Stroke - Cerebral Hemorrhage

Hi,

My uncle had a stroke on 27th Sept 2010. We took him to the emergency. He was complaining of severe headache and neck pain. He had a CT Scan and was found to have cerebral hemorrhage due to high BP. His Systolic BP was 212 upon admission. He was operated by a neurosurgeon 7 hours after the stroke. An EVD was attached and he was sedated and was kept on a ventilator. On 29th he was taken off the ventilator and was shifted out of the ICU (I later found out this was because of lack of beds in the ICU. His doc was not happy but had no choice). He was responsive and alert, recognized everyone (including distant friends) and was eating and talking. He had weakness on the right limbs. However, he was a bit delusional and was hallucinating, often thinking about work, saying things like, "Bring my hard disk" or "I've sent a print out" etc. He thought the ceiling lights were a TV set and kept asking to change the channel.
On 3rd Oct, he had two episodes of high BP, both reaching to 250 Systolic. He was given an infusion of Labetalol, and the BP was brought down to 150. For the next two days, he was still delusional and hallucinatory. On 5th, he developed fever and fearing an infection, he was broad spectrum antibiotics. On 6th (today) his breathing was laboured and he was moved back into ICU, sedated and ventilated.
The doctor says that he is not too worried about the infection as he is being given Meropenem, the "nuclear bomb of antibiotics".
How ever he is worried about the EVD. He says that 220 ml of CSF is being drained per day for the last 3-4 days. On the first day, it was 250 ml/day. This has to be reduced to 50 ml per day in order to remove the EVD. Till then, he doesn't want to give us any false hopes.

I know that my uncle is in good hands, and there is nothing much I can do about it, however, knowing what is going on helps us prepare for possibilities and helps reduce anxiety.

It's been 10 days for the EVD surgery. I've read that this is a maximum and it should be replaced with a new one to prevent infections. I haven't been told about any possibility of another surgery yet.

I need to know if the rate of drainage can reduce and if 50 ml / day is the target, how long can it take to reach? Has anyone else had a similar case?

Some info about the victim:
Age: 57
Sex: Male
Medical History: Mildly diabetic, was on medications
Not aware of any BP issues so was not on medication.
Has Gout due to excess uric acid and hence foot pain once in a while.

His boss was harassing him at work, yelling all the time, and he was always tensed due to work. We have evidence from his colleagues, that just before his stroke, he was insulted, yelled at and threatened to be fired over a non-issue. Apparently, the boss had just been promoted and is over-enjoying his authority.

Can someone with no history of Blood Pressure (check up has done 6 months before) get it to levels > 200 so quickly?

I would appreciate any insight and comments.

Not sure if it helps, here are some vague pictures of his CT Scans:

CT Scan upon admission (27th Sept)
http://www.dropmocks.com/mB1TO

Second CT Scan (28th Sept)
http://dropmocks.com/mB9S8

Third CT Scan (3rd Oct)
http://www.dropmocks.com/mB6IQ


Thanks,
Tony!

[rumpled]

I am sure they did this, but ask just in case - did they check his kidneys and adrenals for abnormalities such as a pheo, or issues with the renin/aldosterone axis? BP can be a hormonal issue, not just stress.

[gilla28]

Thanks for your reply. I'm not too sure if they tested him specifically for that, but i remember the doctor telling me that his kidneys are okay. However, I'll ask him tomorrow.