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Originally Posted by nexxo
Just a brief post of support... Dealing with brain injury is difficult at the best of times, but particularly so when you have a new baby to look after as well! I hope your wife will make a good recovery. In fact, as a neuropsychologist working on a brain injury rehabilitation ward (in- and out-patient), I can tell you that these things always look a lot worse in the beginning than they tend to pan out in the long term. Give it time; progress is always slow in the first months.
From what little you mentioned in the forum I cannot form a very detailed picture, and I'm sure you've been explained all this much better in Hospital by the experts who are treating your wife, but just for what it's worth:
The basal ganglia are involved in automatic motor processes, memory, habitual behaviour, drives and basic emotion. The right basal ganglia specifically regulate motor movement in the left part of the body. A bleed in that region tends to affect these functions primarily. The right hypocampus (predominantly visual memory) can be affected as well, and also the visual pathways running past that region, resulting in some loss of left visual field. It is therefore best to sit at your wife's bed on her right side.
On the up-side, if the injury is limited to the basal ganglia, higher cognitive processes should stay unaffected so although your wife will be pretty groggy and disoriented right now, in the long term she should not suffer personality change or significant change in intellectual ability. She may be a bit slower, and left with some memory problems (easily compensated for) and at first, some initiation problems (finding it hard to start actions). She will be very tired a lot. She will probably have some left motor problems, in walking and balance, as well as co-ordinated movement of left arm and leg, but physiotherapy can improve this considerably. Language again will be fine, so although I know I don't have to tell you to keep talking to her, take heart in knowing that at some level she can hear and understand you. Her speech may be affected by left sided motor problems however, so her speech may be slurred at first.
Her brain stem (life-support systems) should stay unaffected, and I imagine doctors will be keeping a close eye on any swelling of the site of injury, so it doesn't press down on the brain-stem structures. This tends to be the main focus of acute management, and they're pretty good at it. Your wife's unconsciousness is, in a way, the brain's way of protecting itself from further damage by lowering its metabolic needs.
I'm keeping my fingers crossed. I know all you can do is wait, and powerlessness is a terrible thing to feel. But for what it's worth, I'm optimistic about this one. Take care of yourself.
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Wow! Why can't the doctors that I have make things this clear? I have dealt with three or four neurologists (no neuropsychologists yet), and none of them told me what the basal ganglia primarily control or what kinds of things to look out for long-term. All they tell me is that they don't know how much she'll recover and to wait.
Unfortunately, she has had two hemmorages (one about the size of a silver dollar in right basal ganglia and one in the left that is twice the size) caused (they think) by an initial thrombosis in the inferior sagital (spelling?) sinus vein that they missed in the first MRV. They only caught it four days after the first stroke in a cerebral angiogram. I can't help but think that if they had not misunderstood the first stroke as a reaction to Reglan or that if they had caught the thrombosis on the second day, that things might be better. They might not have tried clotting therapies like platelets and cryofactor and they might have gotten her on a blood thinner on the FIRST day so that the second stroke wouldn't have happened. I don't think that's malpractice (and I really HATE people that sue over simple mistakes), but I'm still frustrated.
Oh well. Done is done. At this point, I just want my wife to recover. I hope that swelling caused by those hemmorages goes down as they are absorbed and she recovers some of her emotions and initiative. It really hurts to see her so .... flat. Nothing makes her happy or sad. Language is coming back but still includes some things like saying "Crystal Corn Flakes" instead of "Kellog Corn Flakes". Memory isn't good, as you noted, and she had difficulty yesterday with the idea that her mom (dead 16 years) didn't need a sweater.
Physically, she is doing much better. I got to help her walk down a hallway yesterday.