Subject: Re: Brain injury due to lack of oxygen
Forum: The Neurology and Neurosurgery Forum
Topic Area: Traumatic Brain Injury
Posted by ccf neuro M.D.* on May 15, 1998 at 22:53:12:
In Reply to: Brain injury due to lack of oxygen posted by Michael A. Pesoli on April 29, 1998 at 19:42:29:

My Mother-in-law went into surgery for a hysterectomy, stopped breathing while in the recovery room (no one noticed for at least six minutes), and she is now severely brain damaged. She can't walk, can't talk, and can't eat.

She went into rehabilitation once she came out of her coma and made very little progress. She is now at home with in home health care. She is not improving. She can barely move her arms and her hands are always cramped. She can barely speak. It takes forever for her to say one word and it is barely audible. She tries but her mouth has a very hard time forming the words.

However, she at times seems to have depth mentally. For example, last year before her injury she read a certain book. When we asked her who the author of the book was, she shook her head no to the wrong authors names that we were naming, and yes when we mentioned the correct author's name. Her biggest problem seems to be her brain not being able to tell her motor skills what to do.

I have lots of questions:

1.) Is time a factor when dealing with brain injuries? As soon as she came out of her coma or while she was still in her coma were there procedures that could have been done or measures that could of been taken that would have ensured maximum recovery? I hope not because it has now been almost seven months.

I have heard it said, "When you have a big medical problem you go to a big city for great treatment." She's in Norman, Oklahoma. I've always felt that we should take her to Houston or Dallas.
2.) Is this usually true?

We have been told two things about brain injuries due to lack of oxygen. We have been told that brain injuries due to a lack of oxygen (unlike brain injuries due to a blow to the head or some sort of head trauma) do not recover and cannot be rehabilitated. The brain cells are dead and there is no fixing them or bringing them back to life.
We have also been told that people who have had brain injuries due to lack of oxygen have indeed recovered, and some have recovered so completely that you couldn't even tell that they ever had a brain injury due to lack of oxygen.
3.) Which is correct?

What we have seen so far almost seems to support both theories. She has definitely made SOME improvement from her original condition-basically a coma and then only some eye movement and blinking when you move your hand toward her eyes. To now, where she tries to say words and sometimes you can understand them. She can spell out words and short phrases on a speak-and-spell type of machine (her only problem with this seems to be that her hands are so cramped and her motor skills are so poor that she has trouble hitting the right letters). But there has also been no real improvement in a long time and it seems almost like this is as good as she'll ever get.
4.) Is there a chance that almost seven months after her injury she could make more progress and continue to get better?

I also remember one time hearing about a show someone saw (on PBS or something like that) which talked about a Hospital in (I think) New Orleans that specializes in brain injuries due to lack of oxygen. They had some radical new procedure they used (something like a pressurized oxygen chamber) that the patient would get in and it was producing impressive results.
5.) Is this true? If so what is the name of the hospital?

Her neurologist can not give us any answers as to what we can expect.
We've asked him these questions and he's given us these answers:
Q: How brain damaged is she?
A: I don't know we'll just have to wait and see.

Q: How much better will she get?
A: All I know is that I expect her to get better than she is, but I don't know how much better.
6.) After almost seven months shouldn't her Neurologist have more answers than that?

I know that she has, what looks like, a lot of cramping all over her body. Her Neurologist calls them seizures but they seem more like continual severe cramping all over her body, her legs, and her hands. I can't tell if this is the real cause of her inability to perform basic motor skills. I know when I have a really bad muscle cramp I can't move very well. They have tried to combat these seizures with different medications but none of them have cured them. They only seem to keep the seizures from being too severe or painful.
7.) Are seizures (severe muscle cramping) a common occurrence with patients with brain injuries due to lack of oxygen?

Watching her go through all this is very painful for us. I feel so helpless. I wish my wife could see her mother and my daughter could see her Grandmother get better.

Sincerely,

Michael A. Pesoli
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Hello Michael,

Your questions are simply too many and too specific for us to address in the forum format, which is intended to provide general information rather than be an automated second opinion. I will try to provide you with some general information about postanoxic brain injury. Brain injury due to oxygen deprivation can improve typically up to about a year post-injury, and significant additional recovery beyond such a period of time is unusual. The recovery that is made is due to surviving nerve cells sprouting new nerve endings to reconnect with other surviving nerve cells in an attempt to recreate the original functions of the damaged area(s) of brain. This process is rarely completely successful in compensating for the lost brain cells. Oxygen deprivation typically affects certain parts of the brain more severely than others. Especially susceptible to injury structures include the hippocampus, which is responsible for memory; the cerebellum Purkinje cells, which are responsible for coordination; and the pyramidal cortical cells, which are cells near the surface of the brain that are responsible for all higher brain functions like communication, thinking, and mathematics. Seizures are a common problem after such injuries due to damage to the pyramidal cortical cells, and are often persistent and somewhat stubborn to treat. If you would be interested in a second opinion for your mother-in-law, of course we'd be happy to provide you with one at the Cleveland Clinic. Our number is 1-800-223-2273 extension 45559. If you are looking for a major medical center closer to home, I would suggest Sothwest in Dallas, or the University of Colorado in Denver, both of which are reasonably close to Oklahoma. Please rememebr that the information provided on the forum is intended for general medical informational purposes only, and that the actual diagnosis and treatment of your mother-in-law's specific medical condition should be strictly in conjunction with her treating physician(s). We hope you find the information useful, and wish you and your family well in striving to meet the many challenges of caring for a loved one with a chronic, disabling condition.

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