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What Causes Vasospasm?
Question: Hi Doctor,
My mother-in-law suffered brain haemorhage on the morning (approx. 8.30 AM) of 25th of Nov 15. She was rushed to a local hospital where they gave some medicine to subside the headache. Later in the day, the CT scan revealed brain haemorrhage. She was admitted to a speciality hospital in the wee hours (01.00 AM) of 26th, and later operated upon by a neuro surgeon in the evening of 26th Nov.
The doctor's managed to stop bleeding, and diagnosed it as vasospasm. Two days later, doctors found cerebrospinal fluid (CSF). So they operated her again to insert the shunt and remove the fluid. The doctors also mentioned that she suffered from subarachnoid haemorrhage.
Now it has been 10 days for her in the Medical ICU. While she wakes up for some time, most of the time she remains in a heavy drowsiness state. For the past 3 days she didn't wake up, not opening her eyes, when it's time for relatives to meet the patient.
We are all very worried if she went into coma. Our worry is further aggravated by stories of how hospitals keep the patients in ICU hoping to mint as much money as they can, and sometimes even keeping already brain dead patients on ventilator just to show their relatives that they are alive. Doctors are not very forthcoming on what's going on. All they say is she is improving and will need to be kept in ICU for another 10-15 days.
Could you please help with your detailed diagnosis of this condition and what are the chances of recovery, and whether she must be kept in ICU or is it ok if she is moved to an ordinary ward? Why doctors are insisting on keeping her in ICU? Do they expect recurrence of the spasm?
Regards,
XXXX XXXXXXX
My mother-in-law suffered brain haemorhage on the morning (approx. 8.30 AM) of 25th of Nov 15. She was rushed to a local hospital where they gave some medicine to subside the headache. Later in the day, the CT scan revealed brain haemorrhage. She was admitted to a speciality hospital in the wee hours (01.00 AM) of 26th, and later operated upon by a neuro surgeon in the evening of 26th Nov.
The doctor's managed to stop bleeding, and diagnosed it as vasospasm. Two days later, doctors found cerebrospinal fluid (CSF). So they operated her again to insert the shunt and remove the fluid. The doctors also mentioned that she suffered from subarachnoid haemorrhage.
Now it has been 10 days for her in the Medical ICU. While she wakes up for some time, most of the time she remains in a heavy drowsiness state. For the past 3 days she didn't wake up, not opening her eyes, when it's time for relatives to meet the patient.
We are all very worried if she went into coma. Our worry is further aggravated by stories of how hospitals keep the patients in ICU hoping to mint as much money as they can, and sometimes even keeping already brain dead patients on ventilator just to show their relatives that they are alive. Doctors are not very forthcoming on what's going on. All they say is she is improving and will need to be kept in ICU for another 10-15 days.
Could you please help with your detailed diagnosis of this condition and what are the chances of recovery, and whether she must be kept in ICU or is it ok if she is moved to an ordinary ward? Why doctors are insisting on keeping her in ICU? Do they expect recurrence of the spasm?
Regards,
XXXX XXXXXXX
Brief Answer:
Request for CT scan reports to know size and location of the hemorrhage
Detailed Answer:
Hi XXXXXXX
Thanks for writing in to us.
I have read through your query in detail.
Please find my observations below.
1. I regularly report CT scans where patients have developed brain hemorrhage and it is important to first review the CT scans of your mother in law to know the magnitude of the hemorrhage and the latest CT scan which can explain the cause of her non responsiveness.
2. The was probably obstruction to the flow of CSF which caused hydrocephalus or increased pressure inside the head necessitating the second surgery and placement of shunt. This is a known complication after operating for hemorrhage.
3. Every brain hemorrhage is unique and always counted as a probable life threatening situation, even after surgery is done.
4. ICU stay for a brain hemorrhage patient is important. In most ICUs the patient gets complete attention and care. You can always try and know the vital parameters like pulse, blood pressure, respiration and oxygen saturation from the doctors. These can take time to stabilize and once they are in normal range then it is safe to transfer to ward. This information can be asked to the doctor treating your mother in law.
5. Nothing can be said for the first 10 days in a brain hemorrhage patient. I request you to please send CT scan images after hemorrhage and following surgery to know the exact situation right now. The size of hemorrhage and chances of recovery including ICU will be based on CT scan findings and clinical condition.
Hope your query is answered.
Please do write back if you have any doubts.
Regards,
Request for CT scan reports to know size and location of the hemorrhage
Detailed Answer:
Hi XXXXXXX
Thanks for writing in to us.
I have read through your query in detail.
Please find my observations below.
1. I regularly report CT scans where patients have developed brain hemorrhage and it is important to first review the CT scans of your mother in law to know the magnitude of the hemorrhage and the latest CT scan which can explain the cause of her non responsiveness.
2. The was probably obstruction to the flow of CSF which caused hydrocephalus or increased pressure inside the head necessitating the second surgery and placement of shunt. This is a known complication after operating for hemorrhage.
3. Every brain hemorrhage is unique and always counted as a probable life threatening situation, even after surgery is done.
4. ICU stay for a brain hemorrhage patient is important. In most ICUs the patient gets complete attention and care. You can always try and know the vital parameters like pulse, blood pressure, respiration and oxygen saturation from the doctors. These can take time to stabilize and once they are in normal range then it is safe to transfer to ward. This information can be asked to the doctor treating your mother in law.
5. Nothing can be said for the first 10 days in a brain hemorrhage patient. I request you to please send CT scan images after hemorrhage and following surgery to know the exact situation right now. The size of hemorrhage and chances of recovery including ICU will be based on CT scan findings and clinical condition.
Hope your query is answered.
Please do write back if you have any doubts.
Regards,
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Hello Doctor,
Thank you for your detailed reply. It was helpful.
You had asked me to get the CT Scan report so that you can further explain your prognosis. It took some time but now I have a couple of them.
Kindly find them attached in this email.
Do share your thoughts on what you think is the prognosis.
Btw, my mom-in-law is now showing some signs of improvement. She has started having small conversations with visitors. Although the docs have still advised her to be kept in ICU.
Your response would be greatly appreciated.
Thanks in advance
XXXX
Thank you for your detailed reply. It was helpful.
You had asked me to get the CT Scan report so that you can further explain your prognosis. It took some time but now I have a couple of them.
Kindly find them attached in this email.
Do share your thoughts on what you think is the prognosis.
Btw, my mom-in-law is now showing some signs of improvement. She has started having small conversations with visitors. Although the docs have still advised her to be kept in ICU.
Your response would be greatly appreciated.
Thanks in advance
XXXX
Brief Answer:
Patient is expected to improve slowly in weeks
Detailed Answer:
Hi XXXXXXX
Thanks for writing back with an update.
1. The CT scan report shows there was a persisting block in the passage of CSF which is fluid in the brain. This caused increased pressure and there was bleeding in the ventricles which itself is a serious condition. The first 3 months are important in these patients. I hope she is getting physiotherapy and her nutrition is normal.
2. Going by the CT scan finding, I expect slow improvement in your mother in law. By slow I mean days to weeks. During this periods she requires supportive care and probably she is still in the ICU right now. If she is improving and able to maintain vital functions like pulse, blood pressure, respiration, heart function and her brain is responding to some commands then you can consider transferring her to private ward.
3. It is very difficult to decide on shifting patient out of ICU without knowing complete clinical information. However prolonged ICU stay can cause other infections and you can request a discussion with the doctor on this topic.
Hope your query is answered.
Please do write back if you have any doubts.
Regards,
Patient is expected to improve slowly in weeks
Detailed Answer:
Hi XXXXXXX
Thanks for writing back with an update.
1. The CT scan report shows there was a persisting block in the passage of CSF which is fluid in the brain. This caused increased pressure and there was bleeding in the ventricles which itself is a serious condition. The first 3 months are important in these patients. I hope she is getting physiotherapy and her nutrition is normal.
2. Going by the CT scan finding, I expect slow improvement in your mother in law. By slow I mean days to weeks. During this periods she requires supportive care and probably she is still in the ICU right now. If she is improving and able to maintain vital functions like pulse, blood pressure, respiration, heart function and her brain is responding to some commands then you can consider transferring her to private ward.
3. It is very difficult to decide on shifting patient out of ICU without knowing complete clinical information. However prolonged ICU stay can cause other infections and you can request a discussion with the doctor on this topic.
Hope your query is answered.
Please do write back if you have any doubts.
Regards,
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Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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