Prognosis for a Person with Brain Hematoma and Unconsciousness for 5 Days
The chances of survival for a person with a brain hematoma who has been unconscious for 5 days are poor, with mortality rates ranging from 40-75% depending on hematoma location, size, and timing of intervention.
Factors Affecting Prognosis
Hematoma Location
- Temporal or temporoparietal hematomas carry the worst prognosis, with 41% showing signs of transtentorial herniation compared to frontal or parieto-occipital hematomas 1
- Brainstem hematomas have high mortality rates but some patients can survive with persistent neurological deficits 2
- Posterior fossa hemorrhages (cerebellar) >3cm in diameter with brainstem compression or hydrocephalus require urgent surgical decompression 3
Hematoma Size
- Hematomas larger than 30cc, especially in temporal/temporoparietal regions, significantly increase risk of brain-stem compression and poor outcomes 1
- The volume of ICH and Glasgow Coma Scale (GCS) score on admission are the most powerful predictors of 30-day mortality 3
Duration of Unconsciousness
- Prolonged unconsciousness (5 days) indicates severe neurological injury
- Patients with severe neurological deficits, altered level of consciousness, and large parenchymal hemorrhage have significantly worse outcomes 3
Management Considerations
Surgical Intervention
- For patients with intracerebral hemorrhage and decreased consciousness:
- Cerebellar hemorrhages >3cm should undergo surgical decompression 3
- Supratentorial hemorrhages with GCS score ≤8 may benefit from minimally invasive surgical evacuation 4
- Timing of surgery is critical - earlier intervention (within 2.5 hours for subdural hematomas) shows better outcomes than delayed surgery (4.5 hours) 5
Medical Management
- Blood pressure control is crucial with a target systolic BP <140 mmHg 4
- Intracranial pressure (ICP) monitoring is recommended for patients with deteriorating neurological status 4
- Correction of coagulopathy is essential if present 4
Outcome Predictors
Negative Prognostic Factors
- Age over 65 years 6
- GCS score of 3-4 on admission 6
- Postoperative ICP greater than 45 mm Hg 6
- Large hematoma volume (>30cc) 1
- Presence of intraventricular hemorrhage 3
- Hydrocephalus 3
Positive Prognostic Factors
- Cortical location of hemorrhage 3
- Mild neurological dysfunction at presentation 3
- Prompt surgical intervention when indicated 5
- Effective control of postoperative intracranial pressure 5
Conclusion
For a patient with brain hematoma who has been unconscious for 5 days, the prognosis is generally poor. Garcia-Cabrera et al. reported mortality rates of 75% for patients with cerebral hemorrhage undergoing surgery within 2 weeks, 67% for surgery between 2-3 weeks, and 40% for surgery after 3 weeks 3. The extended duration of unconsciousness (5 days) suggests severe neurological injury, which is associated with higher mortality and poorer functional outcomes.
The management approach should focus on preventing secondary brain injury through appropriate medical and possibly surgical interventions based on hematoma characteristics, but expectations for full recovery should be tempered given the extended period of unconsciousness.