I was recently asked to review a patient with sudden left-sided weakness. He is in his late sixties, an ex-smoker, with background medical history of high blood pressure and slightly raised cholesterol levels.
On admission to the hospital, he was alert. Brain scans were done. Overnight, he deteriorated, and became comatose. How did this happen? Why? These were the necessary questions on the minds of immediate family members. Is there treatment for him? Will he wake up again?
Massive strokes occur in 10% of all patients with strokes. They strike out large areas of the brain, and are potentially fatal. These brain cells die within minutes to hours, and chemicals are released into the surrounding areas, resulting in brain swelling over 24 to 48 hours. The pressure in the brain rises dramatically. This threatens the livelihood of nearby healthy brain cells. Without treatment, up to 80% of this group of patients die.
Such patients lose consciousness rapidly. They may not be able to breathe on their own, and will have to be placed on artificial life support system. One important intervention to consider is immediate brain surgery, especially in younger patients as it offers them the best chance of returning to near independence state.
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