aneurysm surgery

[Brenda-Salem]

  My husband, age 44, had an aneurysm erupt. He was a grade II or III, he was talking and oriented to self and place and quite aware of what was happening.  Six hours later he was taken in surgery for clipping, this was not successful and 5 days later he was in surgery again. After the second surgery his ICP began to rise, and it was not treated until i reached around lower 50's. After 15 hours he was given mannitol for another 37 hours.Finally the nurses paged the Dr and he came after about two more hours and at first said "there is nothing I can do" then half an hour later does a ventriculostomy and drains some fluid, this immediately lowered his ICP to below 20.  He had a CT scan done right before the ICP began rising so much and it show very little damage. There was one done the following morning after this all happened and it showed a large ischemic event had taken place. My husband now has aphasia, other than that he seems quite normal. No memory problems or anything. Is it possible that the damage done was due to the CPP being too low and his brain not getting enough blood flow due to the ICP being too high and CPP being too low, at times it was well below 50. Could that be what caused the damage in his speech area. I have seen the CT scan pictures and there is a hole in his brain that was not there before the high ICP?
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It is very difficult to answer this question without access to very spevific
details from the medical records however I will give you some facts which may
help you to make up your own mind.
These do not constitute a diagnosis of what happened in this particular case.
Aphasia is a focal process, it involves a restricted area of the brain
supplied by one blood vessel, this sort of specific problem does not result from
global processes like fluctuating intracranial pressures which affect
the entire brain more or less equally.
The days after a subarachnoid hemorrhage are characterised by a complication
known as vasospasm, this is the sudden constriction of an individual blood vessel
due to the irritant effect of blood fronm the ruptured vessel, it is one
of the most difficult and unpredictable of the compplications folowing
subarachnoid hemorrhage.
Vasospasm since it effects individual vessels can give rise to isolated or
focal defecits in small areas of the brain causing focal signs like those seen
the more usuall type of stroke.
I cannot say what the "hole" in the brain constituted, but it obviously
suggests a focal process of some sort rather than a global process which
would affect the entire brain equally.