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Dr. Andrew Rynne
MD
Dr. Andrew Rynne

Family Physician

Exp 50 years

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What Is The Prognosis For An Unresponsive Stroke Patient With Brain Swelling?

My Father in law (66) had a brain non-cancerous tumor removed last Friday, came through surgery ok just to discover 2 hours later he had developed a large blood clot and had to be rushed back into surgery to have it removed. On Saturday sometime he had another CT Scan that showed the right side of his brain had stroked. He has swelling in the brain and is unresponsive at this point. However, he does react to pain in his extremities. His left pupil reacts to light somewhat, but right pupil nothing. The doctor has been very vague and not sharing much information with us. He is off all sedation medication and was breathing just yesterday unassisted. He has not woke up yet and scans are only being done about every 3 days. We have been told by nurses that we should just wait to see if he does wake up or wait for a response from a command given. The doctor has stated that if the swelling goes down that the stroke can reverse itself and that he may recover. All vitals are great, heart rate, blood pressure and 02 levels. Should he have awakened by now? I know my Father in law would not want to lay there like that, but we really don t want to lose him either. What should we expect and can he recover and what time period should we expect to see a commanded response?
Mon, 1 Dec 2014
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Neurologist,  's  Response
I read your query and I am sorry about what you are going through.
From what you are describing he has had a severe stroke involving a large area of the brain. The fact that you say his right pupil is large and unresponsive indicates a big lesion with edema which is compressing his brain stem and if the pressure augments even more it could be fatal. Unfortunately right now as your doctor has said you should just wait for the edema (swelling) to stop and then gradually subside, even in the best case scenario it won't happen in one or two days, could take several weeks. Also there is also the risk of other non neurological complications which could present in many intensive care unit patients, like for example infections which in his critical condition are more likely to happen and difficult to treat, pulmonary embolism etc.
As for the long term, that is in case he survives this critical phase and recovers consciousness, you should understand that most probably some residual disability will be left. Some part of his brain is irreversibly dead, given the stroke gravity you're describing that is for sure I am afraid. I am not saying that improvement is not possible, but it will depend more on the undamaged areas compensating for the lost ones. How much improvement there will be varies, even for the same stroke size and gravity it may vary from one patient to the other. What you should understand is that it would take several months and it will be more a question of prolonged physical therapy rather than miracle working drugs.
I hope things will work out for the best.
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What Is The Prognosis For An Unresponsive Stroke Patient With Brain Swelling?

I read your query and I am sorry about what you are going through. From what you are describing he has had a severe stroke involving a large area of the brain. The fact that you say his right pupil is large and unresponsive indicates a big lesion with edema which is compressing his brain stem and if the pressure augments even more it could be fatal. Unfortunately right now as your doctor has said you should just wait for the edema (swelling) to stop and then gradually subside, even in the best case scenario it won t happen in one or two days, could take several weeks. Also there is also the risk of other non neurological complications which could present in many intensive care unit patients, like for example infections which in his critical condition are more likely to happen and difficult to treat, pulmonary embolism etc. As for the long term, that is in case he survives this critical phase and recovers consciousness, you should understand that most probably some residual disability will be left. Some part of his brain is irreversibly dead, given the stroke gravity you re describing that is for sure I am afraid. I am not saying that improvement is not possible, but it will depend more on the undamaged areas compensating for the lost ones. How much improvement there will be varies, even for the same stroke size and gravity it may vary from one patient to the other. What you should understand is that it would take several months and it will be more a question of prolonged physical therapy rather than miracle working drugs. I hope things will work out for the best.