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What Does The Following MRI Report Indicate?
Question: Sir, My father has gone through CABG on 05.05.2015. On 06.05 he was removed from ventilator but within half an hour he asked for water and became aggressive and had to be given anaesthesia. Since, then he is on ventilator. Later it was found that he had kidney problem so every alternate or once in three days dialysis was done. Due to ventilator Doctors could not perform MRI. on 29th the MRI was done and the report of that is attached herewith. Doctors are now saying he is in coma and having severe brain haemorrhages in the different parts of brain due to which he is not able to breath and he has given up saying once he is removed from ventilator will not last long. Please suggest what to do now?
Brief Answer:
poor prognostic condition
Detailed Answer:
Hi
Thanks for using hcm
This is really a sympathetic condition to be more concerned.
Was this on pump or off pump grafting?
What about the carotid Doppler report and ultrasound abdomen and pelvis report prior to surgery?
How many vessels were blocked?
Was it an elective or emergency surgery?
Any details of blood investigations,blood gas report?
Please let me know the details.
As such,with the findings of the MRI report it seems to be ischaemic encephalopathy of the brain involving multiple important areas of the brain,suppressing the respiratory system--due to which the comatose stage can be irreversible (with very minimal chances of reversibility).
In these conditions it is really difficult to bring the patient out of ventilator.
Tracheostomy is done to keep the airway patent,prevent secretions and lung infections.
Ventilator disconnection can lead to hypoxia and respiratory arrest even leading to death.
Dialysis in these cases is done due to renal shut down,due to insufficient perfusion,which can be due to cardiac by pass on pump or post operative complications.
With these two major complications,the chances of bringing back the patient to normal brain and kidney functions are very very minimal.
Hopefully wishing for his recovery
All the best
Take care.
poor prognostic condition
Detailed Answer:
Hi
Thanks for using hcm
This is really a sympathetic condition to be more concerned.
Was this on pump or off pump grafting?
What about the carotid Doppler report and ultrasound abdomen and pelvis report prior to surgery?
How many vessels were blocked?
Was it an elective or emergency surgery?
Any details of blood investigations,blood gas report?
Please let me know the details.
As such,with the findings of the MRI report it seems to be ischaemic encephalopathy of the brain involving multiple important areas of the brain,suppressing the respiratory system--due to which the comatose stage can be irreversible (with very minimal chances of reversibility).
In these conditions it is really difficult to bring the patient out of ventilator.
Tracheostomy is done to keep the airway patent,prevent secretions and lung infections.
Ventilator disconnection can lead to hypoxia and respiratory arrest even leading to death.
Dialysis in these cases is done due to renal shut down,due to insufficient perfusion,which can be due to cardiac by pass on pump or post operative complications.
With these two major complications,the chances of bringing back the patient to normal brain and kidney functions are very very minimal.
Hopefully wishing for his recovery
All the best
Take care.
Above answer was peer-reviewed by :
Dr. Raju A.T
Madam,
We are not sure whether this was off-pump/on-pump surgery but there were 4 vessels blocked out of which 1 was 99%, 2 were 90% & 1 was 70% blocked. The surgery was not elective it was advised by the Cardiac after performing angiography. His complaints were breathing problem and little bit talking problems. Earlier after shifting to ICU on 08.05.2015 daily dialysis was done but later on the urine started passing almost 100-120 ml per hour so dialysis frequency was reduced to once in the 4-5 days.
I would like to know after looking at the MRI report is there any chances of survival/recovery???? Please suggest any medicines so that we can talk to the doctor that can give us some hopes for survival. Please help we are very much disappointed with his condition. Please help us.
We are not sure whether this was off-pump/on-pump surgery but there were 4 vessels blocked out of which 1 was 99%, 2 were 90% & 1 was 70% blocked. The surgery was not elective it was advised by the Cardiac after performing angiography. His complaints were breathing problem and little bit talking problems. Earlier after shifting to ICU on 08.05.2015 daily dialysis was done but later on the urine started passing almost 100-120 ml per hour so dialysis frequency was reduced to once in the 4-5 days.
I would like to know after looking at the MRI report is there any chances of survival/recovery???? Please suggest any medicines so that we can talk to the doctor that can give us some hopes for survival. Please help we are very much disappointed with his condition. Please help us.
Brief Answer:
poor neurological outcome
Detailed Answer:
Hi
Thanks for following up once again in hcm.
As per the MRI report the injury to the brain could be due to ischaemic or hypoxic,with prognosis being very poor,and meagre chances of good outcome and recovery.
Accordingly, 4 vessel cardiac surgery itself is a high risk one that too for a patient who already had breathing problems (probably due to poor left ventricular function) and talking problems (where he could have already had previous age related brain problems too)
You can discuss with your treating cardio thoracic surgeon and the cardiothoracic anaesthetist for a neurological opinion.
Intracerbral blooming,gliosis are all indications of moderate to severe brain damage,almost being irreversible.
Neuroprotective drugs like citicholine,cerebroproteins like cognistar,antioxidants and neurovitamins like capsule co-q,osmotic diuretics like mannitol,steroids,careful and judicial use of modaphylline ,magnesium can be useful with all other added treatments.
Dialysis once in 5days, with good urine output is one of the good sign.
But with the detiorating neurological problems,there is nothing much to do.
You can discuss these issues with the treating doctor.
Your plan of treatment will be based on the observation with the neurological outcome and improvement.
As per my experience with cardiothoracic cases the chances of total recovery with such patients is very poor.
Even if they prolong the life, chances of infection,sepsis,pneumonias,bedsores,renal failure,are more.
If there is no significant improvement, I would suggest you to shift him to a rehabilitation center with good nursing care till the rest .
Really feel sorry, for this is what I can help you,as I can understand your present helpless situation.
All the best.
Take care.
poor neurological outcome
Detailed Answer:
Hi
Thanks for following up once again in hcm.
As per the MRI report the injury to the brain could be due to ischaemic or hypoxic,with prognosis being very poor,and meagre chances of good outcome and recovery.
Accordingly, 4 vessel cardiac surgery itself is a high risk one that too for a patient who already had breathing problems (probably due to poor left ventricular function) and talking problems (where he could have already had previous age related brain problems too)
You can discuss with your treating cardio thoracic surgeon and the cardiothoracic anaesthetist for a neurological opinion.
Intracerbral blooming,gliosis are all indications of moderate to severe brain damage,almost being irreversible.
Neuroprotective drugs like citicholine,cerebroproteins like cognistar,antioxidants and neurovitamins like capsule co-q,osmotic diuretics like mannitol,steroids,careful and judicial use of modaphylline ,magnesium can be useful with all other added treatments.
Dialysis once in 5days, with good urine output is one of the good sign.
But with the detiorating neurological problems,there is nothing much to do.
You can discuss these issues with the treating doctor.
Your plan of treatment will be based on the observation with the neurological outcome and improvement.
As per my experience with cardiothoracic cases the chances of total recovery with such patients is very poor.
Even if they prolong the life, chances of infection,sepsis,pneumonias,bedsores,renal failure,are more.
If there is no significant improvement, I would suggest you to shift him to a rehabilitation center with good nursing care till the rest .
Really feel sorry, for this is what I can help you,as I can understand your present helpless situation.
All the best.
Take care.
Above answer was peer-reviewed by :
Dr. Raju A.T
Dear Madam,
Based on the condition of my father, it was decided collectively to remove the ventilator considering there are almost nil chances of survival. The ventilator was removed by 2.15 pm today with oxygen on and till the time the breathing is going on. Doctors saying the result, whether positive or negative will be visible within 12-24 hrs. However, till the time Blood Pressure, urine, Heart beats and breathing everything is normal. But there is no conciousness or there is no sensation in the body parts. A very very deep pain given like deep pinching only makes little bit movement in hands. There is swelling also observed in hands and legs. Eye lids are opening for hardly 1-2 minutes per 6 hours but there is no movements in the eye pupil. We are trying to talk to him very loud even but there is no response. All the neuro related medicines are going on as per the doctors and were started from the day he was shifted to ICU i.e. 08.05.2015. We are again in dilemma about his condition we are not able to decide whether any alternate treatment may cure him or whether this is coma condition or as doctor said within 12-24 hours result may be seen. In this condition of helplessness we would like to know what can recover him or what are the other options???? Please help.
Based on the condition of my father, it was decided collectively to remove the ventilator considering there are almost nil chances of survival. The ventilator was removed by 2.15 pm today with oxygen on and till the time the breathing is going on. Doctors saying the result, whether positive or negative will be visible within 12-24 hrs. However, till the time Blood Pressure, urine, Heart beats and breathing everything is normal. But there is no conciousness or there is no sensation in the body parts. A very very deep pain given like deep pinching only makes little bit movement in hands. There is swelling also observed in hands and legs. Eye lids are opening for hardly 1-2 minutes per 6 hours but there is no movements in the eye pupil. We are trying to talk to him very loud even but there is no response. All the neuro related medicines are going on as per the doctors and were started from the day he was shifted to ICU i.e. 08.05.2015. We are again in dilemma about his condition we are not able to decide whether any alternate treatment may cure him or whether this is coma condition or as doctor said within 12-24 hours result may be seen. In this condition of helplessness we would like to know what can recover him or what are the other options???? Please help.
Brief Answer:
needs observation at least 24--72 hours.
Detailed Answer:
Hi
Thanks once again.
Really feel very concerned and sorry for your father's clinical status.
In this clinical condition with no response to deep painful stimuli and non reactive pupils, neurological coma almost similar to brain death there is nothing much or some other treatment that we can do,as the duration of 3 weeks is sufficient to assess the condition.(8/5/15)
Wait and watch is the best decision in this case at least up to 24--72 hours off ventilator.
Sometimes the same status can prolong from hours,days,weeks or still longer until the heart functions,without the brain,as you know euthanasia is not followed in our country.
I know it is very difficult and hard to accept the truth,but you have to take a hard decision and make all the others in the family collectively understand the situation.
As a doctor and your well wisher I can only wish and suggest you to pray to the Almighty to ease his sufferings as early as possible.
Wishing all these events will not have any psychological effects on you and your family
Take care
needs observation at least 24--72 hours.
Detailed Answer:
Hi
Thanks once again.
Really feel very concerned and sorry for your father's clinical status.
In this clinical condition with no response to deep painful stimuli and non reactive pupils, neurological coma almost similar to brain death there is nothing much or some other treatment that we can do,as the duration of 3 weeks is sufficient to assess the condition.(8/5/15)
Wait and watch is the best decision in this case at least up to 24--72 hours off ventilator.
Sometimes the same status can prolong from hours,days,weeks or still longer until the heart functions,without the brain,as you know euthanasia is not followed in our country.
I know it is very difficult and hard to accept the truth,but you have to take a hard decision and make all the others in the family collectively understand the situation.
As a doctor and your well wisher I can only wish and suggest you to pray to the Almighty to ease his sufferings as early as possible.
Wishing all these events will not have any psychological effects on you and your family
Take care
Note: For further follow-up it is advisable to consult an emergency medicine specialist. Click here.
Above answer was peer-reviewed by :
Dr. Vaishalee Punj
Answered by
Dr. Sabiha Banu
Pain Medicine & Palliative Care Specialist
Practicing since :2000
Answered : 749 Questions
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