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Massive stroke affecting her right temporal & occipital lobes. Information on what the patient is going through terms of alertness, awareness?

DOCTOR OF THE MONTH - Nov 2013
Nov 2013
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My mother has had what's been described as a massive stroke affecting her right temporal & occipital lobes. She wasn't a candidate for TPA, as it was called something about a waking stroke, waking up (or not in her case) so that time of stroke could not be determined. It's been 5 days now, she was taken off the ventilator today & given a pec tube to feed her. Her prognosis is not good. My question is a difficult one to ask & answer. Is there any literature or any studies that would help me understand what she may be going through right now in terms of alertness, awareness. Does she know that I'm there? Is she in any pain? Is she trying to communicate but unable to? Any information would be helpful.
Posted Mon, 14 Oct 2013 in Brain and Spine
 
 
Answered by Dr. Sudhir Kumar 1 hour later
Brief Answer:
My detailed reply is below.

Detailed Answer:
Hi,

Thank you for posting your query regarding your mother.

As you said, it is difficult to answer your questions, however, I will try my best.

Your mother has suffered stroke affecting right side of brain. The important functions that are controlled by the affected part include strength of left arm and leg, vision on the left side, and sensations on the left side of body. So, we can assume that these functions would have got affected in her.

Language including understanding of spoken words is controlled by left side of brain. So, it would be fair to assume that she may be able to understand your speech.

Similarly, if the stroke on the right side was not big (causing pressure on the brain), then, she may not be deeply unconscious. In that case, she would be able to perceive pain. However, if the stroke was large, she may be deeply comatose, and unable to perceive pain. This can be clinically tested, by applying manual pressure over the center of chest, and looking for any attempt to move the right hand towards the site of pain.

Doing an EEG (electroencephalogram) would also help in assessing her consciousness level.

I hope I have answered some of your queries. I would be pleased to answer any follow up queries.

Best wishes,
Dr Sudhir Kumar MD DM (Neurology) XXXXXXX Consultant Neurologist
Above answer was peer-reviewed by
 
Follow-up: Massive stroke affecting her right temporal & occipital lobes. Information on what the patient is going through terms of alertness, awareness? 30 hours later
I posted a follow up question and uploaded her MRI scans yesterday & report but haven't heard anything back.
 
 
Answered by Dr. Sudhir Kumar 7 minutes later
Brief Answer:
Follow up question and MRI are not uploaded

Detailed Answer:
Thank you for getting back.

I can not find your follow up question and MRI reports here, possibly they could not get uploaded. Please re-upload them. If you require any assistance, please contact XXXXXXX staff.

Best wishes,
Dr Sudhir Kumar MD DM (Neurology)
Above answer was peer-reviewed by
 
Follow-up: Massive stroke affecting her right temporal & occipital lobes. Information on what the patient is going through terms of alertness, awareness? 14 hours later
I just uploaded again
 
 
Answered by Dr. Sudhir Kumar 3 hours later
Brief Answer:
Reports show a large stroke on the right side

Detailed Answer:
Thank you for uploading the MRI brain reports.
I have gone through the MRI reports, it shows extensive infarction on the right side. This suggests damage to several important areas on the right side of brain. This would lead to long-term weakness of the left half of body, as well as decreased vision and alertness.
In addition, she also has infarction in temporal lobes and thalamus, which would lead to impairment of memory and language too.
Mid brain involvement is also there, which would lead to decreased alertness.
In summary, she has extensive brain stroke, and recovery would take a long time. Also, significant improvement is unlikely to occur.
Best wishes,
Dr Sudhir Kumar MD DM (Neurology)
Above answer was peer-reviewed by
 
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