I came across your website while researching brain aneurysms. My aunt suffered from one 2 weeks ago and we are extremely concerned for her. I would really appreciate your opinion on her case:?
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Fri, June 2, 2006 - aneurysm ruptured (we believe the location was left front, don’t know the size of the aneurysm). ?
Sun, June 4 2006 – aneurysm clipped. ?
Fri, June 9, 2006 - doctors told us she had vasospasm. ?
June 10-12 – critical. ?
Wed, June 14 - seemed to be coming out of vasospasm as evidenced by her increased alertness, but started bleeding from a wound in her mouth(suspected cause – fall when aneurysm ruptured) and the place where surgery was performed(external bleeding). ?
Thu, June 15, 9 am – CT scan done, all OK, still alert. ?
Thu, June 15, 10.30 am – started going downhill, was almost unconscious by 4pm, put on ventilator . ?
Fri, June 16 – CT scan done again – found small amount of blood had seeped into her skull from the bleed at the place of surgery. Another ‘mini’ surgery to remove that blood and clean up – we’re told that was successful. Also was given platelets because her count was down. Stopped bleeding. Found ‘ancinobacter’ infection in her throat, negative in blood and urine samples, being trated with highest level of antibiotics available (we don’t know what it is). ?
Fri, June 16, PM and June 17 Sat – responsive, could move her hands, answer questions with signs. ?
Sun, June 18 till now – unresponsive, very occasionally we’re able to rouse her and even then she just opens her eyes, but does not look like she’s seeing anything (or we don’t know if she is). ?
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Do you have any ideas/opinions on her case? Is this usual among ruptured brain aneurysm patients? Will she come out of this and what about her prognosis? What kind of recovery times do you usually see?

Dr. Joshua’s Answer:

It would help to know her age. It’s been more than three weeks now since the bleed, so the risk period for vasospasm is over. It would help me if you could send a copy of her latest CT scan. It’s very hard for me to say anything without knowing her age or seeing any pictures. Also it would help to know what kind of condition she was in when she was first admitted. Generally, if the patient is unresponsive after three weeks, and depending on age (the higher the age the poorer the prognosis), it suggests a high grade subarachnoid hemorrhage (aneurysm bleed), and recovery from that is difficult at best. I’m happy that she has been conscious most of this time, and that speaks for a better prognosis. It’s impossible to say what her prognosis is, but I’d venture to say that at best, recovery will take time, and we may not know the degree of her recovery until 6 months to a year from now. It’s important to rule out any treatable conditions that may hinder recovery; one such condition common with subarachnoid hemorrhage is hydrocephalus (disturbance of cerebrospinal fluid flow), which requires a shunt operation. I’m sure her neurosurgeons have considered this possibility.

You should of course ask the attending neurosurgeon the same questions you asked me - he/she will be in an infinitely better position to explain the situation and give you a prognosis.

If you can provide more information and a copy of the latest CT scans, I can take a look and see if can explain the situation better.