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Suggest Treatment For Dead Brain Cells
Question: Hi..my mother in law is in critical condition. The operation was performed on her last month to took out the tumor from the back of the eye. After that Doctor was saying that she will be recover in 4 to 6 week as the some part of brain is damaged while operation. Now two days back, Doctor said that all cells of brain is dead so he can't do anything. And as if now the brain is not working so what is the best option for us to do now? Will you prefer us to go rehab center?
Brief Answer:
Read below.
Detailed Answer:
I read your question carefully and I am sorry that your mother's in law condition has deteriorated.
Answering your question would be a lot easier if you had been able to provide some more information.
First of all the type of tumor is not clear, there are different types some benign some malignant.
Also it is not clear at all what changed the doctor's opinion, what complication led him to say that all cells are dead, a hemorrhage, a brain infarction, an infection after the surgery? If you can provide some photo of some medical document, a CT or MRI report, anything really might be useful.
Or is the cause of the deterioration the worsening of some preexisting condition like heart failure, kidney failure etc.
Also some description of the condition is necessary, is she in a coma or awake, is she able to speak, swallow, can she move her limbs, if not on which side. Does she have fever, difficulty breathing, bed sores etc. Any info may be useful.
Generally speaking, what you should do depends on whether there is any chance sudden worsening needing another surgery. If that is not the case, if all she is taking now is supportive treatment and no special therapy, then I believe the best course is indeed the rehab center.
As I said without viewing reports it's hard to judge the extent of the damage, but no matter what it is not something which can be regained through medication. Whatever improvement is hoped will come due to the left cells (surely that statement that all cells are dead is not true) over time creating new connections and compensating for the lost ones. Rehab is the only available means of aiding that process.
How much of an improvement there will be will depend on how big the damage is in the first place and also on avoiding complications related to immobilization like infections, bed sores etc. Also that applies to the case of a benign tumor whic was removed, if the tumor is a malignant one it will probably continue to evolve and worsen.
I remain at your disposal for other questions, but in order for me to be better equipped to answer, please try to provide some more information on her condition and the cause.
Read below.
Detailed Answer:
I read your question carefully and I am sorry that your mother's in law condition has deteriorated.
Answering your question would be a lot easier if you had been able to provide some more information.
First of all the type of tumor is not clear, there are different types some benign some malignant.
Also it is not clear at all what changed the doctor's opinion, what complication led him to say that all cells are dead, a hemorrhage, a brain infarction, an infection after the surgery? If you can provide some photo of some medical document, a CT or MRI report, anything really might be useful.
Or is the cause of the deterioration the worsening of some preexisting condition like heart failure, kidney failure etc.
Also some description of the condition is necessary, is she in a coma or awake, is she able to speak, swallow, can she move her limbs, if not on which side. Does she have fever, difficulty breathing, bed sores etc. Any info may be useful.
Generally speaking, what you should do depends on whether there is any chance sudden worsening needing another surgery. If that is not the case, if all she is taking now is supportive treatment and no special therapy, then I believe the best course is indeed the rehab center.
As I said without viewing reports it's hard to judge the extent of the damage, but no matter what it is not something which can be regained through medication. Whatever improvement is hoped will come due to the left cells (surely that statement that all cells are dead is not true) over time creating new connections and compensating for the lost ones. Rehab is the only available means of aiding that process.
How much of an improvement there will be will depend on how big the damage is in the first place and also on avoiding complications related to immobilization like infections, bed sores etc. Also that applies to the case of a benign tumor whic was removed, if the tumor is a malignant one it will probably continue to evolve and worsen.
I remain at your disposal for other questions, but in order for me to be better equipped to answer, please try to provide some more information on her condition and the cause.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Ok Sir, I got these information from the Dr.
Type of tumor is Pituitary gland macroeconoma and its non malignant. After the operation she had bilateral thelamic infract. So Dr told us that the area which affected by infract is mainly eye opening, breathing and temperature, So she was unconscious at that time. But she can move her all limbs on pain sensation. I am attaching the MRI report of that with the discussion.
But suddenly 2 days back Dr told that due to the thrombotic in the any are of the body, she can not breath and due to that hypoxia occurs in everywhere in her brain like this includes some parts in her brain so now she is in coma and she is on supporting system. Right now she has no any infection, swelling or no any bad issues. Except her brain every organs are working perfectly.
Here is MRI which two days old.
MRI of brain has been performed in multiple planes. Both T1 and T2 weighted images are obtained. In addition, MR angiography of Head and Neck has been performed using 3D TOF technique.
Clinical profile: recently operated case of pituitary macroadenoma POD 2.
There is evidence of an abnormal focal areas of restricted diffusion with corresponding ADC hypointensity representing fresh infracts seen in both thalamic, subthalamic, bilateral peraqueductal region of the midbrain and left pontomidbrain junction. These areas are wellappreciated on FLAIR images.
Flair hyperintensity in basal cisterns and sylvian fissure on either side represent subarachnoid harmorrhage. In addition, area of blooming in third and occipital horn of both lateral ventricles on SWI images represent intraventicular bleed.
Frontal horn of both lateral ventricles reveal presence of small air pockets. There is no shift of the midline structures.
Altered signal intensity in the region of pituitary fossa and sphenoid sinus is consistent with post operative changes. Surgicel is seen in situ in operative bed.
The MR Angiography of Head reveals normal intracranial segments of both ICA, MCA and ACA. In addition , basilar and the visualised posterior cerebral arteries also appear unmarkable. No appreciable evidence of vascular occlusion or irregularity is seen.
The MR Angiography of Neck reveals norml carotid bifurcationand internal carotid arteries on either side.Both vertebral arteries are well visualized and appear normal in calibre. No appreciable evidence of narrowing or occlusion is detected. The origin of great vessels from arch of aorta appear unremarkable.
Impression: The MR study of brain reveals:
Both thalamic, subthalamic, bilateral periaqueductal region of the midbrain and leftpontomodbrain junction fresh infarcts.
Mid degree of subarachnoid haemorrhage with associated intraventicular bleed and pneumocephalus.
Post operative changes in the region of sell/sphenoid sinus with surgical in situ.
The MR Angiography of Head and Neck is unremarkable. No evidence of vascular occlusion of focal stenosis is detected.
Type of tumor is Pituitary gland macroeconoma and its non malignant. After the operation she had bilateral thelamic infract. So Dr told us that the area which affected by infract is mainly eye opening, breathing and temperature, So she was unconscious at that time. But she can move her all limbs on pain sensation. I am attaching the MRI report of that with the discussion.
But suddenly 2 days back Dr told that due to the thrombotic in the any are of the body, she can not breath and due to that hypoxia occurs in everywhere in her brain like this includes some parts in her brain so now she is in coma and she is on supporting system. Right now she has no any infection, swelling or no any bad issues. Except her brain every organs are working perfectly.
Here is MRI which two days old.
MRI of brain has been performed in multiple planes. Both T1 and T2 weighted images are obtained. In addition, MR angiography of Head and Neck has been performed using 3D TOF technique.
Clinical profile: recently operated case of pituitary macroadenoma POD 2.
There is evidence of an abnormal focal areas of restricted diffusion with corresponding ADC hypointensity representing fresh infracts seen in both thalamic, subthalamic, bilateral peraqueductal region of the midbrain and left pontomidbrain junction. These areas are wellappreciated on FLAIR images.
Flair hyperintensity in basal cisterns and sylvian fissure on either side represent subarachnoid harmorrhage. In addition, area of blooming in third and occipital horn of both lateral ventricles on SWI images represent intraventicular bleed.
Frontal horn of both lateral ventricles reveal presence of small air pockets. There is no shift of the midline structures.
Altered signal intensity in the region of pituitary fossa and sphenoid sinus is consistent with post operative changes. Surgicel is seen in situ in operative bed.
The MR Angiography of Head reveals normal intracranial segments of both ICA, MCA and ACA. In addition , basilar and the visualised posterior cerebral arteries also appear unmarkable. No appreciable evidence of vascular occlusion or irregularity is seen.
The MR Angiography of Neck reveals norml carotid bifurcationand internal carotid arteries on either side.Both vertebral arteries are well visualized and appear normal in calibre. No appreciable evidence of narrowing or occlusion is detected. The origin of great vessels from arch of aorta appear unremarkable.
Impression: The MR study of brain reveals:
Both thalamic, subthalamic, bilateral periaqueductal region of the midbrain and leftpontomodbrain junction fresh infarcts.
Mid degree of subarachnoid haemorrhage with associated intraventicular bleed and pneumocephalus.
Post operative changes in the region of sell/sphenoid sinus with surgical in situ.
The MR Angiography of Head and Neck is unremarkable. No evidence of vascular occlusion of focal stenosis is detected.
Brief Answer:
Conscience area heavily involved.
Detailed Answer:
Thank you for thee additional information. I imagine that MRI report must have taken some time to write, may I suggest that in the future when you have a written report you can simply make a photo and upload it in reports section, would be less work for you.
Regarding the damage...it is unfortunately not good at all. It is an infarction of the brain, irreversible damage to some cells due to lack of blood/oxygen. Severity of an infarction depends on the size and the area involved. In this case the area happens to be a very critical one. That is because the midbrain and the thalami are the parts of the brain mainly responsible for keeping us awake and conscious. So consciousness is heavily impaired and since the damage is on both sides, meaning one can not compensate for the other, it is possible for it to remain that way.
If all the rest is functioning well she can go to a rehab clinic. Whether there will be improvement or not only time will tell, it is not a question of an extra procedure or surgical therapy to be administered, only of supportive treatment to avoid bed immobilization complications and trying to create a stimulating environment for which rehab is perhaps more suited than the hospital.
Let me know if you have further inquiries.
Conscience area heavily involved.
Detailed Answer:
Thank you for thee additional information. I imagine that MRI report must have taken some time to write, may I suggest that in the future when you have a written report you can simply make a photo and upload it in reports section, would be less work for you.
Regarding the damage...it is unfortunately not good at all. It is an infarction of the brain, irreversible damage to some cells due to lack of blood/oxygen. Severity of an infarction depends on the size and the area involved. In this case the area happens to be a very critical one. That is because the midbrain and the thalami are the parts of the brain mainly responsible for keeping us awake and conscious. So consciousness is heavily impaired and since the damage is on both sides, meaning one can not compensate for the other, it is possible for it to remain that way.
If all the rest is functioning well she can go to a rehab clinic. Whether there will be improvement or not only time will tell, it is not a question of an extra procedure or surgical therapy to be administered, only of supportive treatment to avoid bed immobilization complications and trying to create a stimulating environment for which rehab is perhaps more suited than the hospital.
Let me know if you have further inquiries.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Brief Answer:
Read below.
Detailed Answer:
Hello again!
I viewed the MRI and CT you kindly provided. The midbrain area responsible for awareness has indeed been severely damaged. Improvement is hoped, in particular during the first 6 months, but to what degree is hard to say. With such extensive damage to conscience and awareness areas you must be prepared for the possibility of not regaining consciousness.
She has two factors on her side. One the fact that she is a young patient, the younger the higher the recovery ability. The second is the fact that you say other organs and systems are fine, often in such cases life is endangered by secondary complications involving other organs, so it is important that her body is holding up well putting the brain in the best position to recover. Only time will tell though with this kind of damage. As I have been saying it is not a question of intervening now, if she is breathing on her own care can be continued in rehab center.
I hope things will work out for the best.
Read below.
Detailed Answer:
Hello again!
I viewed the MRI and CT you kindly provided. The midbrain area responsible for awareness has indeed been severely damaged. Improvement is hoped, in particular during the first 6 months, but to what degree is hard to say. With such extensive damage to conscience and awareness areas you must be prepared for the possibility of not regaining consciousness.
She has two factors on her side. One the fact that she is a young patient, the younger the higher the recovery ability. The second is the fact that you say other organs and systems are fine, often in such cases life is endangered by secondary complications involving other organs, so it is important that her body is holding up well putting the brain in the best position to recover. Only time will tell though with this kind of damage. As I have been saying it is not a question of intervening now, if she is breathing on her own care can be continued in rehab center.
I hope things will work out for the best.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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