April 30 update (by boyfriend) Finishing songs, repeating names and fulfilling commands of doctors. Knows who people are. Speaking both languages now, so not as one-sided as yesterday. Difficult to initiate conversation, like pushing a heavy door. Loud talking, especially when not being paid immediate attention. sister and uncle went in to visit today. Talking with doctor B. for a long time, I was let in after a time. Very tired, was able to say hi and squeezed my hand.
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April 29 update 2 The patient is talking. Asking for her Italian uncle to come. Saying hello by videconference to aunt. Prompted with a line from a song, replied with the following line of the song. Not pleased with being in an ICU. Has occasional panic attacks (seem to me possibly flashbacks to the accident). Generally major progress since April 27 (last time I saw patient) and huge progress since April 25.
April 29 update Big news. The patient has spoken, repeating, among other things the name of the rehab doctor who reports this. I consider this major progress. This is 3rd hand. Visiting hours start in 2 hours and 13 minutes. I may update after seeing and hearing and all that. Old news: April 28 patient agitaated to the point that benzodiazapenes (aka valium) were administered. Reportedly patient was trying to get up on hands and knees. Notably pattern of dilated pupils and racing pulse can be flight or fight response (aka adrenaline) directly caused by brain trauma. Pulse definitely responds to stimuli in an exaggerated but otherwise normal way (eg other patient getting angry and nurse responding sharply). All managed (although note example of stimulus -- maybe better managed somewhere quiter than the ICU ward).
April 27 update. This is me reporting to a doctor who asks me questions which show that she knows a lot more about medicine than I do 18:40 Hai inviato Intensive care attending (primaria) says intensive care no longer really needed. DR who knows more than me: What is her heart rate Me:Fever down to 37.5 central (so according to (other doctor we both know) not a real fever). Sometime they switched antibiotics. DR: Sister says patient follows commands per neurosurgeon what does melia say Me: When reasting 120 maybe 130. Steady except sometimes she moves around (as if seeking comfortable position) and it goes up. Old unexplained tachycardia (days ago) no longer happening (see update below) DR: Why is it high now Hai inviato Melia said she does not follow instructions. My effort was blink and tell her to blink and she blinked. Seems way more alert and eye tracking me. Likes to hold hand Hai inviato You asked why pulse so high (120). I guess often lower. I just saw “not tachycardia” DR:
April 26 update Patient much more alert today than yesterday. left eye still closed by swelling, but definitely tracked Marina with her right eye. She seemed angry. success saying “if you understand then blink” followed by patient blinked So good today. We are deciding where to do put in plastic skull replacement and rehabilitation Informally consulted neurologist notes that even a low grade fever (0.8 degrees centigrade) has a major effect on people with brain trauma. Fever stable and not alarming. message from neurosurgeon
Clinical: Doctors all consistently positive saying things are going well. Currently they are reducing sedation bringing the patient out of an artificial coma. April 22, sister reported that patient recognized her, responded to commands, and appeared to laugh at a joke. April 23, father notes seems in light sleep with patient's typical restlessness when sleeping. This is very different from absolute stillness during the full artificial coma period (which lasted a week). Patient never concious. Occasionally opened right eye, but didn't fix on anything. Doctors consistently report that patient responds to pinches by reaching for pinched area. Definite right side weakness (injury on left). April 23 patient spontaneously moved right leg. Right limbs respond. Weak (won't last) not paralyzed (might last). So OK I guess. Today (April 24) should reveal more
Here is the referto of the MRI. See the key point is that there is contusion but not detectable ischemia (suspected some small areas of ischemia somewhere). The effects should be temporary. Also Dr Veneziani says the bruised area has no known function -- when it is removed to remove a tumor, there are no known effects. So very good my effort to translate Exam rquested and executed in basal conditions with sequence t1,t2,presente, flair, GRE T2 amd with sequences weighed in diffusion according to axial, sagitale and coronal axes and with an axial sequence aiming in correspondende to the “tratto di rachide” C-4-C6 Extensive craniotomy temporal and fronto- parietal on the left. A collection of extracerebrale fluid collected near the surgical breach of maximum thickness of 18mm. Frontal and temporal bilaterally (walways more evident on the left, there is an extensive area of hyperintensity in the FLAIR and T2 sequences with some characteristics also of a hypointense component i