Jim is a 54 year old gentleman who experienced sudden onset confusion and weakness in his face and arm on the left side. He was rushed to the hospital. A head CT was performed that didn’t show any abnormalities. A CT angiogram showed no blood flow to the right middle cerebral artery.
Despite excellent medical care including an attempt to retrieve the blood clot lodged in his middle cerebral artery, his symptoms didn’t improve. Several hours after coming to the hospital, his head CT showed a large stroke.
Jim began having more confusion and decreased consciousness. Another head CT showed not only the stroke, but shifting of the brain due to swelling.
We took Jim to the operating room for a procedure called a decompression hemicraniectomy. The purpose of this procedure is to provide room for the brain to swell by removing a large portion of the skull and opening the covering of the brain.
Jim survived. The bone was replaced with a second surgery. However, he has some permanent disabilities related to his stroke including neglect and decreased movement of the left side of his body.
Decompressive hemicraniectomy is performed in an effort to save the life of a patient with uncontrolled brain swelling. Unfortunately, the treatment doesn’t fix the underlying problem–a large stroke in this case. The decision to perform surgery or not requires careful communication and discussion with the neurosurgeon and the patient’s family.
**Jim is not the patient’s real name but is used to help portray the story while protecting the patients identity**