Inadequate Oxygen To The Brain

Once the seizures are controlled, there’s a chance for improvement provided the individual’s immune system is muted and held in check. This can cause seizures and coma. Sometimes autoimmune encephalitis is due to undetected cancer. In those cases, a good outcome also involves identifying and treating the cancer. Autoimmune encephalitis is seen mainly in younger patients, and thus, outcomes tend to be better than for encephalitis that develops in older individuals. Pus that collects in the brain from an infection is called a brain abscess. The outcome of a single brain abscess is dependent on whether a patient is a good surgical candidate. They’re also preferable for patients with suppressed immune systems and small, widespread abscesses. The chances for recovery are poor if the patient is comatose before an abscess is treated and, particularly, if the abscess has ruptured into brain ventricles. When that happens, a severe meningitis will cause a rapid decline and, often, death. Multiple brain abscesses are a concern because their entry into the brain’s ventricles allows deep spread of the infection and generally results in a poor outcome. Neurosurgeons often place a catheter into the cavity to drain the pus.

Love The Thought

Other treatments include prescribing antibiotics or antifungal medications or using a catheter and medication in combination. However, antibiotics don’t always help in these cases. Cardiac arrest means no effective contraction of the heart muscle and no blood flow to the brain, which leads to sudden loss of consciousness. Halted blood flow injures the brain because it deprives the brain’s neurons of oxygen, which they need to function. The longer this continues, the worse the outcome. The outcome of cardiac arrest is also much worse when no one is available to start chest compressions immediately. Even with the best resuscitation efforts, the blood pushed forward to the brain is just a fraction of what it should be. The extent of injury, however, often is variable. Bad outcomes can occur after short resuscitations and good outcomes after long ones. Once the heart starts beating again and there’s subsequent return of spontaneous circulation through the body and good blood pressure, a person’s brain can potentially resume its function. The window for this to happen, however, is small. The abrupt cessation of blood flow virtually stops the brain’s complex machinery.

None Of The Above

Calcium floods into brain cells leading to very severe damage. Additional injury also can occur when circulation is restored and blood flows back into damaged areas. Many of these harmful pathways are active for hours to days after circulation has been restored. Patients whose hearts have stopped and been restarted may remain in a coma and not awaken even after steps to reduce swelling. This test evaluates the integrity of the pathways in a nerve that begins in an arm and extends into the spinal cord and up to the brainstem before ending in the cerebral cortex. Each structure along the way gives off a waveform after the nerve is shocked over 100 times. The absence of the N20 waveform in the cortex is always associated with a very poor outcome and, often, prolonged coma. Absence of N20s may be an even better predictor of poor outcome than a bedside neurological examination. However, relying on a test that shows absence of something is problematic because the same result could occur if the test was done incorrectly or it was performed correctly but the patient moved too much. This type of expertise often is only available in large medical centers. Many hospitals don’t offer this potentially very useful test. What all of this means is that most of the time we are fully reliant on a neurologic examination.

Take It Away

When these symptoms occur, we can anticipate a prolonged coma, and patients may never fully awaken. Often, the best that we can hope for is a minimally conscious state, in which individuals opens their eyes and look about at times but aren’t clearly aware of and can’t engage with their surroundings. We’ve learned that improvement is most often seen in the first 3 to 7 days after a person becomes comatose. After that time, the chances become slimmer, although some patients do improve after longer periods of coma. Often, neurologists can’t reliably predict the outcome of brain injury after cardiac arrest, and it’s become even more complicated recently because methods used to cool patients delay the clearance of drugs from their bodies for days and sometimes weeks. We need to review the multitude of serious medical conditions that a patient has and their ramifications. We can’t look at one organ system alone. I should emphasize one more important fact. Brain damage can potentially occur if blood flow is adequate but there’s not enough oxygen in the blood. This is very uncommon and requires a severe dip in oxygen levels. Very low oxygen alone occurs in patients who have acute severe lung disease. The worst injury is one that results from both no blood flow and lack of oxygen to the brain. That’s far worse than any trauma, infection or stroke. The brain can’t tolerate oxygen deprivation for more than a minute. Once the medical team has assessed a comatose patient’s condition, family members need to be informed about what to expect. Some will opt to continue life support, holding on to the remote possibility of improvement. We honor that, but only after repeated discussions emphasizing that they must be prepared for an extremely frustrating experience. Patient with unlimited continued critical care. Full benefit of care and a potentially good outcome is rightly anticipated. This pathway is considered when, after resuscitation, the patient continues to decline and the function of other organs dwindles. Aggressive resuscitation followed by continued critical care, but a major complication occurs and the decision is made to provide palliative care only. Poor outcome with no benefit already evident on admission and no treatment other than comfort measures. It should be emphasized that none of these decisions is ours to make. A living will or advance health care directive can help in making decisions.