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How Long Does Massive Bleed To The Brain Stem Take To Get Cured?

Posted on Mon, 19 May 2014

Question: Hello, I have just returned from Scotland where my brother (49) had been out running (very fit) in April last year and had a massive bleed to the brain stem and finished up in a coma for 7 weeks...... I visited him in September (I live in Australia) and he did show some signs of response with a thumbs up or a wink of the eyes, occasional mouthing of words and I was there earlier this month and feel that the responses are not as good as 6 months or so ago. I was told that there is some scar tissue on the brain stem and he has deteriorated somewhat re does not swallow no more and has been on nil by mouth since December. It is hard to see my younger brother like this and would not wish this on anyone. All I am looking for is some better understanding of what is happening and what it could all lead to and possible line expectancy as deep down he would not wish this - a cruel world sometimes. I thank you kindly......

Answered by Dr. Sudhir Kumar (38 minutes later)

Brief Answer:
Recovery may take a long time.

Detailed Answer:
Hi,

Thank you for posting your query.

I have noted your brother's diagnosis and current neurological status.

It is indeed unfortunate that he suffered a massive bleeding in the brainstem.

The chances of recovery and the time required for the recovery would depend on the size of bleed as well as the exact location.

In addition, presence of additional comorbid factors such as infections, high sugars or BP, adequacy of physiotherapy, nutritional status, etc would also have an impact on the recovery.

In people with brain stem bleed, complete recovery is unusual. Most people are left with disabilities such as difficulty in walking, swallowing, speaking, impaired consciousness level, etc.

At this stage, good physiotherapy, good nutrition, and positive outlook are most important in speeding his recovery.

I hope my reply has helped you.

I would be pleased to answer, if you have any follow up queries or if you require any further information.

Best wishes,
Dr Sudhir Kumar MD (Internal Medicine), DM (Neurology) XXXXXXX Consultant Neurologist
Apollo Hospitals, Hyderabad,
For DIRECT QUERY to me: http://bit.ly/Dr-Sudhir-kumar
My blog: http://bestneurodoctor.blogspot.com/

Above answer was peer-reviewed by : Dr. Prasad

Follow up: Dr. Sudhir Kumar (13 hours later)

Thanks for the prompt reply.

My brother is in special care and is being fed with a PEG as it is felt that the act of swallowing has been diminished (non existing) and small pads are used behind the ear to curtail saliva. A Catheter is used constantly and he even pulled it out one day that must have been excruciating indeed - has some movement of his arms.
One burning question that I have is what is the life expectancy of cases like this to give me some idea as I am trying to pull together a management plan for the next few years with his house for an example and this would give me some idea as too how long my brother could suffer like this and make the management plan worthwhile. Many thanks......

Answered by Dr. Sudhir Kumar (5 hours later)

Brief Answer:
Difficult to predict the expected survival.

Detailed Answer:
Thank you for getting back.

I can understand your difficulty in not knowing the exact prognosis. Regarding survival, it varies. In a previously healthy person, in case of brainstem bleed, if good nursing care is given, survival can be for several years. What I mean, if that, if the person survives one month, then, brain stem bleed would not cause the death. The causes of death are other comorbid illnesses such as pneumonia, clotting of blood in leg veins, poor nutrition, bed sores, etc.

So, we should plan for him to survive 4-5 years at least. However, any new complication may shorten this expected survival.

Best wishes,
Dr Sudhir Kumar MD DM (Neurology)

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Sudhir Kumar (27 minutes later)

Many thanks for being honest with me. One of the reasons making my brother nil by mouth was the choking that was happening and possible aspiration with some basic food at that time going down the wrong way. Although a very fit individual my brother do get pneumonia in 2004 while visiting me in Australia in 2004 and was not allowed to fly back until much better. He always did say that in the cold of the Scottish winter he feels a tightness sometimes in his chest so I can understand that the doctors do not want to cause infection in any manner.
When he moves this summer to a further unit specialising in brain injury hopefully we will see a difference as he will have his own room, people with the same/similar issues but hopefully gets more stimulation as away from the clinical environment. Fingers are well and truly crossed and I thanks you once again for you help and understanding.....XXXX

Answered by Dr. Sudhir Kumar (5 hours later)

Brief Answer:
I hope he gets the best care.

Detailed Answer:
Thank you for getting back and providing more information.

I do hope that he gets the best care and he makes a good improvement with physiotherapy and rehabilitation.

PEG tube feeding the best option in his case to prevent aspiration pneumonia.

Best wishes,
Dr Sudhir Kumar MD DM (Neurology)

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar