Hypoxic brain injury

[Tomtom34]

Hi there. I'm writing this post in a cry out for people with any similar experience. My mom had hypoxic brain injury following a cardiac arrest after massive clots in her lungs. She was revived but unfortunately according to an MRI scan, she had some hypoxic injury in the deeper parts (basal ganglia) of her brain. This happened two and a half months ago. She was in a medically induced coma for almost two weeks after which she woke up butbis still minimally conscious and occasionally communicates by eye blinking when we ask her to show us she understands us. A neurologist came around last week, saying that this is probably as good as she will get. She was improving gradually from a state of no communication at all for a few weeks but then started becoming more consistent with her responses. Now she is showing some arm contractures probably secondary to the neurological damage. I was wondering if anyone has experienced anything similar and mostly wondering about the timescales for waking up/ regaining higher level of consciousness. Some say that not regaining it by 3 months after injury means the chances for recovery are very low. I really need some encouragement and to hear thoughts or experiences of people who went/are going through a similar situation. Thank you!

[cat3]

Tomtom, I've copied this article from the 'Brain Foundation' site. It's lengthy, but explains how progress after a minimally conscious state isn't necessarily limited to 3 months.

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Minimally Conscious State

Description.

The minimally conscious state is a defined as severely altered consciousness in which minimal but definite, sustained and/or reproducible behavioral evidence of awareness of self or environment is demonstrated.

The person may have periods where they can communicate or respond to commands, such as moving a finger when asked.

A person may enter a minimally conscious state after being in a coma or vegetative state. In some cases a minimally conscious state is a stage on the route to recovery, but in others it's permanent.

A continuing minimally conscious state means it has lasted longer than four weeks.

However, it's more difficult to diagnose a permanent minimally conscious state because it depends on things such as:

the type of brain injury

how severe the injury is

how responsive the person is

In most cases, a minimally conscious state isn't usually considered to be permanent until it's lasted several years.

To make the diagnosis of MCS, limited but clearly discernible evidence of self or of environmental awareness must be demonstrated on a reproducible or sustained basis by one or more of the following behaviors:

1.Follow simple commands (eg touch your nose, look up).

2.Gestural or verbal yes/no responses (regardless of accuracy).

3.Intelligible verbalization.

4.Purposeful behavior that is not due to reflexive activity. Eg appropriate smiling or crying in response to emotional but not to neutral topics or stimuli – reaching for objects demonstrating a clear relationship between object location and direction of reach – touching or holding objects appropriately in relation to the size and shape of the object – pursuit eye movement or sustained fixation that occurs in direct response to moving or salient stimuli.

Treatment can't ensure recovery from a state of impaired consciousness, however supportive treatment is used to give the best chance of natural improvement. This can involve:

providing nutrition through a feeding tube

making sure the person is moved regularly so they don't develop pressure ulcers

gently exercising their joints to prevent them becoming tight

keeping their skin clean

managing their bowel and bladder – for example, using a catheter to drain the bladder

keeping their teeth and mouth clean

efforts should be made to establish functional communication and environmental interaction when possible.

Offering opportunities for periods of meaningful activity – such as listening to music or watching television, being shown pictures or hearing family members talking

Sensory stimulation;

visual – showing photos of friends and family, or a favourite film

hearing – talking or playing a favourite song

smell – putting flowers in the room or spraying a favourite perfume

touch – holding their hand or stroking their skin with different fabrics

In all circumstances, the patient should be treated with dignity, and caregivers should be cognisant of the patient’s potential for understanding and perception of pain.

In early MCS, prevention of complications and maintenance of bodily integrity should be emphasised because of the likelihood of further improvement. While not empirically validated, families have reported benefits from arousal regimes, such as those implemented by Dr Ted Freeman (eg Coma Arousal Therapy). The therapy involves family members taking the coma patient through a regimen of controlled auditory, visual and physical stimulation for up to six hours a day every day.

A person with experience in neurologic assessment of patients with impaired consciousness should be primarily responsible for establishing the diagnosis and prognosis and for coordinating clinical management. An additional opinion of a physician or other professional with particular expertise in the evaluation, diagnosis, and prognosis of patients in MCS is recommended when the assessment will impact critical management decisions.

Prognosis (outlook for recovery)

To date, the natural history and long-term outcome of MCS has not been adequately investigated. MCS may occur in a variety of neurologic conditions, such as traumatic brain injury, stroke, progressive degenerative disorders, tumours, neurometabolic diseases, and congenital or developmental disorders. Following an acute injury, MCS can be a transitional or permanent state.

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Hope this helps.

You might also like to contact the Headway helpline on Monday for additional advice and printed information on hypoxic injury and the possible after-effects. The number is 0808 800 2244 and the calls are free. Best wishes, Cat x

[Tomtom34 in reply to cat3]

Thank you Cat, I appreciate it. That is very encouraging!

[janb777]

Hi Tom, So sorry to hear about your Mum. It is only a very short time since everything happened and there is no time limit on this. The brain is very complicated and in my opinion nobody knows enough about it to assume what the outcome outcome will be.

My Son, Ade had a cardiac arrest 6 years ago, this resulted in brain injury, I was told he would be in a vegetative state. However, through perseverance help and patience, it is still work in progress. He is learning to walk but he is a wizz on his electric wheel chair. He cannot talk or swallow food, but he is so clever. He uses a light writer to talk to us, is fed through his tummy, (but he finds it quite easy to swallow a bottle of beer, very strange) and he has just joined a wheelchair football team.

Tom, what I am trying to say is don't give up, you will know yourself when the improvements begin, not when people tell you they should. Play music, read to her, have conversations and remind her of all the memories you have and include future ones.

I hope I have not made you too sad. My love and prayers are with you and your Mum. Remember to also look after yourself, you will need all your strength. Take Care.

Jan xxx

[Tomtom34 in reply to janb777]

Thanks Jan for the kind words. I can only imagine how difficult the last 6 years have been for you and yours, but I also know that you have and are doing an amazing work for your son and that he is in good and loving hands that got him to where he is today.

[oldbessie]

How sad. But never give up hope. xx

[Bradybunch35]

Hi Tom I'm so sorry to hear about your mom x lots of people have posted very encouraging stuff on here and the thing to remember is never give up. Everyday repeat the same stuff it will make new pathways in her brain. Read sing talk and mostly love her, touch is so important. I used to get in bed and cuddle my husband when he was in icu. Medics give you the worst scenario at all times- I stopped listening. Everything you do with her will have an impact.

Please take care of yourself xx

[Tomtom34 in reply to Bradybunch35]

Thank you!

[peaches2]

So sorry to hear about your mum Tom, everyone above has given great advice so there's nothing left me for me to say except that I am thinking of you and wishing your mum well. xx

[millie67]

Hi Tomtom

Sorry to hear about your mom, all I can say is every person is different and progress in different ways, my partner who was 39 when he had his hypoxic brain injury was in an induced coma for 2 weeks never actually recovered, he went from minimally conscious to being in a vegetative state and remained that way for 4 years, but obviously during that time I spent a lot of time in brain injury units and rehab centres and can honestly say you never see two cases the same, people symptoms and progression are all different. Never give up but remember to take time to look after yourselves. Hope the end of your story is a good one xx

[Tomtom34 in reply to millie67]

Thank you Millie for sharing your story with me. All we can do is hope for a good outcome at this point I guess...

[Tomtom34]

Thanks so much! That is an amazing story and very encouraging... we all try to keep optimistic and do all we can for her, but sometimes we have our dark moments as well where despair takes over. Thank you for your kind words and sharing your story, it fills me up with hope again!

[jayne_h]

Hi Tom

I'm sorry to hear about this. I do not have experience of this sort of injury, just post concussion syndrome. Headway are great so call them. People are right to say each brain injury is different. Don't give up hope and being informed will help you.

I hope your mum improves more.