Post-Surgery Concerns in Neurosurgery: A Patient's Journey

Postoperative issues following brain surgery?

Hello, Dr.
Ding.
My father is 72 years old and accidentally hit his head on August 3rd.
A CT scan revealed intracranial hemorrhage, and he was initially sent to the intensive care unit for observation.
After 2 hours, he fell into a coma, exhibited unequal pupil size, and was unresponsive.
A second CT scan showed that the amount of bleeding was ten times greater than initially detected.
The doctors recommended intubation and immediate surgery.
During the procedure, they found poor coagulation and an estimated blood loss of about 1000 cc.
After a craniectomy to remove the brain hemorrhage, his intracranial pressure returned to normal, and his Glasgow Coma Scale score was 6-7.
However, his eyes became swollen to the point where the eyelids were distended.
The doctor prescribed eye drops and ointment covered with gauze, but after 3-4 days, there was no improvement, and no detailed examination was conducted due to the recommendation against moving him post-surgery.
On August 10, his condition had not worsened, and the doctor suggested that he practice breathing.
They plan to extubate him on August 14 to test for spontaneous breathing; if unsuccessful, he may need to be re-intubated or undergo a tracheostomy.

1.
Is there a chance my father will wake up?
2.
Are there other possible causes for the eye swelling?
3.
Can the swelling in his arms and legs improve?
4.
Does the brain require further examination?
5.
What impact does a tracheostomy have on the patient?

Xiao Xin, 30~39 year old female. Ask Date: 2015/08/12

Dr. Ding Xianwei reply Neurosurgery

Due to the lack of additional information, I cannot provide specific advice; however, it has only been three to four days without improvement, so patience is necessary.
You should also discuss this with your attending physician to determine the next steps in treatment.
Please do not rely on any tests, as they will not lead to patient improvement; only treatment can facilitate progress.
Additionally, there are many causes of systemic edema, so please discuss the possible reasons with your attending physician for targeted treatment.
Furthermore, considering your father's age, he is at a higher risk for complications, so it is important to be aware of this.

Reply Date: 2015/08/12

More Info

Your father's situation is indeed concerning, and it’s understandable that you have many questions regarding his recovery after neurosurgery. Let’s address your concerns one by one.

1. Possibility of Awakening: The Glasgow Coma Scale (GCS) score of 6-7 indicates a severe level of consciousness impairment. However, recovery is possible, and many factors influence this, including the extent of the brain injury, the patient's overall health, and the time elapsed since the injury. Patients can sometimes regain consciousness after prolonged periods of coma, but the timeline is unpredictable. Continuous monitoring and supportive care are crucial during this phase.

2. Eye Swelling: The swelling around your father's eyes could be due to several factors, including the surgical procedure itself, fluid retention, or even a reaction to medications. After brain surgery, it’s common for patients to experience swelling in various areas due to the trauma and the body’s inflammatory response. If the swelling persists, it may warrant further evaluation to rule out complications such as infection or hematoma formation.

3. Improvement of Limb Edema: Swelling in the limbs (edema) can occur post-surgery due to various reasons, including fluid imbalance, immobility, or the body’s response to trauma. Elevating the limbs, ensuring proper hydration, and gentle movement (as tolerated) can help reduce swelling. Physical therapy may also be beneficial in promoting circulation and reducing edema.

4. Further Brain Evaluation: Given the severity of your father's condition and the significant intracranial hemorrhage, further imaging studies, such as a follow-up CT or MRI, may be necessary to assess for any complications, such as residual bleeding, swelling, or other changes in the brain. These evaluations can help guide further treatment and rehabilitation strategies.

5. Impact of Tracheostomy: If your father requires a tracheostomy, it can significantly affect his care and recovery. A tracheostomy allows for easier breathing and can help prevent airway obstruction, especially in patients who are unable to protect their airway due to decreased consciousness. However, it also requires careful management to prevent complications such as infection or blockage. The decision to proceed with a tracheostomy is typically made based on the patient's ability to breathe independently and the anticipated duration of respiratory support.

In conclusion, your father's recovery will depend on various factors, including the extent of his brain injury and the effectiveness of the medical interventions. It is essential to maintain open communication with the healthcare team, who can provide updates on his condition and any necessary adjustments to his care plan. Supportive care, rehabilitation, and patience will play critical roles in his recovery journey. If you have further concerns or notice any changes in his condition, do not hesitate to reach out to his medical team for guidance.

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