brainsteam stroke

[mces]

My dad in Indonesia, 63 years old, is currently in hospital due to stroke (brainsteam?) since a month ago.  Based on what I heard, I am in usa, he is currently physically getting better. He can write and move his hand/foot. However, he still can not breath by himself and rely on the ventilator although the doctor did tracheotomy. Everytime, the ventilator is taken out and replace with the oxygen, he start having difficulty to breath. The doctor has been trying to take out the ventilator a week ago but he still fails to breath by himself. Yesterday, he is able to stay about 3 hours only without ventilator. My question are:
- will he be able to recover back and breath by himself ?
- is there any treatment that usually used to help him?

Thanks

[abbybabby]

A related discussion, when will he wake up was started.

[naira1970]

A related discussion, low thrombocyte was started.

[Dr Rajgopal]

Hi,
I have mentioned the causes of low thrombocyte levels above. One of the above mentioned causes may be resulting in the low levels. The cause needs to be investigated. If you do not find a specialist doctor, please search in the nearest big city. You must consult a hematologist if possible.  Take care and regards!

[mces]

Dear Sir,
My father condition is not improving. he is able to breath without ventilator but the thrombozyte keep dropping and the doctors(a few doctors try to help) still do not know what happened and another problem is my father is in a small town and not many specialist doctors are there. one of the doctors suspect because of lung infection. is that true?  However they are not sure also. he got transfusion a few times to keep his thrombozyte level. Is there any suggestion that you can give?

thanks,

ed

[Dr Rajgopal]

Hi,
It is a good sign that your father’s condition is improving.
The most common cause of low Thrombocyte levels is Heparin treatment. Low Thrombocyte levels may also result from low synthesis, high breakdown or pooling. If Thrombocyte gets decreased < 30/nl bleeding symptoms may be noticed.
The causes of low synthesis are- Low Thrombocytopoesis in Bone marrow, Congenital defect in Megakaryocytopoesis, Low thrombopoietin, Bone Marrow damage(through Leukemia, metastasized tumors, medicament, chemotherapeutics or radiation therapy), Low conversion of megakaryocytic cells in to Thrombocyte due to  Vitamin B deficiency (causes Megaloblastic Anemia and Thrombocytopenia).
High Breakdown is caused by -  Immunological reaction (eg. Dengue fever), ITP immune thrombocytopenic Purpura, also called auto immune thrombocytopenic puerpura (ATP).

Consumptive coagulopathy (disseminated intravascular coagulation, DIC)- intra-vascular clotting activation like in sepsis leading to too much use of Thrombocytes leads to low Thrombocyte count. Please wait for the investigation results to know the cause of low Thrombocyte levels.
Take care and regards!

[mces]

Hi Doctor,
thank you very much with your reply. Currently my father condition slightly improves. The nurse even trained him to eat and drink small amount of water.
Today they tried to remove his ventilator, but his condition drops due to thrombocyte level is drop and he felt cold (cold sweating). so they put the ventilator back.
The thrombocyte level issue was happened a many times before and the doctor thought it was due to dengue. However, he, now, thought it might be another problem and he will call blood specialist doctor.
My question is:
- in your opinion, is the thrombocyte level a part of stroke problem or is it caused by removing the ventilator/low level oxygen or is it different disease that he might have?

Thanks,

ed

[Dr Rajgopal]

Hi,
I am really sorry to hear about your father’s condition. Recovery from a stroke is normally a very long process. The greatest amount of recovery occurs in the first 2-6 months in most of the patients, but slow improvement may occur for several years. The recovery time is different for each person and takes longer with more severe strokes. Respiratory dysfunction associated with strokes may result from discrete or diffuse lesions to key components of the respiration controller. The clinical presentation of respiratory disorders in stroke include abnormal breathing patterns, hypoxemic and hypercapnic respiratory failure, aspiration pneumonia due to an inability to clear the airway by coughing, and acute pulmonary embolism due to prolonged inmobilization. There is a variety of altered respiratory patterns associated with strokes. It is very difficult to say when your father will be able to breathe by himself. Ventilator support is a must. Treatment is primarily supportive using a mechanical respirator and supplemental oxygen.
His symptoms may improve slowly. Please do not be tensed about it.  You must consult a pulmonologist for management plan of the symptoms. I wish your father a speedy recovery. Hope this answer helps you. Take care and regards!