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What Does The Following EEG Result Indicate?
Question: 57 yrs obese male patient k/c/o type 2 DM , HTN, hypothyroid, LBBB hospitalized at Shalby hospital, XXXXXXX , XXXXXXX on 9/10/2016 with endotracheal tube in situ and invasive ventilation started in previous Hospital following cardiac arrest on 8/10/2016. Patient managed with IV antibiotics( Meropenem, tecoplanin, Clarithromycin) IV antifungal( fluconszole), vasopressor support ( NORAD) , IV sedation with fentanyl, IV insulin. Supportive treatment and ventilatory support. Patient had bradycardia following cardiac arrest on 11/10/2016 at 5AM which was revived with CPR and IV adrenaline. 2D ECHO revealed severe LV dysfunction, EF-25℅, restricted LV filling pattern, global hypokinesia, moderate to severe MR, dilated LA. No PAH,mild TR. CAG revealed normal coronary arteries, TPI placement and IABP insertion done. HRCT chest done. Reports attached. Presently on ventilator support, IABP, IV NORAD and dopamine infusion with adrenaline support
He suffered a cardiac arrest again while on ventilator 4 days back. Which injured the upper part of his brain which is responsible for consciousness. His lower part if the brain is working fine and all other parts of his body including heart lung and kidney are showing remarkable improvement. Even ventilator support is minimised a lot. His sedation was removed 48 hours back and he is unconscious now.
This EEG recording showed very low voltage diffuse slow waves over both hemispheric leads with superimposed motion/electrical artefacts
No paroxysmal events or epileptiform discharges noticed
Impression
This EEG record abnormal, representing severe encephalopathy of any cause. Clinical correlation advised
Diagnosis - Hypoxic ischaemic encephalopathy
Injection piracetam being given.
Pressors are omitted from Wednesday
Spontaneous breathing trials are on but still not completely established
Global involvement diagnosed.
Please help with inputs on what more can be done to help my uncle recover with above report.
He suffered a cardiac arrest again while on ventilator 4 days back. Which injured the upper part of his brain which is responsible for consciousness. His lower part if the brain is working fine and all other parts of his body including heart lung and kidney are showing remarkable improvement. Even ventilator support is minimised a lot. His sedation was removed 48 hours back and he is unconscious now.
This EEG recording showed very low voltage diffuse slow waves over both hemispheric leads with superimposed motion/electrical artefacts
No paroxysmal events or epileptiform discharges noticed
Impression
This EEG record abnormal, representing severe encephalopathy of any cause. Clinical correlation advised
Diagnosis - Hypoxic ischaemic encephalopathy
Injection piracetam being given.
Pressors are omitted from Wednesday
Spontaneous breathing trials are on but still not completely established
Global involvement diagnosed.
Please help with inputs on what more can be done to help my uncle recover with above report.
Brief Answer:
Good neurological recovery is less likely.
Detailed Answer:
Hi Ms XXXXXXX
Thank you for posting your query.
I am Dr Sudhir Kumar, Neurologist, and would try my best to help you.
I have noted your uncle's clinical details.
It is unfortunate that your uncle suffered cardiac arrest two times, resulting in reduced blood flow and oxygen supply to the brain, which has resulted in severe brain damage. This damage seems to be severe, and good recovery seems less likely.
Treatment is going along correct lines and same should be continued. Good physiotherapy should be given. BP and oxygen supply should be maintained.
Despite these treatments, there is a high chance that he would remain in unconscious state and may require help for all activities of daily living.
Also, his heart is weak and he may suffer cardiac arrest in future, which may pose risk to his life.
I hope my answer helps. Please get back if you have any follow up queries or if you require any additional information.
Wishing you good health,
Dr Sudhir Kumar MD (Internal Medicine), DM (Neurology) XXXXXXX Consultant Neurologist
Apollo Hospitals, XXXXXXX XXXXXXX
Click on this link to ask me a DIRECT QUERY: http://bit.ly/Dr-Sudhir-kumar
My BLOG: http://bestneurodoctor.blogspot.in
Good neurological recovery is less likely.
Detailed Answer:
Hi Ms XXXXXXX
Thank you for posting your query.
I am Dr Sudhir Kumar, Neurologist, and would try my best to help you.
I have noted your uncle's clinical details.
It is unfortunate that your uncle suffered cardiac arrest two times, resulting in reduced blood flow and oxygen supply to the brain, which has resulted in severe brain damage. This damage seems to be severe, and good recovery seems less likely.
Treatment is going along correct lines and same should be continued. Good physiotherapy should be given. BP and oxygen supply should be maintained.
Despite these treatments, there is a high chance that he would remain in unconscious state and may require help for all activities of daily living.
Also, his heart is weak and he may suffer cardiac arrest in future, which may pose risk to his life.
I hope my answer helps. Please get back if you have any follow up queries or if you require any additional information.
Wishing you good health,
Dr Sudhir Kumar MD (Internal Medicine), DM (Neurology) XXXXXXX Consultant Neurologist
Apollo Hospitals, XXXXXXX XXXXXXX
Click on this link to ask me a DIRECT QUERY: http://bit.ly/Dr-Sudhir-kumar
My BLOG: http://bestneurodoctor.blogspot.in
Above answer was peer-reviewed by :
Dr. Prasad
hi doctor. attached is the MRI report. please tell us if he has chances of survival. does upper brain not functioning mean brain dead?
Brief Answer:
Chances of survival are poor.
Detailed Answer:
Thank you for getting back.
The patient is not brain dead. For brain death, both upper (cerebral cortex) and lower (brainstem) should be non-functional.
I have noted the MRI brain findings, and it shows extensive damage due to lack of oxygen and blood supply to brain.
In view of severe heart weakness and extensive brain damage, the chances of survival are poor.
Best wishes,
Dr Sudhir Kumar MD DM
Chances of survival are poor.
Detailed Answer:
Thank you for getting back.
The patient is not brain dead. For brain death, both upper (cerebral cortex) and lower (brainstem) should be non-functional.
I have noted the MRI brain findings, and it shows extensive damage due to lack of oxygen and blood supply to brain.
In view of severe heart weakness and extensive brain damage, the chances of survival are poor.
Best wishes,
Dr Sudhir Kumar MD DM
Above answer was peer-reviewed by :
Dr. Nagamani Ng
hi doctor... seemingly my uncle has started developing kidney trouble as his hands are swelling up. rest of the condition remains same. pulmonary edema and upper brain not functioning. please suggest if it's a good idea to shift him to a metro city big hospital. will that help? and is air ambulance equipped with all facilities for shift?
Brief Answer:
Decision is based on clinical condition as well as financial situation.
Detailed Answer:
Thank you for getting back.
I have noted the additional details. The decision of shifting him to a better hospital would depend on two factors- the actual clinical condition of the patient and the chances of good recovery; and the financial condition.
Treatment is likely to be very expensive, and the actual chances of good recovery seems poor.
So, based on the above, decision to shift or not to shift may be taken.
Best wishes,
Dr Sudhir Kumar MD DM (Neurology)
Decision is based on clinical condition as well as financial situation.
Detailed Answer:
Thank you for getting back.
I have noted the additional details. The decision of shifting him to a better hospital would depend on two factors- the actual clinical condition of the patient and the chances of good recovery; and the financial condition.
Treatment is likely to be very expensive, and the actual chances of good recovery seems poor.
So, based on the above, decision to shift or not to shift may be taken.
Best wishes,
Dr Sudhir Kumar MD DM (Neurology)
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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