“Your mother admitted in emergency has bleeding in the brain and is causing severe increase in pressure inside brain. She needs an urgent surgery” I told the son waiting outside. The old lady was admitted late in the evening in an unconscious state following road traffic accident. She was not opening eyes, was just minimally moving left upper limb on painful stimuli. She had weakness of right upper and lower limb.
We explained to patient’s relatives regarding urgent need of surgery and convinced them for surgery. We immediately took consent for surgery, sent all blood investigations and shifted the patient to OT(Operation theatre) after necessary preparation for surgery. Within half an hour patient was in the operating room. To save time, we did head shaving of patient on Operating table (most of the medicos will be knowing importance of barber in Government hospital and their availability on time!!!!)
We removed part of her skull bone, kept it in abdomen and evacuated hematoma from the brain. Post operative, she was still in unconscious state and showed little improvement. But scan showed decrease in mass effect (pressure inside brain) and expansion of brain. After two week stay in hospital we discharged her in unconscious state on medications. We guided the patients relatives regarding physiotherapy, frequent stimulation of lady with musical therapy, Ryle’s tube (tube inserted through nose in stomach) feeding. Relatives were also supportive and were quite active in her rehabilitation.
Patient like her usually have poor prognosis. According to traumatic brain injury prognostic calculation
Her predicted probability of 6 month mortality was 59 percent
And predicted probability of 6 month Unfavourable outcome was 82 percent.
To our surprise, she showed drastic improvement at home care; thanks to her relatives. Treating doctors barely play any role in head injury patient’s rehabilitation after acute treatment period is over.
At 4 week follow up, she started to respond to spoken worlds but still was not able to speak, her weakness also improved slightly in right upper and lower limb.
At 12 week, I really got surprised. She came walking, was talking (fluency was less).Only problem was she had lost weight in these days.
Now she is on diet as advised by dietician and is responding well. She is being planned for second surgery with replacement of bone in skull in few days time.
We often see such patients in clinical practice but only few relatives are so much supportive and are willing for home care. These patients commonly show slow improvement, stays for weeks in hospital and thereby making hospitalization expenditure reach six to seven digits.
Do share your experiences with us!