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Old 11-06-2007, 11:33 PM   #1
Deelow
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Hey everyone. I need a little input.
My girlfriend's father had a Aneurysm rupture over the weekend, luckily near a hospital, he is alive and lies in a medically induced coma.
Unfortunately they are not able to measure the damage at this time or really give a long term prognosis until swelling in the brain goes down and blood is drained. This could be days or weeks. If he makes it to the recovery stage there are major hurdles but for now it is one step at a time. I suppose at this stage I am just looking for some first hand information...does anyone have experience dealing with this sort of brain injury? What was the process? Expectations? Recovery...or not?
Thanks.
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Old 11-06-2007, 11:44 PM   #2
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http://www.mayoclinic.com/health/bra...582/DSECTION=8

Some information here on it.
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Old 11-06-2007, 11:47 PM   #3
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Well my dad is a neurologist. This is his specialty. Also, I worked in a stroke research lab. Basically, the thing is this. Assuming bleading has stopped, he may have a chance at recovery. Next it depends on the extent of the bleading and the size of the area damaged. Basically what happens once the bleading stops is a process called necrosis. Here the immune system essentially carves out all the tissue in the brain it believes to be damaged. So it will often carve out tissue surrounding the site even though it is not damaged or tissue that has merely been bled into.

On top of this there may be other complications. Depending on where the rupture happened it could disrupt blood flow to major parts of the brain, essentially resulting in stroke. Another problem is possible blood clotting. If this happens they would have to adminster tissue plasminogen activator (TPA), which destroys clots, but also increases bleeding by thinning the blood.

As for his chances. No way to tell. The brain is a complicated thing. If he is in a coma, odds are he already has some kind of extensive damage. All really depends on where the damage is. Whether he survives or his quality of life is anything to speak of once if he does regain consciousness depends on a lot of different factors.

That being said some people recover from these things w/ no to little damage, so there is always hope. I haven't seen the exact case so there is no way to comment any further. Honestly all I can say is these things happen and I hope for you and your gfriends sake her father is one of the lucky ones.
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Old 11-07-2007, 12:30 AM   #4
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I'd agree with most of what blankall is saying, but with some differences.

In a time where I'm sure everyone is trying to be empathetic/optimistic and sugar coat everything, I'm going to be slightly blunt with you, because I suspect you might want some hard answers.

His prognosis depends entirely upon where the bleed occurred, how much blood was released, and where the blood went. Every patient is different, but the older we get, the less resiliant the brain is. I suspect things are pretty bad if he's been put into a medically induced coma - this is often done when there is frank brain swelling, and they need to attempt to control the resultant increase in intracranial pressure. At this stage there is not much more that they can do to intervene, short of some potential surgical decompressions if things get really bad and salvation might be possible. If the bleeding is from a ruptured aneurysm, the blood often tracks very intimately around the brain, throughout it's many crevices, making it nearly impossible to manually remove the blood. This free blood itself is rather caustic to adjacent arteries, causing vessel spasm, which occludes distal blood supply to other areas of the brain (more strokes). The so called "clot busting" drugs are not an option for this man, as these strokes are not caused by clots. Furthermore, rapidly breaking up any clots he has, might be like opening up a dam in areas that were bleeding before but have stopped because of the clotting.

For the most part it is a waiting game. If there is encouraging progress, you are looking at weeks. Either the brain will recover enough on it's own to wean him from his life supports, or it will not. If it looks like there is no positive progression, end of life decisions will have to be faced. Sadly, in the older adults, many do not recover, and if they do, they are not without lasting deficits.

With respect to your girlfriend, she and her family needs to reflect on whether or not there is a family history of intracranial aneurysms in the past; she may already qualify in getting herself screened for un-ruptured aneurysms. Obviously this does not need to be done right away, but it is important that it does not become forgotten in the ensuing events. These things can be like ticking time bombs, waiting to burst. If caught before however, interventions that can be performed to "defuse" them before this happens.

Hopefully this helps
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Last edited by NuclearFart; 04-16-2011 at 09:48 PM.
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Old 11-07-2007, 01:01 AM   #5
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Sounds like this guy knows what he is talking about. It's been a while since I worked in a lab. I agree not a bad idea to get your girlfriend screened. Many aneurysms can be treated if properly screened.
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Old 11-07-2007, 08:07 AM   #6
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Interesting, thanks guys. The swelling has been quite severe and they were contemplating more surgery yesterday but were able to bring the swelling down with even more sedation.
A little back ground on this coma. They are telling the family that he is sedated to keep from thrashing about and having the pressure in his head rise again. When they did bring him out a little bit he was able to open his eyes on command and squeeze the Dr.'s hand. I don't know if that means anything, the family is taking it as a positive sign though. Does that make sense?
I should also mention a coil has been inserted and the bleeding has stopped.
BTW I am not sure of his exact age but I know he isn't any older than 50.
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