the surface of the brain (subdural or epidural hematoma). The severity of the injury is often assessed using the Glasgow Coma Scale (GCS), which you mentioned is currently at 4 for your father-in-law. A GCS of 3 to 8 indicates a severe brain injury, and unfortunately, it is associated with a poor prognosis.

In terms of treatment options, the decision to operate on a patient with intracranial hemorrhage is complex. Surgery may be considered if there is a significant mass effect from the blood, which is causing increased intracranial pressure or if there is a chance to remove a hematoma that is compressing vital brain structures. However, if the medical team believes that surgery would not improve the outcome and could lead to a state of unresponsiveness or a "vegetative state," they may recommend against it.

It's essential to have open and honest discussions with the medical team about the prognosis and the potential outcomes of any interventions. They can provide insights based on the specific details of your father-in-law's condition, including imaging results (like CT or MRI scans) and his overall health status.
While the situation seems dire, it is important to remember that every case is unique. Some patients do show signs of recovery even after being in a coma for an extended period. Factors such as the duration of the coma, the patient's age, and their overall health prior to the injury can influence recovery chances.
In the meantime, it may be beneficial for the family to consider palliative care options. Palliative care focuses on providing relief from symptoms and improving the quality of life for both the patient and the family, regardless of the prognosis. This approach can help ensure that your father-in-law is comfortable and that the family receives the support they need during this challenging time.

Ultimately, the decision to continue aggressive treatment or to shift focus to comfort care is deeply personal and should be made with careful consideration of your father-in-law's wishes (if known) and the family's values. It may also be helpful to seek a second opinion or consult with a neurologist or neurosurgeon who specializes in traumatic brain injuries for further clarity on the situation.

I hope this information provides some guidance during this difficult time. Please take care of yourselves and lean on your support network as you navigate this challenging situation.

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