Doctors Lounge - Neurology Answers
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Forum Name: Neurology Topics
|sirkevinthegeek - Mon Apr 13, 2009 9:20 pm|
My fiance is now 25 years old. She has an arteriovenous malformation (AVM), which has caused her to have three brain hemorrhages in her life. The third one happened in January, and it led to a stroke. She suffered damage to her brainstem. Specifically, I know there is damage to the midbrain (due to her third nerve palsy). She has recovered her breathing, but she has been in a vegetative state for almost three months. Her level of consciousness seems to waver a bit; she consistently responds to painful stimuli, but no consistent localizations. I'm not sure if the damage extends into the reticular formation or not. She has shown some storming/tremoring on her right side. Can anyone give me an educated discussion on cerebral atrophy in someone like Jessica? I need to know because it may help me help her, and it's a tough topic to try to research on my own. More about my fiance's story is at http://www.protectjessica.com/. Thanks.
|John Kenyon, CNA - Mon May 18, 2009 9:00 pm|
Your question involves a very esoteric area of neurology. While I am conversant in the emergent area of many neurological problems what you're looking for is far more specialized. What I'm going to do is refer this to the neurological team here and see if anyone is able to advance any ideas or provide any helpful guidance in the area of stroke recovery specific to brain stem injury. Please check back here in a day or two to see if anything new is posted. Meanwhile, just FYI, the website URL requires an invitation and will not allow me access. I'm not sure why this is so, but thought you should know.
My best to you and your finace. I hope we're able to find some answers for you here.
|S. Anderson, M.D. - Tue May 19, 2009 4:26 pm|
You describe a worrisome result and condition. I am sorry for your difficult situation.
Your question asked specifically about cerebral atrophy, however, I am going to answer in a more broad manner, as I believe it applies in this situation.
If your lady has suffered a stroke that damaged brainstem functions, along with previous strokes, there are ways to determine the extent of some of this.
Often, brainstem functions are evaluated by way of corneal reflexes, calorics, doll's eyes, as well as response to pain and/or ability to breathe without a ventilator.
Cerebral function can be evaluated by combination of MRI and EEG. These would answer at least basic questions about extent of involvement of stroke damage, actual physical atrophy, and EEG would give evidence of generalized slowing, a "comatose" state, if there are active frequencies, sleep, or even nonclinical seizures present. This last can interfere with consciousness, without being obvious as seizure activity.
More specific evaluation of processes and function can be obtained by a QEEG; quantitative EEG. This is done like a regular EEG. However, it provides a "brain mapping" giving specific information of different processing areas of the brain, to see what the amount of damage is to different regions.
Atrophy itself, is usually a resulting sequelae of cerebral injury, whether from remote trauma, stroke, infectious processes, or other. It's presence does not necessarily give you quantitative or qualitative information. How it manifests itself in a patient's condition depends on where it is, how severe it is, cause, etc.
I hope this is helpful.
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