Is Waiting the Only Option for My Father's Brain Hemorrhage?

Is there nothing to do but wait for a father with a brain hemorrhage?

Hello Doctor, my father was admitted to the emergency room on February 14th due to a cerebral hemorrhage, where a CT scan revealed approximately 20cc of bleeding.
He underwent an immediate craniotomy for drainage with two drainage tubes placed.
Postoperatively, his Glasgow Coma Scale (GCS) score declined from around 10 to 9, 8, and then 7, and he gradually stopped opening his eyes.
During this time, his blood pressure remained elevated, and he experienced intermittent fever.
His intracranial pressure (ICP) was around 20.
However, a subsequent CT scan revealed significant brain swelling.
On March 7th, the hospital notified us that his ICP had rapidly increased to about 71, and another CT scan indicated acute hydrocephalus.
One of the original drainage tubes was ineffective and showed surrounding blood clots, so he was taken back to the operating room for the placement of two additional drainage tubes.
Later that day, an MRI showed arterial occlusion on one side of the posterior brain, and the hydrocephalus did not improve, leading to an urgent craniotomy.
It has now been four days, and my father remains unresponsive.
Currently, only one of the drainage tubes is producing approximately 300-400cc of cerebrospinal fluid (CSF), and his ICP has fluctuated from 6-7-8 to 13-14 post-surgery.
The doctors have advised us to wait, but I am very concerned that if the CSF does not drain properly, it could lead to brainstem compression.
Could you please advise if there are any more proactive measures we can take besides just waiting? Thank you, Doctor.

ANITA, 30~39 year old female. Ask Date: 2016/03/11

Dr. Zhang Junwei reply Neurosurgery

Based on your description, it seems that there are currently no effective methods available!

Reply Date: 2016/03/11

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 a brain hemorrhage, especially in the context of complications like hydrocephalus and elevated intracranial pressure, it can be incredibly stressful to feel like waiting is the only option. However, it's important to understand the medical context and the potential options available.

Firstly, brain hemorrhages can lead to a variety of complications, including increased intracranial pressure (ICP), which can be life-threatening if not managed properly. The fact that your father underwent surgery to place drainage tubes indicates that the medical team is actively trying to manage the situation. The goal of these interventions is to relieve pressure on the brain and allow for better circulation of cerebrospinal fluid (CSF).

In cases of acute hydrocephalus, where there is an accumulation of CSF due to blockage or impaired absorption, the placement of external ventricular drains (EVDs) is a common approach. These drains help to remove excess fluid and can be adjusted based on the patient's needs. If one of the drains is not functioning effectively, it may be necessary to replace it or add additional drains, as was done in your father's case.

The waiting period can be frustrating, especially when there are concerns about rising intracranial pressure and the potential for further complications. However, it's crucial to allow the brain some time to stabilize after surgery. The medical team may be monitoring your father's neurological status closely, looking for signs of improvement or deterioration. They may also be adjusting medications to manage blood pressure and prevent further complications.

If you feel that your father's condition is not improving or if you have concerns about the level of care he is receiving, it is entirely appropriate to seek a second opinion or request a transfer to a larger medical facility with more specialized resources. Larger hospitals often have more advanced imaging capabilities and specialists who can provide additional insights into complex cases like this.

In terms of more aggressive interventions, the options may be limited depending on your father's overall health, the extent of the brain injury, and the specific circumstances surrounding his condition. In some cases, additional surgeries may be considered if there is a clear indication that they could improve outcomes. However, these decisions are typically made on a case-by-case basis, weighing the risks and benefits.

It's also important to maintain open communication with the medical team. Don't hesitate to ask questions about your father's treatment plan, the rationale behind waiting, and what specific signs they are looking for that would indicate a need for further intervention. Understanding the medical team's perspective can help alleviate some of the anxiety associated with waiting.

In summary, while waiting can feel like the only option, it is often a necessary part of the recovery process after a brain hemorrhage. However, if you have concerns about your father's care or if his condition worsens, seeking a second opinion or discussing the possibility of transferring to a larger facility can be appropriate steps. Your father's health and well-being are paramount, and advocating for him is an important part of the process.

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