Post-Surgery Coma and Brain Injury Recovery

Coma after brain surgery due to a car accident?

My mother was hit by a motorcycle while crossing the street and suffered a severe intracranial hemorrhage.
She was urgently taken to the hospital, where the doctor reported extensive bleeding and significant edema in the posterior part of the brain.
During the first surgery, a blood clot was removed from the brain, which lasted about two hours.
Afterward, she was sent to the intensive care unit for observation, but her intracranial pressure remained consistently high.
The doctor asked us to decide whether to proceed with a second surgery to relieve the pressure.
About three hours post-surgery, we decided to go ahead with the second operation, which involved the left side of the brain and lasted over four hours.
Following this, her intracranial pressure decreased.
The next day, her left facial swelling was quite pronounced, and the medical team administered anesthesia to maintain stable intracranial pressure.
On the third day, her facial swelling slightly subsided, and the hospital decided to stop using anesthesia, opting for medication to control the intracranial pressure instead.
After about 4.5 hours, her condition remained relatively stable, but later, her intracranial pressure rose again, prompting the medical team to administer anesthesia once more.
That day, they began feeding her milk.
By the fourth day, her facial swelling had significantly reduced, but her hands and feet were noticeably swollen, although her intracranial pressure remained normal, ranging from 7 to 9.
She was able to eat without issues, but she remained in a comatose state.
On the fifth day, she still had no consciousness, and her hands and feet were severely edematous.
Additionally, her body temperature fluctuated significantly over the past few days, while her intracranial pressure was maintained between 8 and 11.
Is the edema in her hands and feet something that can only resolve on its own? Why is the swelling worsening? Are we left with no choice but to wait?

Ya Mi, 20~29 year old female. Ask Date: 2010/08/13

Dr. Ding Xianwei reply Neurosurgery

I'm sorry to hear about your mother's condition, and I hope she can turn her misfortune into good fortune.
Generally speaking, in cases of head trauma, if surgery is performed to remove a hematoma, it is likely that the hematoma was compressing the brain, necessitating the operation.
Subdural hematomas are more concerning, as their prognosis is not as favorable, while epidural hematomas tend to have better outcomes.
In cases of diffuse bleeding, surgery may not always be beneficial.
If there is no hematoma, the primary concern is elevated intracranial pressure compressing the brainstem, in which case we would perform a decompressive craniectomy, removing a larger section of the skull to create space for the brain to swell.
The skull may not be replaced immediately.
Additionally, a temporal lobe decompression may be performed to increase intracranial space.
The current state of coma may be due to the trauma itself or induced pharmacologically to reduce the risk of increased intracranial pressure.
Maintaining intracranial pressure between 8 and 11 mmHg is actually quite good.
Typically, after an injury, the swelling peaks around three to five days post-injury (including the brain), after which it gradually subsides.
Since it has only been three to five days, further observation is necessary.
Please note that due to the incomplete information and the fact that we have not personally treated her, the following suggestions are for reference only.

Reply Date: 2010/08/13

More Info

Understanding post-surgery coma and brain injury recovery is a complex and nuanced topic, particularly in cases involving significant intracranial hemorrhage and subsequent surgical interventions. Your mother’s situation, involving multiple surgeries to manage intracranial pressure and edema, is indicative of the serious nature of her injuries.

Firstly, it’s important to understand that after a traumatic brain injury (TBI), the brain can undergo a variety of physiological changes that affect consciousness and recovery. The initial state of coma or altered consciousness can be influenced by several factors, including the extent of the injury, the presence of edema (swelling), and the effectiveness of surgical interventions. In your mother’s case, the need for multiple surgeries suggests that her condition was critical, and the management of intracranial pressure was paramount.

The swelling you observe in her limbs, particularly the hands and feet, is likely a result of several factors, including fluid retention, the body's inflammatory response to injury, and possibly the effects of medications used during her treatment. Edema is common after brain surgery and can be exacerbated by immobility, which is often the case in patients who are in a coma or semi-conscious state. The body’s natural healing processes can lead to fluid accumulation, and while it may seem concerning, this is often a temporary condition that resolves as the patient begins to regain mobility and as the underlying inflammation decreases.

Regarding the management of her edema, it is crucial to maintain proper positioning and to monitor her fluid intake and output. Elevating her limbs, when possible, can help reduce swelling. However, the primary focus should remain on her neurological status and overall recovery. The medical team will likely continue to monitor her closely for any signs of improvement or deterioration.

As for her consciousness and recovery trajectory, it is essential to understand that recovery from a coma can be unpredictable. Some patients may gradually regain consciousness and cognitive function, while others may take longer or may not recover to the same level of function. The Glasgow Coma Scale (GCS) is a useful tool for assessing consciousness, but it is not the only measure of recovery. Fluctuations in consciousness can occur, and it is not uncommon for patients to show periods of responsiveness followed by times of unresponsiveness.

In terms of prognosis, factors such as the duration of the coma, the initial GCS score, and the presence of any secondary complications (like infections or further bleeding) will all play a role in determining the likelihood of recovery. It is also important to engage in rehabilitation as soon as the medical team deems it safe, as early intervention can significantly impact recovery outcomes.

In conclusion, while it may feel like you are in a waiting game, it is crucial to remain in close communication with the healthcare team. They can provide updates on her condition and any potential interventions that may help facilitate her recovery. Additionally, advocating for her needs, including physical therapy and occupational therapy when appropriate, can help optimize her recovery process. Remember that recovery from brain injury is often a marathon, not a sprint, and patience, along with appropriate medical care, is key to navigating this challenging journey.

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