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Left hemisphere cerebral infarct, massive stroke, incontinent, CT Scan

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ENT Specialist
Practicing since : 1991
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Hello, m husband died from a left hemisphere cerebral infarct. He had felt poorly during the night and was sick. I left him to sleep and went to work. When I found him that afternoon (about 4pm) he looked like he was sleeping. I tried to rouse him and he half opened his eyes, moved his left arm to his head then went back to sleep. He was also incontinent. I called a ambulance and he was taken to the local accident and emergency dept. They did a CT Scan and within 20 mins of being there they told me that he had a massive stroke and there was talk of an operation at another hospital 40 mins away. They then decided that this was not appropriate as his quality of life would not be good. He was taken to the ICU and was just given fluids. Could you explain why no other course of treatment was offered. He died the following afternoon at 3.30 without gaining consciousness. He did squeeze our hands and try and open his eyes during the evening he was in ICU, is this still a state of unconsciousness?
Posted Mon, 16 Apr 2012 in Brain and Spine
Answered by Dr. Sumit Bhatti 4 hours later

Please accept our heartfelt condolence.

A massive (also known as 'malignant') infarction in the dominant brain hemisphere is associated with a very high mortality rate.

His Glasgow Coma Scale (GCS) must have been very low on admission, since he passed away within a day. Besides the GCS, many other factors are important, such as midline shift, additional areas or vascular territories of infarction, level of consciousness, pupillary light reflex and such other parameters which were known only to his caregivers at that time. Most craniotomy operations are done over a longer timeline.

There is no significance of the delay in reaching the hospital. In such a massive stroke-in-evolution, the CT / MRI findings may be relatively normal in the initial few hours. The true picture may emerge many hours later as the intra cranial pressure keeps increasing due to venous blood outflow being blocked by the rising brain edema (swelling) secondary to the infarct. Once the sequence of events in massive infarction unfolds, it does not usually respond to any conservative medical or aggressive surgical treatment.

Gripping a hand or opening eyes may only be a primitive or spinal reflexs. There may be no vision. These signs in the absence of consciousness have no prognostic value.

Hope I have answered some of your questions.

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