Subdural Hematoma and Post-Surgery Complications in Elderly Patients

Grandma fell and has a subdural hematoma?

Hello, I would like to ask about my grandmother (89 years old).
She fell and hit the back of her head, resulting in a subdural hematoma in the frontal lobe.
At the time of the injury, she was fully conscious.
However, around the third day, she began to experience drowsiness, although her consciousness remained relatively clear.
The doctor mentioned that there was blood and fluid accumulation in her brain and recommended a drainage surgery.
The surgeon reported that the operation was very successful, but it led to my grandmother entering a state of severe coma, with her Glasgow Coma Scale score dropping from around 12 or 13 to approximately 7 or 8.
After a week, there was no improvement in her consciousness.
The doctor performed a CT scan and confirmed that there was no further bleeding.
He assessed that due to my grandmother's age and brain atrophy, air may have entered the cavity during the surgery, causing her coma.
The doctor seemed confident that once the air is expelled, my grandmother would definitely wake up.
However, I would like to know how significant the impact of air entering the brain can be.
Is it possible for her to go from being relatively alert to severely comatose after drainage, with no improvement over a week? I have seen many cases where patients improve quickly after surgery, especially since my grandmother's condition was not initially severe.
Can you please clarify how much of an effect can air entering the brain truly have? Thank you.

Lau, 20~29 year old female. Ask Date: 2015/11/13

Dr. Zhang Junwei reply Neurosurgery

A small amount of air entering the brain generally has little effect, but if the volume of air is excessive, or if it enters the bloodstream and causes an embolism, it can have significant consequences.

Reply Date: 2015/11/13

More Info

Subdural hematoma (SDH) is a condition that occurs when blood collects between the dura mater (the outermost layer of the meninges) and the brain, often due to trauma. In elderly patients, such as your grandmother, the risk of developing SDH increases due to factors like brain atrophy, which creates more space for blood to accumulate and can lead to a higher likelihood of injury from falls.
In your grandmother's case, it seems that she experienced a fall that resulted in a subdural hematoma. Initially, she was alert and oriented, but her condition deteriorated after the surgical intervention to drain the hematoma. This is concerning, especially given her age of 89 years. The fact that she was initially conscious and then became severely comatose post-surgery raises several important considerations.

One of the potential complications of neurosurgery, particularly in older adults, is the introduction of air into the cranial cavity, which can occur during surgery. This phenomenon, known as "pneumocephalus," can lead to increased intracranial pressure and may affect neurological status. The presence of air can disrupt normal brain function and may contribute to confusion, lethargy, or even coma. However, the degree to which air can impact consciousness varies among individuals and depends on several factors, including the amount of air introduced and the patient's overall neurological health.

In your grandmother's case, the surgical team may have been confident that the air would eventually be reabsorbed by the body, leading to an improvement in her condition. However, the fact that she has not shown signs of improvement after a week is concerning. It is essential to consider that elderly patients often have a more complex recovery trajectory due to pre-existing conditions, such as cognitive decline or other comorbidities, which can complicate their response to surgery.

It is also important to note that while many patients do recover well after subdural hematoma surgery, outcomes can vary significantly based on individual circumstances. Factors such as the size of the hematoma, the patient's baseline neurological status, and the presence of other medical issues can all influence recovery. In some cases, the brain may take longer to heal, and the effects of surgery may not be immediately apparent.

Given your grandmother's current state, it would be prudent to have ongoing discussions with her healthcare team. They can provide insights into her specific situation, including the potential for recovery and any additional interventions that may be necessary. If her condition does not improve, further imaging studies or evaluations may be warranted to assess for any other complications or underlying issues.

In summary, while the introduction of air into the cranial cavity during surgery can have significant effects, the overall recovery from subdural hematoma surgery in elderly patients can be unpredictable. Continuous monitoring and communication with her medical team are crucial in navigating her care and understanding her prognosis.

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