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My 78 year old mother fell a week ago and had surgery for a brain bleed 6 days ago. She woke up from the surgery and seemed fine. Carried on conversations and wasn’t in much pain. Later in the day she became very agitated (dementia and/or alcohol withdrawal). Ativan was administered. She really hasn’t been awake since. She has had a couple follow-up CTs and the docs say her brain looks fine. She only kind of opens her eyes when the physical therapist makes her stand for a few seconds and then back to sleep she goes. She hasn’t had anything for pain the past few days and the hospitalist says this isn’t normal but we aren’t getting any answers. The last year or so she started drinking a lot more than she used to which contributed to her falling. Looking for any advice to point us in the right direction.

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When my mom had her stroke (a complete stroke - no surgery and no TPA) she was still much more alert and able to answer questions etc than she was 24 hours after. My mom’s stroke is considered a massive stroke and her brain took months to heal after. I’m not sure of the difference and trauma to your mom’s brain after her bleed and surgery to tell you their differences, but it took my mother much longer to become responsive after hers. Her brain did swell and honestly She slept a lot. When she was awake - she could answer questions for me with thumbs up and thumbs down but she hardly responded for the drs at all. Her eyes were closed but she would do leg workouts with me one day and then sleep for days. She also couldn’t swallow or talk for over a month. The therapy would come in and move her but she was so weak. It just took longer for my mom than some others. I’m sharing with you what we experienced, without knowing the full extent of your mom’s injuries. But I have seen the brain do a lot of things after an injury and I saw in the beginning how much rest it really needed and how much the smallest thing took from it and exhausted it. I believe it can also speed up dementia and underlying cognitive issues.
Mare her vitals all good? Did they add in any new medications (blood pressure meds? Anything new? My mom was on zero meds before her stroke and needed many the first few months until her body readjusted to its new normal and the BP meds knocked her out. She is a lightweight on meds though so she was also affected by all the new medications. As I was able to wean her off some - she without a doubt became more alert. Sending prayers
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ingalou Jul 2020
Thank you! Yes, her vitals are all good. She was not on any medications prior to the fall and bleed. She is now on anti-seizure medications through a feeding tube. Just feel like she should be at least opening her eyes for a little bit each day. Maybe we just need to adjust our expectations.
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Some anti-seizures meds can cause sleepiness and confusion among other side effects. Find out what kind of anti-seizure she is on then google it or talk to her Dr.

There can be many other things causing this. I am sorry that you are not getting answers you need and should be getting. Also, I am sorry that you and your family are going through this.

Lots of Hugs!!
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Escalate to the medical team. Could be narcotized (effects of too much medication)? Delerium? Further brain bleeds or stroke *should* show up on CT but sometimes do not. What about MRI?
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ingalou Jul 2020
Not sure why they haven’t done an MRI. Will ask that of the team tomorrow. We have pushed for a consultation with the medical team all at once
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Wow, this sounds like my Dad’s situation in 2000. I get the call his has pneumonia. He’s at the ER. I get there, he’s in ICU. It’s that bad. He’s up and talking. Infectious disease doctor does culture for type of pneumonia but its a waiting game so they start IV antibiotics. This was back in the day when you couldn’t stay more than 15 minutes as he was an a ward. Next day I get there he’s on a ventilator and they induced a coma because he hated the ventilator. The pneumonia is literally cured in two days. They take out the ventilator give him the reversal drugs for the coma and he will not come out of it. It took at least 10 days for him to wake up and be coherent where he could talk. He didn’t know who any of us were, he talked all kinds of gibberish that made no sense. The doctor thought he was fine, they did scans of his brain and they said he was fine. Things he was saying seemed normal to everyone else but us. One morning at 6 AM I got a call that he got out the night before. He WAS to be transferred to another hospital for a heart procedure. I said he was transferred? No, he ripped out the IV, made it past the nurses station and Down the stairs and went out through the ER leaving a trail of blood. He then jumped an embankment and landed in pricker bushes. He thought the Koreans were chasing him as he was a veteran. I said will the doctor believe me now? Something isn’t right. The problem was they never asked my Dad if he was a drinker. He was a functioning alcoholic. Not as bad in his elder years but still was drinking. That and too much anesthesia put him out for those 10 days. Thankfully in about 3 weeks he was himself. But very scary. I hope the same will be for your mom. Anesthesia is very scary and can really harm someone at any age. My mother in law also was the same after her heart surgery. A nice calm, no meds, no drinking person was nasty, delusional and not herself for 2 weeks from being under anesthesia. Again no brain issues found. Prayers for all of you.
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Do they know about the alcohol situation?

Suddenly stopping can be very dangerous.
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Yes, we were very up front about it. They initially gave her Librium for the withdrawals. This was also stopped a couple days ago.
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My mom was also on anti seizure (precautionary after stroke and swelling). We weaned her off after a few months and they can make you very tired. She had a UTI this past January and the antibiotics along with delirium and had to go back on anti seizure (Vimpat - but it’s a low dose and she has done well on it). Mom was having Nystagmus episodes though nothing ever showed on her eeg.
i agree to keep pushing for additional ct scans - they usually do bloodwork everyday - ask to see them and have them reviewed with you. Check all her electrolytes with bloodwork. My mom was also on a feeding tube and all meds through it. Check potassium levels (this has been one that mom has had drop and it creates some scary or weird behaviors). Ask about ammonia levels and if they haven’t been run ask for it to be run - some seizure meds can increase ammonia levels. Keep us posted - I will try to remember other things we ran into. Try your best to get her to keep responding even with thumbs up and down like we did. 🙏🏼
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Just checking in and hoping you got some answers and mom is feeling better.
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I hope you will get some answers. But you may not. I certainly cannot second guess the docs and sounds as though you are getting good advice. Eventually you will be encourage to accept placement and hospice, or palliative care. You will be the one to know how hard your Mom would want to fight to live. Apparently she has already descended into possible alcoholism to deal with life. I am her age. I myself would not really want to go on and would be thrilled to have hospice give me the good drugs until I could slip the mortal veil. I wish you good luck. It sounds like you are getting really good medical care. You cannot honestly tell with a bleed how much damage it has done to the brain. And it isn't really predictable what will happen in future. But this is looking like a major medical incident. So sorry.
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My mother was hospitalized after a fall and they administered Ativan one night to calm her because they said she became agitated. That drug put her out cold for nearly one week. We were terrified. They did EEG and CT scans and said all results were normal. I just looked at her and knew she was far from it. I did not know why the doctors could not see what I could. She eventually returned to baseline after about three weeks. The hospital said the resident administered too much Ativan. Looking back, mom had mild dementia at that time. I wondered if the new drugs being administered, the change in environment, stress, lack of sleep, etc., made her dementia symptoms worse. I questioned the hospital, but they gave me the same answer that "she was having alcohol withdrawl". I felt like that was a cop out from the medical not having answers. I told them my mom only has 1-2 glasses of wine on weekends, and they replied that if you admit to 1-2, it means you are really having 4-5. WTH? I found it ironic it was mentioned in this thread. It seems you are asking the right questions, and happy your mom has you to advocate for her. I can only suggest to keep her environment as calming as possible and perhaps look at the list of meds being given and side effects especially if your mom is not used to such meds. Prayers to you.
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