Post-Surgery Care for Brain Hemorrhage: Treatment Options

Q: Post-Surgery Care for Brain Hemorrhage: Treatment Options

Hello： Generally speaking, the prognosis for left hemisphere hemorrhage is poor. <br>If the patient's preoperative condition is not good, they are older, and their level of consciousness is quite low, the prognosis is likely to be unfavorable regardless of whether surgery is perf

Post-operative treatment for cerebral hemorrhage?

Hello doctor, we are truly helpless and don’t know what else we can do… My father has severe Alzheimer's disease, Parkinson's disease, and hydrocephalus.
In January, he experienced severe drowsiness, not eating or drinking, and would only wake up when in pain.
Therefore, we took him to the emergency room, where he underwent various tests (CT scan, blood tests, X-rays, MRI, EEG), but the cause of his drowsiness could not be determined.
Ultimately, the doctor suggested it might be a stroke and prescribed Acetylsalicylic Acid (Espin E.M) 100mg/cap (to prevent vascular blockage) and antihypertensive medication, advising us to try the medications.
After a week of hospitalization with a nasogastric tube, he was sent home, but perhaps due to lying down for too long, he began to show symptoms of pneumonia, coughing severely and having intermittent fevers.
After a month of antibiotics, he still did not improve… On the night of February 28, my father had a fever again and was coughing severely.
We thought it was related to pneumonia, but on February 29, we realized something was wrong when he started vomiting and was completely unable to eat.
After an emergency examination, it was found that there was a large hemorrhage in the left brain, possibly a hemorrhagic stroke, and the doctor issued a critical condition notice, stating that if surgery was not performed quickly, he would die… After the surgery that night, the doctor said the intracranial pressure was below 10, and the situation was quite good; they had replaced the bone back into the skull during the operation.
However, starting the next day, my father's intracranial pressure began to rise, and the doctor then stated that as long as the pressure was kept below 20, it would be fine; at that time, my father's coma scale was 6… On the fifth day post-surgery, after a CT scan, the doctor said that the bleeding had stopped in the area of the previous hemorrhage, but there was new bleeding a bit higher in the left brain… However, it should not be a cause for concern… They also suggested we consider a tracheostomy and ventriculoperitoneal shunt… On the sixth day, the doctor said they would remove the intracranial pressure monitor but still recommended a tracheostomy and ventriculoperitoneal shunt to address the accumulation on the right side; by this day, my father's intracranial pressure could no longer be controlled below 20… When we asked the doctor what to do about the intracranial pressure, the doctor said the monitor could not be left in place indefinitely… On the seventh day, during a medication change, the intracranial pressure monitor was removed, and the last recorded pressure value we saw was 3X… When we asked the doctor, they said to continue observing… On the ninth day, a tracheostomy and ventriculoperitoneal shunt were performed, and they mentioned that in two days, if stable, we could arrange for an external respiratory care center to take over the patient… We asked the doctor if the intracranial pressure was being ignored, and the doctor said that the patient's condition would naturally fluctuate, and as long as the blood pressure was fine, there was no need to worry; it would take six months to know for sure… That day, my father's coma scale was only 3… The doctor had previously said that as long as the intracranial pressure was controlled below 20, it would be fine, but when seeing the pressure exceed 30, they did not suggest any treatment or intervention… They just kept saying it was fine and to continue observing, advising us to come back to the emergency room if blood pressure dropped too low or if there was a fever… When we asked the nurse, she said no medications were being used anymore… What we want to ask the doctor is… As we watch my father show no response at all, are we really left with no choice but to wait for him to deteriorate and then take him to the emergency room as that doctor suggested? Are there truly no other treatment options available?

Wúzhù de nǚ'ér, 30~39 year old female. Ask Date: 2012/03/16

Dr. Zhang Yuanyi reply Neurosurgery

Hello: Generally speaking, the prognosis for left hemisphere hemorrhage is poor.
If the patient's preoperative condition is not good, they are older, and their level of consciousness is quite low, the prognosis is likely to be unfavorable regardless of whether surgery is performed.
Since there are no imaging studies available and we cannot accurately assess the patient, it seems that everything that could be done has already been addressed based on the content of the letter.
At this point, we can only wait to see if there is any potential for self-recovery in the future.
Wishing for a speedy recovery.
Sincerely, Dr.
Zhang Yuan-yi, Attending Neurosurgeon, Taoyuan Hospital, Department of Health.

Reply Date: 2012/03/16

More Info

I'm sorry to hear about your father's condition. It sounds like a very challenging situation for both him and your family. When dealing with post-surgery care for brain hemorrhage, especially in patients with pre-existing conditions like Alzheimer's and Parkinson's disease, there are several important considerations to keep in mind.

First, it's crucial to understand that brain hemorrhages can lead to significant complications, including increased intracranial pressure (ICP), which can affect neurological function. The fact that your father's ICP has fluctuated and that he has experienced new bleeding is concerning. In general, maintaining ICP below 20 mmHg is considered safe, but individual cases can vary widely based on the patient's overall health and specific circumstances.

In terms of treatment options, the medical team may consider several approaches depending on the severity of the situation. These can include:
1. Medication Management: Medications such as diuretics (e.g., mannitol) can help reduce ICP. Additionally, sedatives may be used to manage agitation and discomfort, especially in patients who are non-responsive.

2. Surgical Interventions: If there is ongoing bleeding or if ICP cannot be controlled through medication, further surgical interventions may be necessary. This could include decompressive craniectomy, where part of the skull is removed to allow the brain to swell without being compressed.

3. Monitoring and Supportive Care: Continuous monitoring in a critical care setting is vital. This includes monitoring vital signs, neurological status, and ICP. Supportive care, such as respiratory support (e.g., tracheostomy) and nutritional support (e.g., feeding tubes), is also essential, especially if the patient is unable to eat or drink.

4. Rehabilitation: Once the immediate life-threatening issues are managed, rehabilitation becomes a priority. This may involve physical therapy, occupational therapy, and speech therapy, depending on the patient's needs and level of consciousness.

5. Palliative Care: In cases where recovery is unlikely, palliative care may be appropriate to focus on comfort and quality of life. This involves managing symptoms and providing support to the family.

Given your father's current state, where he has a low Glasgow Coma Scale (GCS) score, it is understandable to feel helpless. It's essential to maintain open communication with the medical team. If you feel that your father's condition is not being adequately addressed, you have the right to seek a second opinion or request a transfer to a facility with more specialized care, especially if you believe that his needs are not being met.

In terms of immediate actions, consider the following:
- Document Symptoms: Keep a detailed record of any changes in your father's condition, including his responsiveness, vital signs, and any new symptoms. This information can be valuable for the medical team.

- Advocate for Your Father: Don't hesitate to ask questions and express your concerns to the healthcare providers. If you feel that his ICP is not being managed appropriately or that there are new symptoms that warrant further investigation, voice these concerns.

- Explore Palliative Options: If the prognosis is poor, discussing palliative care options with the healthcare team may provide a pathway to ensure your father's comfort.

- Seek Support: Caring for a loved one in such a critical condition can be emotionally taxing. Consider reaching out to support groups or counseling services for families dealing with similar situations.

In conclusion, while the situation is undoubtedly complex and distressing, staying informed, advocating for your father's care, and seeking support can help you navigate this difficult time. Remember, you are not alone in this journey, and there are resources available to assist you and your family.

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