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Neurology (Expert Forum)
Waking Up from Coma After Brain Tumor Surgery
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Waking Up from Coma After Brain Tumor Surgery
by Cindy, Oct 17, 2005 12:00AM
My question has to do with my mother-in-law (MIL).
Last Tuesday (Oct. 11th) she underwent surgery to remove a brain tumor. The surgery lasted about 5 hours and afterwards the doctor said she was quite confident she had removed the entire tumor (which was approx. the size of a lemon).The pathology report classified this as a benign meningioma.
For the first two days after surgery my MIL experienced several seizures and was given medication to help reduce their duration and frequency. Thankfully she has not experienced anymore seizures since last Thursday. Our biggest concern now is that she is still unconscious and has not opened her eyes once since the surgery. The doctor says it is up to my MIL to wake up and that there is essentially nothing we can do except wait, and it could take several weeks or more.
Is this common? The family is starting to get discouraged as they see her wasting away. She is still hooked up to a respirator and does have a feeding tube in place. An EEG last week revealed that she had brain activity, but it was much slower than normal.
Another question is that as she is lying there in bed her feet appear to be pigeon-toed and her legs are very rigid. What if anything does this mean? Is there any kind of medication that can be given to help my MIL wake up from the coma? Is there anything the family can do to help stimulate her to wake up? Any help you can give is greatly appreciated. We are so worried that she may never wake up.
Thank you for your help!
Last Tuesday (Oct. 11th) she underwent surgery to remove a brain tumor. The surgery lasted about 5 hours and afterwards the doctor said she was quite confident she had removed the entire tumor (which was approx. the size of a lemon).The pathology report classified this as a benign meningioma.
For the first two days after surgery my MIL experienced several seizures and was given medication to help reduce their duration and frequency. Thankfully she has not experienced anymore seizures since last Thursday. Our biggest concern now is that she is still unconscious and has not opened her eyes once since the surgery. The doctor says it is up to my MIL to wake up and that there is essentially nothing we can do except wait, and it could take several weeks or more.
Is this common? The family is starting to get discouraged as they see her wasting away. She is still hooked up to a respirator and does have a feeding tube in place. An EEG last week revealed that she had brain activity, but it was much slower than normal.
Another question is that as she is lying there in bed her feet appear to be pigeon-toed and her legs are very rigid. What if anything does this mean? Is there any kind of medication that can be given to help my MIL wake up from the coma? Is there anything the family can do to help stimulate her to wake up? Any help you can give is greatly appreciated. We are so worried that she may never wake up.
Thank you for your help!
Doctor's Answer
by CCF-Neuro-M.D.-PW, Oct 21, 2005 12:00AM
It depends on how big and where the tumor is essentially. A meningioma does not usually invade the brain (the pathology report would have idenfied this) so it compresses it if large enough. IF an area like the frontal lobe or brainstem is compressed on one or (more often) both sides there may be prolonged return to basleine level of alertness and interaction. There is also a lot of swelling immediately after surgery and for a few days which needs time to settle down. Presumably they did a postop MRI or CT to show the resection, and exlude any other mass lesion or compression of the brainstem? Seizures can occur without any outward signs and can result in prolonged unresponsiveness - regular or cintinuous EEG can identify this. Other metabolic or drug related causes of coma are necessary to look in to also, and I'm sure they are doing this in the ICU setting. Supportive care and medications like steroids for swelling and anti-epileptic drugs for seizures are usuall the most one can do until the brain recovers to its potential.
He had been progressing well, was walking with help, was eating in the cafeteria, and was speaking and reacting appropriately to conversation, though still somewhat confused about things. He had become cantankerous with the rehabilitation center staff, which I saw as actually a positive thing. They were working him hard in rehab, with new things every day. We were looking for a nursing home for a temporary stay, with a goal of bringing him home with day-time nursing help.
Then he became lethargic, and was taken back to the hospital for diagnosis. His initial lung X-ray was clear, but they diagnosed him with pneumonia supposedly caused by his tracheotomy. I could never get a nurse or doctor to really answer me about where the pneumonia was -- maybe just in his throat? He was still talking and responding, but he had a fever.
He was given IV fluids and antibiotics, and appeared to recover in a couple of days: only a slight fever, and sputum clear. But the nurses told us he had also developed a staph infection from the trach. He was unconscious most of the time, and a CT scan revealed that there was still residual fluid in the area were he had had his subdural hematoma (which is really not unexpected -- though they told it to my mother-in-law as though it was surprising). Some information we received secondhand from the nurses indicated that perhaps the amount of fluid might have been increasing.
He was not on a ventilator.
It was becoming difficult to get solid information -- the doctors seemed mostly unavailable or too busy. I think they had already written him off at this point.
A new doctor, a social worker, and a chaplain met two days in a row with my mother-in-law to convince her to remove his hydration and abdominal feeding tube. He was still responding, opening his eyes, asking for help, mouthing questions and comments, scrawling questions about "secondary" infections on a clipboard (he had been a pharmacist and was very knowledgable), and responding in mild mock outrage when we told him that his grandson had taken over his favorite chair.
The "team" told my mother-in-law that he would "never fully recover," and that she ought to withdraw supportive care. They gave her a folder of documentation about good death, the importance of dehydration to dying well, etc. Since he had a living will that said that if he were terminal or unresponsive, there should be no extraordinary measures taken, they convinced her to execute those provisions.
The antibiotic was stopped, all monitoring was removed, and no further fluids or foods were given. He was given morphine, and within 24 hours had became nonresponsive. Within 3 days he was dead.
With the staph infection and pneumonia (claimed to be still there), and some additional symptoms like some mild swelling in the legs, perhaps he truly was terminal.
I can't say if it was wrong or right to stop the supportive care.
But I am pretty sure it was premature.
Rest in peace Walter.