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Have COPD. Cardiac arrest and brain hypoxia. Opening eyes slowly, moving hand, myoclonic jerks. On ventilation

DOCTOR OF THE MONTH - Nov 2013
Nov 2013
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my father is a COPD patient and we had admitted him to hospital. His saturation had come down and was to shift to general bed. But the day he was to shift . he had cardiac arrest and than brain hypoxia as per Doc. Its almost 5 weeks now. Now he is opening eyes slowly and his left hand is moving but has micronic jerk/convulsion. he is in ventillation
Posted Sat, 22 Sep 2012 in Brain and Spine
 
 
Answered by Dr. Sudhir Kumar 20 hours later
Hi AAAAA
Thank you for contacting XXXXXXX regarding your father.
This conition is referred to as hypoxic-ischemic-encephalopathy (HIE). In this condition, brain suffers damage due to hypoxia (less oxygen supply to brain) and ischemia (less blood supply to brain). The extent of damage depends on the duration of cardiac arrest. As the brain is very sensitive to lack of oxygen and blood flow, any cardiac arrest more than 5 minutes leads to long-term brain damage and incomplete recovery of brain functions.
Myoclonic jerks are a type of convulsions (fits) which occurs typically in HIE. This can be treated with medications like levetiracetam and sodium valproate. Though there is no medicine to repair the brain damage, certain drugs such as piracetam and citicholine are given in this condition.
Other supportive treatments such as mechanical ventilation (to aid in good oxygenation), proper nutrition (by naso-gastric tube), regular physiotherapy, stimulation (by music via head-phones) are useful in recovery.
The exact extent of brain damage can be assessed by clinical examination done by a neurologist and certain investigations such as EEG, evoked potential studies and PET scan of the brain.
I know it is a difficult situation for you and your family, as the neurological recovery may not be complete. However, I hope he makes good recovery.
Best wishes,
Dr Sudhir Kumar MD DM (Neurology)
XXXXXXX Consultant Neurologist
Apollo Health City, Hyderabad
Above answer was peer-reviewed by
 
Follow-up: Have COPD. Cardiac arrest and brain hypoxia. Opening eyes slowly, moving hand, myoclonic jerks. On ventilation 2 hours later
Thank you so much Doctor for your prompt reply. At the moment he is opening his eyes on touching and vocal sound.Both Eye balls are moving and on pressing his elbow joints, feet, palm I feel he is responding. Father is very very dear to all of us. So I would like to know Is there any chance of his recovery. How fast can he recover? Are the above signs Response or Reflex? or last He is in ventillation forh last 5 weeks as hi Co2 is high. Thanks and rgds, Paromita
 
 
Answered by Dr. Sudhir Kumar 1 hour later
Dear AAAAA
Thank you for getting back with more details. Some of the responses like spontaneous eye movements, and movements in response to pain could also be a reflex at spinal cord level and brain stem level. For a person to be conscious, he should be able to communicate by gestures or respond meaningfully to verbal commands. It may be clinically difficult to do that. That is where tests like EEG (which is easily available in most hospitals, and can even be done bedside) can help us. Ventilation should be continued as long as CO2 is high or O2 is low. Recovery is generally slow in this condition.
Best wishes,
Dr Sudhir Kumar MD DM
XXXXXXX Consultant Neurologist
Apollo Health City, Hyderabad
Above answer was peer-reviewed by
 
Follow-up: Have COPD. Cardiac arrest and brain hypoxia. Opening eyes slowly, moving hand, myoclonic jerks. On ventilation 23 hours later
Thanx once again Doc... Is reflex a good sign or shows any sign of recovery? As I had mentioned its more than 5 weeks now and so we are in a very confused state of mind. I want my father to atleast recover to the extent he can . Am really looking forward to that. Please help me by guiding me as far as possible by you. Will be really thankful
 
 
Answered by Dr. Sudhir Kumar 30 minutes later
Dear AAAAA
Thank you for getting back. As I mentioned earlier, the good signs which favour good recovery of brain are- any meaningful response to verbal or painful stimuli. For ex- if you call him and he turns his eyes or head in that direction; or if you pinch his hand, he withdraws the hand away from the painful pinch. Reflex movements may or may not signifiy any brain improvement. As suggested earlier, EEG test will help you more in predicting brain recovery.
I hope, along with you all, that your father recovers.
Best wishes,
Dr Sudhir Kumar MD DM (Neurology)
XXXXXXX Consultant Neurologist
Apollo Health City, Hyderabad
Above answer was peer-reviewed by
 
Follow-up: Have COPD. Cardiac arrest and brain hypoxia. Opening eyes slowly, moving hand, myoclonic jerks. On ventilation 11 days later
Hi Doctor,
Because of Net problem am delayed in getting back to you. Let me start with my fathers development in last 10 days... I feel he recognises us, his limbs are moving - legs not that much but is reacting to tickling below feet, he is giving expressions. When I said him his grandson has scored 98% , my dad gave a very proud smile expression, he wants to speak i guess. he reacted when I said his o2 was showing 100- he again smiled. He is responding to pain. At the moment he is given mechanical oxygen. My biggest concern is - his body jerks are still continuing to quite extent. Please help me as in how to nullify the jerk. I feel its very troublesome for my father as his sensorium has increased. Looking forward to advise and suggestion . Is only sedative available for reducing Jerks? Here in hospital doctors do not want to give sedative as they want his brain to remain active- which I agree with . So pls suggest
 
 
Answered by Dr. Sudhir Kumar 5 minutes later
Hi AAAAA
Thank you for getting back.
I am glad to hear that your father is improving.
To stop the jerks, there are three medications, which are helpful. These include sodium valproate, levetiracetam and clonazepam. Among these three, sodium valproate and levetiracetam are non-sedating drugs. You may discuss regarding these two drugs with the treating doctor.
In addition, piracetam (nootropil) is also useful in this situation.
Best wishes,
Dr Sudhir Kumar MD DM (Neurology)
XXXXXXX Consultant Neurologist
Apollo Health City, Hyderabad
Above answer was peer-reviewed by
 
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