I am a nurse. My life mate of 12 yrs. passed recently with a brain stem stroke secondary to acute myelogenous leukemia. I thought I was seeing long tract signs & pyramidal tract signs since his fentanyl had just been increase 24 hrs earlier. My question is how do you know in a brainstem stroke when true cognition is gone? Are they still cognizant of what they are doing whne the pupils have become pinpoint and lateral and horizontal gaze have been affected. When they are no longer able to speak but turn their head to you when spoken to, I would suppose they are cognizant. I need to know. He would not speak after a cdrtain point but he turned to try and hit me with his fist twice with his right arm. The movement was spastic and his third try to move that arm, he bent it and put in under his chin. I want to know without being comforted if he still was totally cognizant when he made those movements. Was he aware of his movements to hit me? I need some peace in knowing the truth for closur
It seems that you want to know if your partner was dejected or anger issues with you during his last days, and it was due to such reasons that he wanted to hit you.
I would like to assure you that it is not such a case of anger.
Patients with severe stroke due to end stage leukaemia have severe confusion usually due to associated medical issues including delirium and acute psychosis. Hence they show features of aggression to anyone around them including the treating physicians or nursing staff. Though they speak out or appear in their own self, they do not actually mean what they say or do.
With respect to the actual status of normal cognition in stroke patients , it varies with the severity of stroke and the area of the brain affected. In a massive stroke which affects large areas of the cerebral cortex and thalamus, it will be lost almost immediately.
In case of mild strokes, only the internal capsule or the basal ganglia is affected, the most affected are the motor movements and cognition is usually intact.
But eventually, presence or absence of proper cognition can be determined only by clinical assessment and a set of questionaire like Mini Mental Status Examination, etc.
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