Expert: Claes-Gustaf Nordquist, M.D. - 8/23/2009

Question
One of my best friends had a benign but growing brain tumor near his ear that had taken his hearing, made him feel dizzy, and created a loud sound that he heard 24 hours a day.  He had it removed on July 13.  Within 24 hours of the surgery, nurses noticed that he did not know where he was and didn't recognize his wife.  He was taken back to ICU and it turned out he had some kind of dural leaking and pressure on the brain.  They inserted a tube in his head to relieve fluids/pressure, but evidently the drain was inserted too far back (they explained a mistake was made) that led to a blood clot forming in his cerebellum.  He was then opened up again to remove that clot.  He then developed meningitis.  He was completely unconsious and unresponsive for a week, but then began moving his hands and legs and opening his eyes.  Over the past five weeks since, he's battled fever and pneumonia and pressure in the brain, although the pressure seems to be fine now.  He has progressed to moving all body parts completely normally--he scratches and grabs at things and has even snapped his fingers to point at a nurse.  He opens his eyes and will look at you, but there's still a bit of a distant look in his eyes.  He cannot talk because of his trach, but when they did put something in his trach to enable him to talk, they asked him if his new room (he'd been moved out of ICU--this was 4 days ago) made him happy.  He said, "very happy."  However, although this would seem to indicate that he understands language and can speak normally, he still doesn't follow commands.  When asked to squeeze a hand, he usually will not.  When asked to move a leg, he usually will not, although he moves his legs and hands all the time when he wants to.  He's 43 with a wife and four kids and his family is at his side and doesn't know what to expect.  Doctors won't tell them much at all.  It's been 6 weeks.  What is the worst and best case scenarios, in your opinion, and what is--in your opinion--the most likely scenario?  Also, if he were your brother or son, what would you do from here?  Please help--this is a beautiful family that deserves some answers.  Thank you so much!  

Chris

Answer
I'm a medical oncologist & radiation therapist with experience of treating (mostly malignant) brain tumors. BUT I'm NOT a neurosurgeon or a neurologist. This question is concerned with neurological consequences to an accident during a neurosurgical procedure. It is best answered by a neurosurgeon or a neurologist. I therefore strongly suggest that it is directed to such an expert. It may be difficult to find a neurosurgeon here but I think neurologists are available.