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Regaining alertness/consciousness after an acute ischemic stroke
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Regaining alertness/consciousness after an acute ischemic stroke

My 75 year-old mother had an acute ischemic stroke a week ago today.  She had a frontal parietal infarct that damaged a third of her left hemisphere.  She hasn't really regained any level of alertness, though has shown marked improvement every day.  Yesterday was the first time she was able to really open her eyes and look at things, though she closes them again after a few seconds.  She can hear and move all her extremeties, though the movement is much more limited on her right side.

I'd like to know if there's any way to predict when or whether she'll regain an alertness level.  She also still has brain swelling -- is that directly related, and how long does it take for brain swelling to subside?
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Hi
My mother 87 had a severe ischmic stroke also.  Brain swelling is a result. I do not know how long it takes to subside, but I would imagine it is like any other type of swelling.  The fact that she can move all her extremities, even though weak on the right side is great news!!  Stroke patients have to sleep a LOT after the stroke...she will become more alert as time goes on but right now she needs a lot of sleep.  I only know this from my experience and what I have been told.  The brain heals while she is sleeping, so don't try to keep her awake all the time. Hope this helps.
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Don't be afraid to sit next to her and hold her hand/wrist or put your arms around her while she is sleeping. This is very reassuring.
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Update 10 days after the stroke: My mom opens her eyes for very short periods and is focusing on people, but recognition isn't apparent.  She's also able to open and close her mouth, and seems to be regaining a little movement of her tongue.  She was also able to swallow during a speech therapy session.  So she's still slowly improving, and she seems to be responding to commands like "open your mouth" at times, but it's not obvious enough to be 100% definitive.

Thanks for the responses!  I've shown them to the rest of my family and they definitely provide some comfort!  We're still hoping and   praying for some quicker and obvious progress, especially on the cognition level, but we also know that she's still healing and it's still early (though it's the longest 10 days I can remember)...
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Take heart! My little 101 year old sweety-pie is now talking sentences, feeding herself, can walk a little with assistance and laughs continually every day. A very ineractive happy person with a high quality of life. After her strokes she was expressionless and lifting her hand would result in a limp hand falling down. No response or facial expression whatsoever. She could not talk or feed herself. It is heard to believe she is the same person. She has extremely happy days filled with lauighter and enjoys every meal. So the life-force works in magical ways and you should never give up hope.
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Hello
So I dont' repeat myself you might want to read some of the posts I wrote to Amber212.  My mother had a large stroke at the age of 87, also ischemic. She is right side paralyzed and cannot speak.  As for your question re the physicians...it seems to me that they keep the vital signs stable and that is about it.  The first task is to get your uncle eating which they will try to accomplish in the nursing home he will go to after the hospital..then don't expect much from the physicians..they leave almost all recovery up to the physical, occupational and speech therapists.  All the Dr's do is keep the patient alive and try to prevent another stroke.  Hope this helps. They will tell you "all strokes are different" and you cannot tell who will recover and who will not.
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I am so happy to have found this site. My Uncle Jerry who is 64 years young had an acute ischemic stroke on Christmas Eve. What a shock to the family and what a long two weeks this has been. He was driving from KC to Illinois when it occurred, but managed to get to his destination.

Jerry has been moved from an Illinois Hospital to its adjoining convalescent center. He was in the hospital a week and he has been in the convalescent center 10 days. I am visiting every Tuesday and Saturday.

I am trying to read and learn as much as I can to help my Aunt who is lost without him. (they have no children)Jerry has right side paralysis and cannot speak, but tries to grunt. His progress seems very slow, but showing some slow improvement with recognition and left side dexterity. They are now doing twice daily therapy and I just found out the speech therapist has been on vacation, but he should start speech therapy this week. Jerry cant swallow yet and they have him on a feeding tube!

What I am most shocked about is that they assigned him a doctor, but she has not even been to see him in ten days. He has had 3 C/T scans and I will have a copy of the latest one tommorrow. I have sent for his health care directive which fortunately list me along with my aunt and his sister.

My question to the forum is there any recommendations you can give me on what I should be asking of the staff and the physician. Is it common not to have followup from a physician after you leave the hospital?

Any advice to help me help my Uncle would be forever appreciated.
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My mom was discharged from the hospital and is now in a skilled nursing facility, where they're doing pretty aggressive therapy even though she's still not alert for very long periods.

I'm still confused about how long brain swelling can really persist, though.  One neurologist told me that it's mostly gone about 10 days after the stroke, and another said that it can take 4-6 weeks!  I'm hoping the latter, since it would help to explain the fact that my mom still doesn't/can't open her eyes for much longer than 10-15 seconds...Does anyone have any first-hand knowledge of this?
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Re keeping her eyes open more than 10-15 seconds.  I only know what I was told...that after a stroke, the brain needs a lot of healing, this healing takes place while the patient is asleep and they need lots of sleep and are very tired after a stroke..her sleeping is probably what her body is telling her to do.  My mother also slept 24/7 after her stroke.  We only got her up for food, bathroom, sitting up for a couple hours and back to bed.  She slept while sitting up also.
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Thank you for the information -- Can you recall how long it took before she really regained longer periods of alertness?  Our family is resigned to the whole recovery/rehab process being a really long one, but the rehab can't really even begin until my mom regains a much higher level of alertness for longer periods...
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My dad also had a stroke approx. 8 months ago.  In the beginning he was not able to do much therapy because he couldn't stay away.  We researched his chart and found that he was getting vicodin and ativan 2 - 3 times a day.  This had been going on for a few weeks before we found it.  Once we got him off of those two drugs, he became much more alert and was able to do the therapy.  The only problem was that the insurance denied him for more therapy because they said he had plateaued.  We had to fight for 2 months to get him back into therapy, which we finally did... He is now at home with my mom along with some aids helping him.  He still can't really walk, but he can transfer and get to the bathroom.  We are amazed he has made it this far, most of the therapists in the rehab center he was, never thought he would be able to do any of this.  He still goes to outpatient therapy twice a week.  It is a long hard process, but you will see improvements, just remember some times its two steps forward and one step back....Good luck and I wish you the best....
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To Mamino, I think it took about 3-4 mos. before my Mom could stay awake very long.  She still WANTS to sleep all the time, but we try to keep her active during the morning, ADL's etcand breakfast...then a nap...then afternoon out and about, dinner and...early to bed.  It is not only the stroke, but my mother does not have any initiative. I feel that is part of the stroke.

To Lahivna..it was good you got him off Ativan..they use that in nursing homes to calm people down..two of those and my Mom would be "face down in the soupbowl."  Ativan and Vicodin would really knock somebody out.  It is good you fought for PT with the insurance.  I had to do the same thing.  My Mom came down with pneumonia in the nursing home.  The Dr. was NEVER around.  We had to DEMAND a chest x-ray which showed she had pneumonia which was why she could NOT do the PT...we also fought and they put her back on PT for a while, but not very long.  It seems they are not willing to try with elderly stroke patients at all.  We had to hire our own at $90/hr.  She helped Mom start to walk a little, but it is hard to find a PTherapist that will work with a 90 year old stroke patient..it is really sad..it is like they consider it hopeless.  We did find one where we live now who is willing to work with her...just getting her to stand and sit and stand again is a lot..we need that so she can transfer.  Anyway I wanted you to know you were not the only one that had to fight the insurance to get PT...don't listen to the plateau ****...who sets the standards anyway??--the Physical Therapist..he/she can make those standards impossible or attainable.  Hope this helps.  Vicki
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One thing you should keep on top of are the "certificates of necessity" the physicians sign to enable you to obtain equipment from medicare/medicaid or the insurance companies. You often have a great number of options available they don't tell you about. As an example you can often select the mattress, but if you go into "default mode" you may get a plastic-coated very hard mattress. They push "electric beds", but they are very dangerous. The arms of the patient can be easily broken while caught in the rails, and the attendents do not always pay attention when they use them. You should do all the reading you can about strokes in order to make informed decisions.
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Mamino, my grandmother had a stroke and her symptoms are very similar to the ones that you spoke about.  I was wondering if you could update me on the current status of stroke recovery.  Again my grandmother's symptoms are almost identical (no alertness/consciousness, can move all limbs, etc...).  I'm hoping you get this.
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Acute cerebral edema (swelling) reaches its peak in about 72 hours and will generally subside within 2 weeks.
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my father had a stroke 13 days ago is some what alert he  sits up in a wheelchair twice a day but he has pulled his ng tube out so many times
that the dr cannot put it back in. He cannot swallow does any one have any experenice on how long it takes for this funtion to return.

t6643
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It took my husband about 4 weeks to be able to swallow, but he could only eat pureed food.  It took about 2 months for him to be able to eat real food and drink liquid without a thickener.
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please can someone help me, my poor 75 year old mother had a stroke 6 weeks ago, she had a bleed, she had a cat scan last week which showed the bleed is still there.She sleeps all day,totally paralysed down the left side and is not responding at all to therapy.She has never lost her speech,and was able to swallow.They put her on a soft diet and thickened fluids.But now after her getting de-hydrated she is being fed and all fluids through a tube in her nose.She is so desperatley ill,she is making no recovery.Has anyone eles been in the same position? we are going out of our minds.
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Tracey, I don't know what to say that will help you except to say that I will pray for your Mom, re hydration is vital if she is going to commence recovery. My Dad had a stroke on Jan 24th and although he's eating, drinking and walking about he still has limited recognition, cannot feed himself, speak or go to the bathroom on his own. Its tough but we're praying that his mental capacity will improve over time.

Keep the faith,
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Thankyou for your kind words xxxxxxxxxxxxxxx
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Dear Tracey--My 90-year-old mother had a small ischemic stroke three weeks ago.  Her main symptom was speech difficulty--so-called "word salad", where she just said random words when she tried to communicate.  She was taken to the ER, and they did a CT scan, but nothing showed up.  The ER personnel diagnosed "advanced Alzheimer's" (which she does not have), and that diagnosis has followed her for the last three weeks.  After several days in the hospital, and three CT scans, the stroke showed up, but the diagnosis persisted.  The speech therapist in the hospital ordered pureed food (even though my mother did not have swallowing problems, and had a hamburger in the ER).  If your mom is able to speak and swallow, perhaps her diet can be improved, which may lift her motivation.  Check her medications, to be sure that she is not receiving unnecessary painkillers or sleep meds.  It was my experience that you have to be very proactive for your mom.  I became somewhat of a pest in the hospital and nursing home, but now my mom is back in her apartment and receiving home care and therapies.
   A stroke caused by a bleed can be very serious, but people do recover.  Ask for a meeting with the neurosurgeon to get a better idea of the prognosis.  You will be in my thoughts and prayers.  It is a very hard time.  Strength, Pat
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Hi, my grandmother (82 year old) had an ischemic stroke on 3 May. The Dr said it was a massive stroke which affected her left hemisphere. She has just recently started opening her eyes but i dont think she sees us. Its almost been three weeks and there havent been many signs of improvement. She does however sqeeze our hands from time to time. Whenever the family is at the nursing home (they recently discharged her from hospital) we always try to chat with her and keep her awake, but after reading this thread I have realised that it is vital for her to get sleep.

I know that it varies from person to person but my questions are:
* What is the average time it takes for the brain swelling to subside?
* Do stroke victims always become more alert with time or is it possible for them to stay like this forever?

Thank you very much guys.
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Hi kg3,

I've kept a log of my Dad's stroke ( jan 24th 2008). You can track the improvements on the link below

http://www.medhelp.org/posts/show/429418
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Hi,
The swelling will begin to subside in 48-72 hours and will subside in a couple of weeks to a month.
How-ever after a stroke, control signals from the brain often cannot reach some muscles, typically in the hand or foot. Without these signals, the level of electrical activity in these muscles is too low for them to contract adequately on their own. This causes them to become increasingly weaker.
Most gains in a person's ability to function in the first 30 days after a stroke are due to spontaneous recovery.
For a stroke survivor, the rehabilitation goal is to be as independent and productive as possible. That may mean improving physical abilities. Often old skills have been lost and new ones are needed. It's also important to maintain and improve a person's physical condition when possible.
A person's family has a key role in rehabilitation. A caring and able spouse or partner can be one of the most important positive factors in rehabilitation.
ref:http://www.americanheart.org/presenter.jhtml?identifier=4713



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hi my mother had a heamorrhagic stroke about 7 weeks ago on the right side which paralized her left side, after two weeks in the hospital she came home four days later she had two isochemik strokes on the left side this left her unable to speak incontinent both bladder and bowels she has been sleeping for four weeks now opening her eyes briefly for a few seconds she eats with her eyes closed and does physio with her eyes closed what chance has she got for recovery
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My Dad had a massive bleed stroke about five days ago.  He had been on Kumadin and was getting over pneumonia and I think, with all that coughing he caused some bleeding in his brain and cuz of the Kumadin it got out of hand for the last few days he has been having short verbal responses, but with excellent Syntax.  Yesterday he was not that responsive but when I got on the phone with him(He is in Florida, I am an actor doing a play in San Francisco and am going there this Sat night for three days) anyway, yesterday I sang and told him I'm in SF on  a pier looking at the water and he said, "San Francisco?  That's exciting."  and then I spoke for a while and when I stopped for a bit he said, "that's all you have to say?"  But today he is sleeping and they can't seem to wake him up but his vitals are good,  Reading these posts has been comforting when it comes to how much sleep people who have had a stroke, often need and/or have.  Love and prayers to all of you
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My dad is 77, he had a brain stem stroke 9 days ago, he started to feed himself but only puree food and thickened liquids here at the convalescent home in rehab. his speech is slurred and his whole left side is weak and his vision is blurred he also complains of dizziness. We notice throughout the day we can understand him with slur, then there are times we just don't understand him. After his therapy he seems tired and will sleep. Why are there times we don't understand him and why is he tired and slurring more after therapy? Also he randomnly will talk about weird things why? almost dellusional but briefly. his third night in the hospital he went delusional and tried to get up and leave, he was trying to grab things that weren't there. We don't know why that happened either, Dr. didnt really give a reason why it happened. Anyone know? This is a Great site and helpful my prayers to all of you.
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Hi yvette19, My moter also had a brain stem stroke, but it took her a lot longer to eat pureed food, but she still has to get some of her food through a tube feed. She is still paralized on her left side with very little movment with her left leg. It's been seven month now, and she will be coming home this Tuesday. We are going to continue with her therapy. I hear that ACUPUNCTURE does mericales on stroke patience. But, the SOONER the better. We are going to get that done as soon as she gets home. My mother went through all those things you spoke of, It's ok, that's what they go through but make sure she is not on any medication that is not necessary. We had to call my mother' s nerosergon, while at the nursing home, and told him my mom has been acting funny and trying to get out of the bed. He said for us to ask the doctor to order an eeg to get done, to see if her seizuer activities have stopped. So, we did and sure enough they had stopped. We noticed a significante difference in my mother's behavior once they winged her off those TWO seizure medication. She didn't know who we were all the time but now she does. You have to be very very very patient with her, because it can be a long road ahead. Everyone recovers in their own time (God's time). You are going to go through so many emotions. We did. I'm not going to lie, It's been hard, but you have to keep strong and stay possitive around her. My mother laughs and makes jokes now. BOY do I love her. I hope that helped you a little?

loveletter
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My mom, 70, had a stroke 3 days ago. She is right-sided paralyzed and cannot say more than two words and that is difficult. Last night the neurologist said he was going to order another MRI for today as she is showing more of a decline than improvement.

We need a reality check. She lives alone, and we want to know the chances of her ever being able to do that again. My brother and I each live over 100 miles away from her. We do not mind paying her mortgage and bills but it will be a hardship. We will do so if there is a chance she will be independant again. We aren't getting straight answers from the doctor. "Maybe, maybe not" is all he can say as far as her getting better.

She is still in the hospital, her average blood pressures have been 224/112; she originally could move her right arm and leg, now she can't. They will be putting her in a facility by the end of the week.

Are we talking a few weeks of therapy, or pretty long-term? We don't know what to do with her house and dog. TIA for any help/advice/suggestions.  Lynda
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My mother had a stroke last August and the main problem I have is getting her to sleep.  There are days she goes without sleep.  We have been prescribed sleeping aids but the doctor says the sense in her brain to pick the medication up is damaged.  I am at my wits end because the less sleep she gets the more confused she is which takes a great toll on me seeing she lives with me.  When she's well rested she's a totally different person.  Any suggestions??
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My uncle who is 59 had a triple heart bypass this monday 20th Sept, during the procedure he suffered a stroke. They took him off sedation Tues 21st; it is now Fri 24th and he hasn't woken yet and has no movement. Does anyone know how long it can take until a stroke victim can regain consousness? as for the bypass it went well.
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My father 63yrs old suffered a massive stroke during by pass surgery (2 grafts). After the surgery it took him 3 days to open his eyes. He does not respond to anything only opens his eyes occasionally and moves his left arm over his belly. They did a tracheostomy to help him breathe and is being fed through a rice tube through his nose. His heart, lungs, kidneys etc are doing fine. The CT scan shows his left hemisphere has multiple massive infarcts (no bleeding or hemorrhage) and his right hemisphere has a few infarcts. It's been 10 days and we see no improvement other than him yawning or moving his eye balls. Can someone tell us if they had a similar experience and how long it took to recover or if there is any hope for my father. What medications are administered for infarcts? We are living a nightmare any help would be much appreciated.
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Hi mamino, My father seems to have the exact same symptoms as your mom after his stroke on 27th Oct. How is your mom doing now? Please let me know, We simply don't know what to expect it's been 10 days.
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My dearest father,72, had a brain stem stroke a month ago, he was on ventilator for 3 weeks he can now breath on his own but he is still on feeding tube and can only open his eyes for a few seconds during the day also move his left hand and leg. Could any one help by telling me if my poor father in locked in syndrome? and how long it takes before my father regains alertness? Does he see or know us when he opens his eyes? I'm devastated, no therapy yet as he is not alert, I'm lost. God help us.
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hey, my dad is 55. he had a brain stem (i think) stroke on 7 december 2010. after the op the doc said he wasnt gonna make it at all. but miraculously he woke up within a week or so and even regained consciousness and could even hold our hands. he was then moved to the normal ward from icu. however, he contracted pneumonia, and at the normal ward it got worse. after staying there for bout a week or so the pneumonia was getting really bad, until there was once he couldnt breathe at all, and he burst the vessel in the same spot again, this time it was 10% bigger. that happened in january. so many things happened from jan-mid feb, like occasional fever etc, but now his physical condition seems to be under control. though he's opening his eyes more frequently now, but he doesnt seem to have regained his consciousness. his conscious level is 5-6 out of 15. though whenever i hover my hands over his eyes, he seems to be attempting to blink, but he seems to not be able to blink whenever i ask him to. he seems to have lost control of his body already.

im just wondering if anyone has a comment on this?:(
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Hi,
can you please updade me with what happened with your father after almost a year now? coz my mother just had the same problem and I would like to now what will happen latter.

Thanks for any help you can do.
Spongbobah
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So is it normal seven days after a stroke to really not wake up? It makes me so nervous. Putting in a feeding tube today instead of the temporary one she has in her nose. Does anyone know about these feeding tubes?
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So is it normal seven days after a stroke to really not wake up? It makes me so nervous. Putting in a feeding tube today instead of the temporary one she has in her nose. Does anyone know about these feeding tubes?
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All of these comments regarding the need to sleep post a stroke and how the brian needs to heal are very reassuring. My 98 year old Mom had a left sided stroke and post hospital discharge, has been asleep 24/7 for a week. Thank heavens we had a feeding tube put in at the hospital while she still was alert somewhet.
I know we have to be patient and keep by her side to help her heal and for the people at the nursing home not to give up on her.
rm
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How is your mom doing now. My mom had an ishemic left-sided stroke on Nov 20th, 2012. Two weeks after  she is still very sleepy. She has a feeding tube. Is it possible to request a G-tube or should we hope for her to recover her ability to swallow?
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My uncle, who is 52 years old had an ischemic stroke in the right side of his brain (resulting in left side body paralysis) on the 12th where he was rushed to the hospital and had anti-clotting drugs administered. They did not work, and he was monitored for any additional progressive strokes. On the 13th the doctors said that he MUST have surgery to remove the clot or else his life would be in grave danger.

His surgery went well, the doctors placed him in the ICU where he was given a feeding tube. The doctors said that the stroke was caused by his diabetes which was extremely high and still has been despite the drugs given. On the 2nd day after his surgery, the doctors inserted a throat tube because they were having trouble removing the phlegm which apparently is because of the left side body paralysis he is experiencing.

It is now the 4th day since his surgery, all of his family and friends are very worried and we have been taking turns waiting at the hospital 24/7. I visited him yesterday and spoke to him and squeezed his left hand, I was overjoyed when he squeezed back and his left eyeball showed some movement but he was not alert. I was overjoyed because I thought that he was showing some improvement but when my aunt went in he showed no response or movement. I am hoping and praying that this is because he fell back asleep, the yoyo progress is causing a lot of stress and anxiety amongst all our family and friends particularly my grandmother who bursts into tears the moment she thinks of this whole crazy situation. She is still in severe shock at the suddenness of everything.

If anyone feels their situation was/has been in the past similar, please share your thoughts. Is 4 days a long time to be unconscious after surgery? We are all worried sick. Thank you in advance!
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My mom is 66 years old and had a stoke 38 days, she was in the hospital for 8 days and then into rehab... she has days where she is up, alert, and moving around in a wheel chair and then it is like she just goes to into this simi sleep mode and will not do anything...is this normal and will it ever get better because I want to beable to bring her home but I also want to do what is best for her...the rehab therpy said that they can not do anything else with her and they are closing her case..but I think that she has more in her.
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My Grandmother had went in for back surgery the middle of this month. She has since suffered a stroke. For the past week and half she has not been responsive. Her vitals are good and they have put a feeding tube in. My aunt and uncles have a meeting this week to determine what they should do. She is 83 years old. I don't know what to do. Will she eventually
wake up. I keep hearing from the nurses that her prognosis is not good. I am hoping that someone in this thread can help. They have also told us that she has 4 clots in her brain. They are putting her on Coumadin December 1st to take care of them.
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Mamino - I'll have to follow your responses  here.  My Mother in Law has been basically out like a light for almost 6 weeks.  She has opened her eyes and looked around a couple of times - once staying awake for about an hour and once smirking at her daughter and saying "Good Morning" in her now slurring voice.  I keep praying for a complete healing - as only God can do - and have been hoping that the sleep is part of the process of recovery.  Thank you for your query - It takes a little of the concern away.
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