Suggest Treatment For Scar In Brain Stem Due To Brain Stem Bleeding

Posted on Mon, 28 Apr 2014

Medically reviewed by Ask A Doctor - 24x7 Medical Review Team

Mon, 28 Apr 2014 Answered on

Mon, 19 May 2014 Last reviewed on

Question : Hello, I have just returned from Scotland where my brother (49) had been out running (very fit) in April last year and had a massive bleed to the brain stem and finished up in a coma for 7 weeks...... I visited him in September (I live in Australia) and he did show some signs of response with a thumbs up or a wink of the eyes, occasional mouthing of words and I was there earlier this month and feel that the responses are not as good as 6 months or so ago. I was told that there is some scar tissue on the brain stem and he has deteriorated somewhat re does not swallow no more and has been on nil by mouth since December. It is hard to see my younger brother like this and would not wish this on anyone. All I am looking for is some better understanding of what is happening and what it could all lead to and possible line expectancy as deep down he would not wish this - a cruel world sometimes. I thank you kindly......

Answered by Dr. Praveen K Nath (1 hour later)

Brief Answer:
LARGE BRAINSTEM BLEED / needs supportive care

Detailed Answer:
Dear Mr XXXXXXX

I have gone through your brother's medical history in detail. He suffered a large brain stem bleed & now has developed scar in brain stem. In my opinion, you should continue with supportive care like

1. Feeding through feeding tube , as these brainstem lesions cause swallowing reflexes to diminish

2. Watch for regular breathing with OXYGEN/room air therapy , as brain stem bleed causes impairment in breathing signals from brain.

3. Care for pressure points is needed to avoid bed sores etc

4. Foley's catheter/condom catheter is needed for urine output .

These patients need regular care as they are not able to do their routine. We call them as vegetative patients.

PROGNOSIS in large brainstem bleed's is not good. Most of them don't survive to reach hospital & few of them who survive, become vegetative. Only 2-3% of them who get very good supportive nursing care, later start showing minimal recovery .

Wishing a speedy recovery to your brother

Hope this answers your query. Feel free to ask any further question

Thanx
Dr XXXXXXX k XXXXXXX
Director
Deptt. of neurosurgery

Above answer was peer-reviewed by : Dr. Prasad

Follow up: Dr. Praveen K Nath (12 hours later)

Thanks for the prompt reply.

My brother is in special care and is being fed with a PEG as it is felt that the act of swallowing has been diminished (non existing) and small pads are used behind the ear to curtail saliva. A Catheter is used constantly and he even pulled it out one day that must have been excruciating indeed - has some movement of his arms.
One burning question that I have is what is the life expectancy of cases like this to give me some idea as I am trying to pull together a management plan for the next few years with his house for an example and this would give me some idea as too how long my brother could suffer like this and make the management plan worthwhile. Many thanks......

Answered by Dr. Praveen K Nath (10 hours later)

Brief Answer:
LARGE BRAIN STEM BLEED needs good home care

Detailed Answer:
Dear Mr XXXXXXX
Hello
As per your version , your brother is getting good care ,continue all the care as advised .
For patients who are still vegetative even after so many months of bleed , prognosis is not good ,
As the time passes & he is showing no further neurological recovery , chances of getting neurological recovery are getting remote . i.e he is less likely to improve .
BUT we still can not comment on life expectancy ,as it depends on quality of care , infections , nutrition etc.
For these vegetative patients best care is home care . arrange things at home & keep a nurse to continue care .
My best wishes for recovery

Thanx
Hope this answers your querry

Dr XXXXXXX k XXXXXXX

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar