It's me again.

Would like some ballpark ideas on my sister's situation and what to look forward.
As I posted early this year, I learned my sister suffered two brain aneurysms around xmas eve and had brain surgery to relieve blood pressure in the area. Since then, she was kept in pharmacological comma and treated for pneumonia until it was considered safe to reduce the meds and hope she would wake up and figure out the damage to her faculties.
Eventually, they went through her throat to make her breath - will not try to spell the right word, apologies.
A brain scan was performed and it appears there's damage. No clue how severe since she's not waking up.
Tommorrow they will likely put a plate on her skull to cover the hole drilled the previous surgeries.

I haven't been told ANY of this. My mother (82) has kept me completely in the dark and the clinic - I'm told is one of the best - will only communicate once a day with the person in charge of the patient, my mother.
My mother, sister and I are/were in no speaking terms. I consider they got rid of my father when his mental health deteriorated severely and put him in an institution when he could easily afford personal care at home. I blame myself for not confronted them when it was time to do it.
My elderly mother is likely not the right person to take care of my disabled sister and, to me, she has no love or patience for anyone else but her.
Wonder what are the scenarios ahead for my sister when and if she wakes up.

Thank you for your thoughts and prayrs and any practical advise that I can eventually bring to the current situation. Haven't shown up at the clinic so far since it will only make things worse unless I'm somewhat peepared and that is where the SF collective is welcome to assist.

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I'm not a doc but have known a few folks with brain injury and worked on a bunch with injury.
Your sentence of - "A brain scan was performed and it appears there's damage. No clue how severe since she's not waking up." - pretty much says it all at this point.
Until the meds are reduced to allow her to wake up, the extent of the damage is unknown. Where the damage is will determine what deficits there are (if any).

Best of luck to your family.
You're a good man for looking out for your sister even after all the family drama.

Meds have been reduced already to let her wake up on her own. She hasn't.

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Depending on her age and physical condition, it could take days and days for her body to metabolize the meds and their intended effect. I have a friend who suffered a brain aneurysm rupture and had the entire left side of her skull removed to allow for the swelling. It was kept in a freezer at Duke for months until it was the right time to put it back in place. In the meantime she had to wear a football helmet. She has made a full recovery and is back to work, drives, etc. Fully functional. You never know the capacity one might have. Only time will tell. Stay strong for your family. I pray for your sister.

I'll definitely offer a prayer up for your sister, having had an aneurysm rupture a few years back myself. My first surgery they drilled a hole in the front of my skull to relieve the pressure and drain the blood, they air lifted me to a second hospital for coil embolization to seal the ruptured aneurysm using 18 platinum strips to coil into a ball to seal off the rupture. I stroked on the table during the second surgery. They decided that this coil embolization was the best method and least invasive to get me back up and running. Long story short, I had to relearn all the basic functions of daily living that I took for granted like walking, putting on clothes, brushing teeth, showering, using the bathroom, talking etc. My left side and extremities are numb and my balance is shot. I had to leave my job of 25yrs because I could no longer perform most tasks with any confidence and since we worked in high voltage environments, safety was a key issue as you could imagine. My life has taken on a new appreciation of the simple things in life and glad on certain days to still be here, other days can be a challenge. I'm still not certain at this point what my future holds, I just try and do my best to make every day count. I'll be praying for her. Brain injuries are weird stuff, I still experience changes, but I have a strong faith and believe that I can handle my future.

0 - 0, that's not a good situation for any of the family, and my heart goes out to you and all concerned. Comas, whether medically-induced or not, are still very much a mystery, no matter what they say. My son-in-law was in such a state [before I knew him] for six weeks, after a failed suicide attempt using car exhaust. He made a partial recovery, and I'll say no more.

Your family situation seems a lot less than ideal, and all WE can do here is to offer you a mental shoulder, and a holding hand, and, from me, you and your sister have both.

Bless.

tac

Thank you for your time, wishes and replies.

Will, thank you very much for sharing your first hand experience.

My sister is in God hands. My main concern, within the things I can change as an individual, is the fact that my sister will likely be in my mother's care and under her responsiblity.

The way she dealed with my father when his faculties and health declined are the main reason we haven't spoken to each other in years.

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quote:

Originally posted by 0-0:
Thank you for your time, wishes and replies.

Will, thank you very much for sharing your first hand experience.

My sister is in God hands. My main concern, within the things I can change as an individual, is the fact that my sister will likely be in my mother's care and under her responsiblity.

The way she dealed with my father when his faculties and health declined are the main reason we haven't spoken to each other in years.

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You're welcome 0-0. I almost deleted my post mostly because I feel it's kinda personal to disclose my thoughts about my own experiences with this disability. So many people suffer so many maladies even more difficult than my own. I won't lie though, it gets difficult some days and I'm tired of doctors, therapists, hospitals, and meds. Unfortunately my condition has left me with severe neurological pain also from the brain signals getting scrambled and had to manage several years of hard opiates. I finally caved a year ago from 24hr doses of morphine to manage the pain, but gave it up cold turkey because the miserable side effects outweighed the benefits. A tough road to go down for many that have to deal with hard pain. There is so much more about brain injuries than I could have ever imagined and the effects in my life and those close to me. I think one of the biggest issues I have these days is giving up a portion of control to ask for help to do things that were never too difficult to do, sometimes simple things like buckling a seatbelt, sometimes the simplest things. My life has so dramatically changed in so many ways from being a vibrant, strong, outgoing person to an unbalanced weak introvert. Some days are difficult and I've had a network of doctors and therapists helping in so many ways to put pieces back together to make some kind of sense out of things, helping make a better quality of life I guess you could say. If you have anything specific please feel free to ask and I'll try to answer from my experiences. I'll continue to say a prayer for her.

From my personal experience.... The brain is an amazing thing. Even when damaged it has the ability to reprogram, re-route and re-learn.

My Dad has suffered three strokes and a pretty good sized aneurysn over the past dozen years or so. The first ine left him with an issue with his vision (he is blind in one eye from birth). After a couple of weeks his brain was able to compensate and his clarity of vision returned.


His second left him with a speech impediment, speech aphasia, which improved but he still struggles with to some extent.

He suffered no real long-lasting effects from the aneurysm, but the last stroke left his left arm largely paralyzed, but considering how he was immediately following he is doing great!

You just never know...

Praying for all of you...

prayers sent for you and your sister.

Living in the shadows of our mother made my sister a sour, bad tempered soul (in my opinion) that to this day hasn`t learned what love or true friendship means.
She has no family and no long lasting friends that I`m aware of.

A tough path lies ahead of her if she recovers, at the mercy of our aging mother.

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So it sounds like she suffered a subarachnoid hemorrhage. Having an aneurysm doesn’t necessarily cause damage unless it ruptures. Often if one is found and thought to be dangerous they will do surgery to coil or clip the artery involved. If one does rupture then the pressure of the blood pressing on the brain is the problem as well as the lack of blood flow to the brain that is supplied by that artery. A subarachnoid hemorrhage or SAH is considered a stroke. Often the patient can be left with stroke like deficits including weakness or paralysis to one side of the body. They can also be left with sensory and speech deficits.

The goal after an SAH is to relieve the pressure on the brain and help re-perfuse the affected area of the brain. Keeping her blood pressure stable below 160 systolic will help stop an re-bleeding. She will likely need to be on nimodipine to control her BP and to stave off spasms of the artery which can cause re-bleed. Does she have high blood pressure? An SAH can be both spontaneous due to aneurysm or from trauma.

The reason for the brain surgery is to relieve the pressure on the brain so it doesn’t not herniate and crush the brain stem. Hopefully they placed a EVD (External ventricular drain) to manage her intracranial pressure. They can do a craniotomy which is usually just a hole or small flap of skull that is removed or a craniectomy where they remove a larger portion of skull and leave it off to allow the brain to swell. They eventually replace the bone flap keeping it frozen or sometimes inside the patients in a semi-permeable sack placed in their abdomen to keep the bone vascularized.

The reason for the tracheostomy is because a patient can only remain intubated for so long without infection or damage to retropharyngeal airway and vocal chords. Also the longer she is intubated orally the higher chance for infection due to mouth flora getting into the lungs. Likely this is why she had pneumonia. Once trached patients begin doing better fairly quick. As to your question it is hard to tell what type of care she will need until she is fully awake and her neuro status can be fully assessed. Did they tell you if she is following commands? This is a big sign of things moving in the right direction. Either way she will likely need to go to a stroke rehab.

Hope this helps. My thoughts are with you.

For the rest of you guys, especially those with high blood pressure some warning signs or red flags you need to worry about are a sudden onset of the worst headache of your life. We call these thunderclap headaches. Usually the patient can tell you to the minute when it started. These headaches are usually accompanied by sensitivity to light and nause/vomiting. If you one of your loved ones experiences this get yourself to the closest ER for a head CT and lumbar puncture.

Thank you Dusty78.

What you describe is basically what she went through so far. I`m unsure but I think she had 2 ruptured aneurisms.
The EVD draining part was finishwed last week. Then they left her alone to deal with the pneumonia until they decided it was time to start cutting off the meds and see if she would wake up on her own, and she didn`t.
AFAIK, she`s deeply under.

It`s the middle of summer down here. Most of the good specialist are gone and unreachable. Methinks that it`s a skeleton crew down there.
Have a friend that is one of our countries best neurologists but he`s not reachable at the mpment.
Any hints /suggestions will help me understand whatever info the locals are willing to provide.

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quote:

Originally posted by 0-0:
Thank you Dusty78.

What you describe is basically what she went through so far. I`m unsure but I think she had 2 ruptured aneurisms.
The EVD draining part was finishwed last week. Then they left her alone to deal with the pneumonia until they decided it was time to start cutting off the meds and see if she would wake up on her own, and she didn`t.
AFAIK, she`s deeply under.

It`s the middle of summer down here. Most of the good specialist are gone and unreachable. Methinks that it`s a skeleton crew down there.
Have a friend that is one of our countries best neurologists but he`s not reachable at the mpment.
Any hints /suggestions will help me understand whatever info the locals are willing to provide.

0-0

Honestly if she still isn’t waking up that is not a great sign. When she is off the sedation medication will she spontaneously open her eyes? A few things they need to be doing regularly is checking her neurological protective reflexes (corneal, cough, and gag reflexes.) They should squirt some saline in her eyes and see if she has a blink reflex. They should suction her through the trach and see if she has a cough response. They should use an object to induce gagging. While this sounds barbaric they should also be inflicting pain like a sternal rubs or Supra-orbital pressure to see if she responds at all to painful stimuli. When they do this they should be watching for any changes in posture. When I apply pain to a patients nailbed they should instinctively reach for the area that’s painful. That is a good sign. Two signs of bad outcomes are decorticate posture and decerebrate posture with the ladder being worse. If I apply pain to an area of the body and their upper limbs become rigid and come to the midline that is a decorticate posture. A decerebrate posture is when the body becomes rigid and the upper limbs turn outward away from the body. This is a sign of severe brain injury and loss of higher brain function.

Is she totally off sedation now? Did she ever follow commands? Does she have neurological protective reflexes intact? Will she breath spontaneous off of the ventilator? These are all
Questions that the family should be asking.

Let me know if you have any other questions.

I`m not in the information loop.
The doctor responsible for the ICU comes out once a day during 30` to brief all the ICU patients designated relatives. One per patient.
I`m told that he`s not in the comforting people business.
Tried to find out who the actual doctor responsible for my sister was and was told there`s just this guy who briefs the relatives and the rest is a pool of unspecified specialists.

Have no details as the ones you describe. Was told she had a brain scan and it didn`t look good.
They removed/reduced (?) the meds and hoped she would wake up. Methinks she`s breathing on her own.

There`s no family since the Clinic will talk to just one person, I`m told.
No phone information at all other than contact the relative who`s being briefed. AKA my mother.

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Sorry brother that’s a tough situation

Dusty, may I send an email question to you if you have the time, I don't want to derail 0-0's thread unless he does not mind me posting here.

quote:

Originally posted by just1tym:
Dusty, may I send an email question to you if you have the time, I don't want to derail 0-0's thread unless he does not mind me posting here.

Sure email is in profile. Just so you know I’m in emergency medicine so my expertise in neuro is limited to mostly emergent conditions and broader brain/spine traumatic conditions.

'I`m told that he`s not in the comforting people business.'

In that case, he ought not to be in the doctoring business...

tac

I agree with you, tac.

Haven't spoken to the man yet but it is already extremely unusual that a medical service will not provide patients in ICU info twice a day.

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