Brain Stem Injury

[Jcsgt]

Does anybody know about brain stem injuries?

I have a 14 year old friend who was involved in a car accident, last weekend, and has been in a deep, non-medically induced coma. Jessica was riding in a vehicle, not belted in, when the vehicle went into the ditch. Jess was pitched through the windshield and out onto the pavement.

Jess has no broken bones outside of in her skull and face.

The professionals say she has a good deal of injury to her brain stem and the top of her spine is smashed. They can't relieve the pressure in her skull, since it's so splintered, they're afraid to take any piece out. She is intubated (sp?) through the mouth, but due to probable infection, they would like to do a tracheotomy. However, they can't, since they are afraid to move her neck. They said the only function in her brain that is working is the "thinking" part.

The first neurosurgeon said there was very little chance Jess would even survive her injuries, let alone have a chance for any quality of life. However, a second neurosurgeon said there was a chance for "partial recovery" if she survives the first two weeks.

Last night, they tried to do a CAT scan of her chest and she either convulsed or somehow began flailing around. Because of that, they have medically induced paralysis to avoid having her hurt herself.

It just gives me chills to think of her waking up and laying there, aware of what's going on around her and unable to communicate, move or anything else. I can't see where there's any "quality of life" if that's the result.

Do people ever recover brain function from that type of injury? If she were not convulsing and were flailing around, is there any hope that that she may not be permanently paralyzed?

I'm not asking anybody to give a diagnosis, just want to know more what the odds are.

Thanks.

 

[justleesa]

It doesn't sound good - poor girl hoping for a miracle

 

[DA Aquamaster]

The devil is in the details. "The top of her spine is smashed" has different implications depending on how damaged the spinal cord itself happens to be. Few people survive a C1 or C2 (the top two vertebre) severance of the spinal cord and if they do, quality of life is a very relative thing.

I am also assuming from your description that her higher level brain functions are intact but things like breathing are not. I think the critical issue here is how much additional damage the swelling in that and other areas of her brain is causing and that would be the reason for a very dubious prognosis at this point.

To be honest, based the very very small number of clients with that level of injury, who have not survived long enough or recovered enough to work with me (as a vocational rehabilitation counselor), I tend to agree with the opinion of the first neurosurgeon that the odds of survival, and perhaps the desirability of survival, are very very small.

One the other hand she is very young and her brain probably has a greater degree of flexibility in terms finding alternate ways to work around the injured areas than you would expect in an adult so a miracle could happen.

The worst outcome in my opinion would be for her to stabilize in her current condition and remain in a coma. It places the family in a very difficult situation that at best results in no closure while their daughter justs wastes away in a nursing home on life support.

My thoughts are with her and I am praying for the best. 14 is just too young for something like this to happen to someone.

 

[TSandM]

In general, injuries of the magnitude you describe have a poor prognosis for survival or return of function. That said, youth is an amazing thing, and I've seen young patients survive injuries that nobody thought they would. Unfortunately, even when they survive and wake up, there are severe long-term cognitive and emotional disabilities -- they aren't the people they were before they were hurt.

As far as whether she would be paralyzed, that depends on the degree of injury to the spinal cord. If the damage is as high up as you are describing and as severe, most likely she would be quadriplegic and ventilator-dependent.

This is an incredibly sad story. We almost never see this magnitude of injury any more with the increased frequency of seat belt use and air bags in newer cars. Being ejected from the vehicle is one of the worst things that can happen in an accident.

 

[Jcsgt]

Thanks for the info.

I'm really worried about Jess's mom. Jess is in the hospital in Eugene and her mom lives in Eastern Oregon (5 hour drive). Jess's mom has been camped out at the hospital and has even talked her husband into putting their house on the market so she can be here to take care of Jess. I'm so afraid she's going to be in for a huge letdown. The way she talks it's as if she's absolutely banking on Jess getting out of that hospital.

 

[justleesa]

a mothers hope is unwavering.....and often blinds reality.

Why is Jessica so far away? was she evacutated to a special hospital? is there no chance of relocating her?

 

[Jcsgt]

Eugene is set up to handle Jess's types of injuries. I don't think there's anything in Eastern Oregon that would suffice. Besides, I'm not sure they want to move her. Eugene was the closest facility, also, from the accident site. Jess was living with her father, at the time.

The subject has been broached with Susan, her mom, regarding waiting on the selling of the house. She's steadfast about it. Maybe she thinks she's lacking faith in Jess's recovery if she waits and that will somehow make the outcome worse? Susan hasn't even truly broken down and cried. I think she is focusing solely on Jess coming out of this and getting to go home. I'm afraid it's going to kill her if Jess doesn't survive.

 

[TSandM]

This is one of the hardest things to manage as a trauma surgeon. You never, ever want to remove all hope from people -- hope is what keeps us going. But when you see someone with really unrealistic expectations, you know how much they are setting themselves up for a fall. One of the first reactions to a loss is denial, and this is a form of denial. Hopefully, someone can counsel Susan that making decisions like this in a time of crisis is not a good idea -- Does the hospital perhaps have a psychologist who works with their rehab patients? Harborview in Seattle did, and we made use of him from time to time when the situations like these were really problematic.

 

[Jcsgt]

This is one of the hardest things to manage as a trauma surgeon. You never, ever want to remove all hope from people -- hope is what keeps us going. But when you see someone with really unrealistic expectations, you know how much they are setting themselves up for a fall. One of the first reactions to a loss is denial, and this is a form of denial. Hopefully, someone can counsel Susan that making decisions like this in a time of crisis is not a good idea -- Does the hospital perhaps have a psychologist who works with their rehab patients? Harborview in Seattle did, and we made use of him from time to time when the situations like these were really problematic.

That's a good idea. I will try to see what services are available for her. Thanks for your help.

 

[justleesa]

That's what I was thinking too....she needs some support to see things in the right perspective....you're a good friend, good luck