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    What causes delayed emergence, seizure and unconsciousness post heart surgery?

Posted on Tue, 21 Jul 2015 in Headache and Migraines
Question: For a second opinion from a consultant neurologist.
Hi, my mum had an open heart surgery one week ago and ended up with a delayed emergence, seizures and unconsciousness. Heart and breathing is voluntary and normal. After an EEg and a CT on the third day postop, nothing abnormal resulted . On the 4th day an MRI was taken as she was still unconscious (but eyes opened) and this was the result:
Exam performed: MR Head of 22-JUN-2015:
Unenhanced examination including a 3-D time-of-flight sequence through the circle of Willis.
Diffusion weighted imaging demonstrates diffuse , multifocal areas of predominantly cortically based curvilinear restricted diffusion which, in conjunction with asymmetrical hyperintensities affecting the caudate nuclei (left more than right), is consistent with extensive hypoxic ischemic encephalopathy.
No intracranial blood products are present. Normal symmetrical appearances of the ventricular system with no mass effect, midline shift or features of raised intracranial pressure. No intracranial mass lesion or extra-axial collection.
No abnormality of note demonstrated in relation to the circle of Willis time-of-flight angiogram, no dural venous sinus thrombosis pattern present.
Well-aerated paranasal sinuses, patchy inflammatory changes noted in relation to the mastoid air cells and middle ears, more so on the right side. No gross intraorbital or extracranial soft tissue abnormality, well-preserved parapharyngeal spaces.
Impression: Extensive hypoxic ischemic encephalopathy as detailed above.
Very abnormal.

May I ask if :
1) This is mild/moderate/severe damage? and what would be the chances of gaining consciousness and a normal life?
2) Is there any neurological /nutrients which could help brain cells repair/regeneration?
3) Why wouldn't they have detected brain hypoxia during surgery?

Many thanks in advance.
Answered by Dr. Olsi Taka 25 minutes later
Brief Answer:
Read below.

Detailed Answer:
I read your question carefully and I am sorry about what has happened to your mother.

1) Unfortunately to answer to your first question the damage seems to be severe as it is a question of extensive bilateral damages. Exact predictions can not be made at this stage as recovery varies among patients. The fact that you say that she opens her eyes is certainly a positive (as opposed to the possibility of being in a coma), but still looking at that MRI report you must be prepared that at least some degree of disability will remain. Time will tell how much. Improvement is expected beyond these first days, usually during first 6 months.

2) There are no medications proven to help brain regeneration. There are some products around like NeuroAid, Cerebrolysin etc, which claim to positively influence recovery, but efficacy of any of them is yet to be proven and widely accepted.

3) During surgery the patient is intubated under anesthesia, so her brain function could not be tested. So only if there was a heart arrest or some other complication leading to prolonged lack of blood flow in the brain could the brain hypoxic damage be suspected, the doctors should be able to tell you whether that was the case during her surgery.

I hope things will work out for the best.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
Follow up: Dr. Olsi Taka 24 hours later
Thank you. That was very helpful.
I am aware that stem cell therapy is not offered in the US/UK. However, what would be your views on this, if this patient was a member of your family? Would you advise giving it a try for a better outcome?

Answered by Dr. Olsi Taka 5 hours later
Brief Answer:
Read below.

Detailed Answer:
Well as a clinician we are taught that a treatment efficacy must be proven by studies in order to recommend it and up to now there are no such studies to have proven benefit of stem cell therapy in ischemic brain lesions so I can't recommend it.

Now I guess you might say that for every drug there has been a first patient and want to know whether I would have high expectations. The answer unfortunately remains not optimistic. The idea of a cell which can transform itself in other cells is great, but several question marks would arise such as how would these cells develop into the several different types of cells in the brain, simply injecting them is easy, but how to make some of them go to a certain brain area and some in others, how to tell some of them to develop into one type of brain cell and some in others, how to control they create connections with the right cells in accordance with the immensely complex network of neurons.
These are very difficult issues to deal with, not sure that we have any tools to solve them yet.

I am sorry if that wasn't the answer you were hoping to hear.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
Answered by
Dr. Olsi Taka


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