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Anesthesia

Subarachnoid hemorrhage - not waking up

11/30/2007

Question:

My mother suffered a subarachnoid haemorrhage in the left side of her brain. As a consequence she developed pulmonary oedema and needed to be fully ventilated with inotropic support and sedation. The pulmonary oedema is improving. The inotropes and sedation were switched off over a week ago but she hasn`t regained conciousness. She is moving her arms and legs but ? involuntarily. What reasons could there be for her not waking up? She is 65, and a smoker with previously no major health problems.

Answer:

I am terribly sorry about your mother.

As I am sure you are aware, subarachnoid hemorrhage can cause serious injury to the brain. Many patients die. I assume you have sent me your question because you are concerned that the sedation your mother has received is responsible for her not waking up. This is most unlikely to be the case. The hemorrhage may have caused ischemia (lack of oxygen) or even death of brain tissue. Another possibility is that of vascular spasm (constriction of blood vessels supplying the brain) that occurs characteristically a few days to a week after the initial event. This so-called vasospasm is difficult to treat.

Any further questions on this topic should be referred to another expert on NetWellness.

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Response by:

Gareth S Kantor, MD Gareth S Kantor, MD
Assistant Professor of Anesthesiology
School of Medicine
Case Western Reserve University