Sunday, May 28 - 4pm
It has now been 48 hours since Dad's accident.
The Ventricular Catheter installed last night has done a good job of keeping his ICP down. However, his Neurosurgeon explained to us that his condition is still "grave". He has seen patients pull through from this state in the past, but the odds are against him.
The CAT scan this morning revealed significant damage to the frontal lobe, bilaterally. This is the area of the brain that enables Dad to think, feel, react, etc. There are also signs of damage to the back of the brain. While the resolution on the CAT scan isn't good enough to see it, the Neurologist thinks there is a strong chance that Dad has Diffuse Axonal Injury. It is an injury caused by accelleration/decelleration of the brain (the brain sloshing back and forth inside the skull). This injury causes a shearing of the axonal connections of the brain.
The Diabetes Insipidus also continues to be a problem. His body is excreting too much water, and not excreting enough sodium. So, Dad's sodium levels are too high. This is caused by the pressure being exerted on the pituitary gland, which is responsible for releasing antidiuretic hormone (ADH), also called vasopressin.
Another complication now is that Dad's clotting mechanisms are not functioning properly. The medical staff has not yet identified whether this is due to the large amount of clotting capability that was consumed by the many soft tissue injuries, or for some other reason. If it is simly that the clotting capability was consumed, then a couple more units of blood should help. If not, then any surgery would be out of the question due to risk of bleeding.
I mention surgery because - if Dad's ICP were to begin climbing uncontrollably again - the only remaining option would be surgical removal of the right and left, frontal, portions of his skull. Removing these bones would allow more room for the brain to swell without further damaging itself. However, there is little evidence to date that this very invasive procedure reduces mortality or morbidity. Furthermore, if Dad were to survive such a surgery, he would likely be left with very severe cognitive deficits (much like someone who has survived a severe stroke).
The next 24 hours will be critical. If the swelling plateaus, if his ICP is stable and low (below 20 is good/normal is about 5), if the Cranial Profusion Pressure (CPP) [the net of his ICP and blood pressure - meaning how well his body is getting blood to the brain] stays good (60 minimum, 70+ is better), and if the complications don't get worse, then Dad could still recover. The extent of permanent brain damage will not be known for several days yet.
Nonetheless, we are hopeful. I bought a monthly parking pass for the garage at the hospital.
The Ventricular Catheter installed last night has done a good job of keeping his ICP down. However, his Neurosurgeon explained to us that his condition is still "grave". He has seen patients pull through from this state in the past, but the odds are against him.
The CAT scan this morning revealed significant damage to the frontal lobe, bilaterally. This is the area of the brain that enables Dad to think, feel, react, etc. There are also signs of damage to the back of the brain. While the resolution on the CAT scan isn't good enough to see it, the Neurologist thinks there is a strong chance that Dad has Diffuse Axonal Injury. It is an injury caused by accelleration/decelleration of the brain (the brain sloshing back and forth inside the skull). This injury causes a shearing of the axonal connections of the brain.
The Diabetes Insipidus also continues to be a problem. His body is excreting too much water, and not excreting enough sodium. So, Dad's sodium levels are too high. This is caused by the pressure being exerted on the pituitary gland, which is responsible for releasing antidiuretic hormone (ADH), also called vasopressin.
Another complication now is that Dad's clotting mechanisms are not functioning properly. The medical staff has not yet identified whether this is due to the large amount of clotting capability that was consumed by the many soft tissue injuries, or for some other reason. If it is simly that the clotting capability was consumed, then a couple more units of blood should help. If not, then any surgery would be out of the question due to risk of bleeding.
I mention surgery because - if Dad's ICP were to begin climbing uncontrollably again - the only remaining option would be surgical removal of the right and left, frontal, portions of his skull. Removing these bones would allow more room for the brain to swell without further damaging itself. However, there is little evidence to date that this very invasive procedure reduces mortality or morbidity. Furthermore, if Dad were to survive such a surgery, he would likely be left with very severe cognitive deficits (much like someone who has survived a severe stroke).
The next 24 hours will be critical. If the swelling plateaus, if his ICP is stable and low (below 20 is good/normal is about 5), if the Cranial Profusion Pressure (CPP) [the net of his ICP and blood pressure - meaning how well his body is getting blood to the brain] stays good (60 minimum, 70+ is better), and if the complications don't get worse, then Dad could still recover. The extent of permanent brain damage will not be known for several days yet.
Nonetheless, we are hopeful. I bought a monthly parking pass for the garage at the hospital.
posted by Nadav Kaufman at 5/28/2006 04:00:00 PM
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