What causes loss of consciousness after a stroke?

Question

Hi doctor,

My father is 55 years old. He is good in terms of his health and weight. He recently had a large AVM rupture, and he was flown to the nearest hospital. He had a craniotomy to remove an AVM, and the ICH (Intracerebral brain hemorrhage) caused a large stroke.

He was left paralyzed on his right side with the capability to speak, but limited. He says a few words here and there, but mostly mumbles or says things that do not fit the context of the present. He is in a rehabilitation where they are supposed to be helping him with this now.

My concern is that recently he has been having episodes of losing consciousness. It happened a few times for about 10 minutes, and today it lasted over an hour. He was calm and sitting up. He lay back down slowly (with my help, of course) and all of a sudden would not wake up. His vitals were fine, though they had put him on oxygen this afternoon, because it was a little low (high 70's and low 80's).

He was on it when this occurred. Is there any indication as to why this is happening? He has been sent to the emergency room for it a bunch of times, but each time they send him back after doing a CAT (Computed axial Tomography) scan. By the time he would see the doctor, he would be awake.

Recently, his medication was changed from Keppra to Lamictal. He has been experiencing a bit of tremors as well, and I am not sure if it is the new medicine. They will be scheduling him for a neurologist appointment and an MRI (Magnetic Resonance Imaging) in the upcoming week.

Do you have an idea as to why this unconsciousness occurs? He communicates sometimes by saying yes or no, but it is inconsistent. He goes through little stages of being combative, calm, sleeping, aggressive, and then basically aware. Could this unconsciousness be one of these? I seem to be the only one extremely concerned about them, but he has not seen a neurologist about it.

Please help me.

Answer 1

Hi,

Welcome to icliniq.com.

When the cortical damage is widespread, consciousness is impaired. Your father has come out of the deep unconsciousness; he is recovering now. During recovery, these sorts of episodes are common, and gradually the frequency of these episodes comes down.

Other factors, like hydrocephalus or rebleed, can make him drowsy, but a CAT (computed axial tomography) scan has already ruled those things out. A drop in oxygen saturation may be because of reduced respiratory drive (if the lungs are normal).

If you wake him up and ask him to take a deep breath, it may improve just with that. The behavioral changes, which you observe, would improve over a period of time.

Apart from the brain dysfunction, his low blood sodium can make him drowsy. I am sure when you went to the emergency room, your doctors would have checked it.

I hope this helps you.

Thank you.