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What Are The Chances Of Recovery From Head Injury While On Ventilator?
Question: My father aged 67 years, has under gone head surgery on 5th Nov due to heavy internal bleeding in head following a road accident. He was operated on 5th Nov itself, in Tata Memorial Hospital in XXXXXXX XXXXXXX His operation was done by cutting the skull bone, after the surgery he was on ventilator for 12-14 hours and then was without ventilator for about 36 hours post which his condition started going down and further bleeding was found in the head on 8th Nov after doing CT scan. As of this morning doctors said his condition is going down and his sensorium level (GCS) is 4/15 and they don't want to do another surgery to remove the blood and only provide medicine. We would like to take second opinion and take necessary action if there is a chance. He was put back on ventilator on 8th Nov early morning again and he is still on ventilator.
Also want to know the chances of recovery from this stage, and what the other options of treatment are?
Also want to know the chances of recovery from this stage, and what the other options of treatment are?
Brief Answer:
I concur with your surgeons decision.
Detailed Answer:
Hello xxxxxxxxxxxxxxxxx
I have gone through your question and empathize with your problem.
Post traumatic subdural or extra dural hemorrhage are common in elderly person post trauma but intraparenchymal hemorrhage may also occur. Further rebleed can occur in subdural or extra dural hemorrhage. In such situation the decision to operate depend upon clinical condition, amount of bleeding, midline shift on neuroimaging and features of raised intracranial pressure.
As a neurologist I work with a team of experienced neurosurgeons in these kind of cases and based on my experience I agree with his treating surgeons decision. In such cases as the GCS is very low, the risk of operation is more. The possibility of successful surgery or recovery is very less. Therefore it is right that we continue to treat him with medication for decreasing intracranial pressure until it is appropriate to do a surgery.
Further it is also not safe to shift such patient on ventilatory support to some other hospital unless you have a good hospital with expert neurosurgeon in hand and transfer can be made without delay in a ventilatory ambulance or air ambulance.
I completely understand this situation. But in my opinion, I think he is being treated rightly. We need to hold with conservative / medical treatment.
I pray your father recovers. Do get back to me for further queries.
Regards
Dr Neeraj Kumar
Neurologist
I concur with your surgeons decision.
Detailed Answer:
Hello xxxxxxxxxxxxxxxxx
I have gone through your question and empathize with your problem.
Post traumatic subdural or extra dural hemorrhage are common in elderly person post trauma but intraparenchymal hemorrhage may also occur. Further rebleed can occur in subdural or extra dural hemorrhage. In such situation the decision to operate depend upon clinical condition, amount of bleeding, midline shift on neuroimaging and features of raised intracranial pressure.
As a neurologist I work with a team of experienced neurosurgeons in these kind of cases and based on my experience I agree with his treating surgeons decision. In such cases as the GCS is very low, the risk of operation is more. The possibility of successful surgery or recovery is very less. Therefore it is right that we continue to treat him with medication for decreasing intracranial pressure until it is appropriate to do a surgery.
Further it is also not safe to shift such patient on ventilatory support to some other hospital unless you have a good hospital with expert neurosurgeon in hand and transfer can be made without delay in a ventilatory ambulance or air ambulance.
I completely understand this situation. But in my opinion, I think he is being treated rightly. We need to hold with conservative / medical treatment.
I pray your father recovers. Do get back to me for further queries.
Regards
Dr Neeraj Kumar
Neurologist
Above answer was peer-reviewed by :
Dr. Prasad
he is still in coma GCS 3.no improvement since last 6 days,today morning he was put out os ventilator,other paramters are ok.
what are the chances of his recovery and also is there any treatment of this by accupunture
what are the chances of his recovery and also is there any treatment of this by accupunture
Brief Answer:
Minimum GCS score, prognosis not good
Detailed Answer:
Hello,
GCS 3 is minimum score and not considered good with high mortality rates.
If he is off ventilator and maintaining on oxygen or room air then respiratory functions are intact.
The recovery chances are hard to predict at this stage . May be i will put 10% chances for improvement.
Role of acupuncture is not well established mode of therapy.
Hope God helps him in recovery.
Regards
Dr Neeraj Kumar
Minimum GCS score, prognosis not good
Detailed Answer:
Hello,
GCS 3 is minimum score and not considered good with high mortality rates.
If he is off ventilator and maintaining on oxygen or room air then respiratory functions are intact.
The recovery chances are hard to predict at this stage . May be i will put 10% chances for improvement.
Role of acupuncture is not well established mode of therapy.
Hope God helps him in recovery.
Regards
Dr Neeraj Kumar
Above answer was peer-reviewed by :
Dr. Raju A.T
he is moving his left hand little bit on pain stimulation,also lower jaw moving a bit and his right eye lid open mariginally, is this symptoms are good , he is off ventilator for 12 hrs.
what are the significant recovery signs to watch.
what are the significant recovery signs to watch.
Brief Answer:
Certainly signs of recovery appearing
Detailed Answer:
Hello xxxxxxxxxxxxx,
The good signs are off ventilatory state.
Signs of neurological recovery will be spontaneous or eye opening after pain stimulation.
Movement on pain or spontaneously on command will be good sign.
Due to involvement of left side of brain, right side of body may not be having any movement at present.
But movement on left side is also a sign of some recovery.
Hope all goes well and he comes out of this grave situation.
God bless you all.
Do get back to me for further queries.
Regards
Dr Neeraj Kumar
Neurologist
Certainly signs of recovery appearing
Detailed Answer:
Hello xxxxxxxxxxxxx,
The good signs are off ventilatory state.
Signs of neurological recovery will be spontaneous or eye opening after pain stimulation.
Movement on pain or spontaneously on command will be good sign.
Due to involvement of left side of brain, right side of body may not be having any movement at present.
But movement on left side is also a sign of some recovery.
Hope all goes well and he comes out of this grave situation.
God bless you all.
Do get back to me for further queries.
Regards
Dr Neeraj Kumar
Neurologist
Above answer was peer-reviewed by :
Dr. Vinay Bhardwaj
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