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Dr. Frank
Dr. Frank, Board Certified Physician
Category: Neurology
Satisfied Customers: 8999
Experience:  Board certified general Adult Neurologist, with experience in experimental neuroimaging and neurodiagnostics.
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One of my relative (in India currently) met with an accident

Customer Question

Hi,
One of my relative (in India currently) met with an accident in 2012, he was hospitalized for a year and now home. It's been ~4 years but his recovery process is very slow. He is suffering from memory loss and cannot standup by himself.
This was what Doctor in India found out in 2012:
- Ophthalmology consultation revealed that patient had traumatic opthalmopathy, enopthalmos, and corneal injury? Vision, all condition managed conservatively.
- Orthopedics consultation revealed fracture humorous and fracture olecranon as advised by doctor to be managed with pop cast and immolation and conservative management.
- Gastro surgery consultation revealed liver laceration and mild haemoperitonium as advised by doctor did not need exploration, to be managed conservatively.
- Craniofacial surgery under GA, Spinal injury did not need intervention and was managed conservatively.
- Now patient has gas E4V2M5=11/15 vitals stable, has headed corneal ulcers, pt on PEG tube and foleys cather and thromboprophylaxis. Now patient needs active chest and limp physiotherapy, continued present medication, eye care and general nursing care..
Questions:
1. Considering the best neurologists and superior treatment, Would it be a wise decision to bring him over here in USA for treatment for faster recover particularly memory loss? or it's more of now home rest and physiotherapy?
2. As per the doctors in India, normally in this case the recovery takes somewhere around 5-6 years. DO you have any opinion?
3. How much normally the treatment here would cost without insurance?
Thanks!
Submitted: 9 months ago.
Category: Neurology
Expert:  Dr. Frank replied 9 months ago.

Hello. Welcome to JA. I will review your statement and reply shortly. Please read this preliminary answer and respond. Dr Frank

Expert:  Dr. Frank replied 9 months ago.

After 12 months in most traumatic injuries, you reach a threshold and no major improvement should be considered as likely. So I am confused by your statement of 5-6 years?? You did not describe his brain injury. Can you describe his functional status? Does he have language function? Is he alert and responsive or neurovegetative? ( semi comatose in bed) The United States is incredibly expensive with average rates for chronic care guaranteed to be $1000/d or higher, just for baseline supportive care. You might be better investigating countries like Malaysia where US trained doctors have fled in an attempt to lower costs. Where the standard of care is as good or better. Please get back to me with more information and I will reply. Or if satisfied please remember to rate my service by clicking on the rating stars as that is how I am compensated for this work. Thanks. Dr Frank

Customer: replied 9 months ago.
Thanks Dr. Frank.- About 5-6 years, may its physical recovery only then as there is some numbness in his left hand and leg.- About functional status: no functional activities by himself. He can sit/stand with people help and support. Spoon feeding by his family members.- Does he have language function?: Yes.- Is he alert and responsive or neurovegetative?: Most neurovegetative but when you ask any questions he responds back and most of the times accurate answer.ABOUT brain injury:CT scan Brain revealed: acute SDH with pneumoencephalus on right fronto-temporal convexity. Multiple hemorrhagic contusion on both frontal lobe, both temporal lobe, right lentiform nucleus and right ugh parietal lobe with pan ventricular and cistern magna hemorrhagic extension. Mass effect in the form of left sided midline shift 5-6 mms and partial effacement of CSF spaces. Anterior hemispheric fissural and tentorial bleed. Comminuted fracture of frontal bone with displaced and wide open fracture fragments. Fracture of right zygomatic arch and greater wing of right side shphenoid, posterolateral, medial and anterior wall of right maxillary and anterior wall of left maxillary sinus with both maxillary, sphenoid, ethmoid and frontal hemosinus.
Expert:  Dr. Frank replied 9 months ago.

Hi. So the brain injuries are in keeping with his neurocognitive status as you describe it. He might show some improvements with a ventriculostomy given the degree of hemmorhage and midline shift, but if this is an old scan report from the initial trauma ( which he survived) it would need to be repeated before a decision was made on surgery as he may have chronic liquifactive changes which change the brain environment. They did not repair the sphenoid wing and frontal sinus fractures? Let me know how I can help. There are exceptionally good chronic rehabs in the US, especially along the east coast in NYC and Philadelphia. Dr Frank

Customer: replied 7 months ago.
Hi Dr Frank,
I have got his latest medical record (with MRI). Please take a look and let me know your opinion. I also attached his old medical records.New documents are prefixed with "new" and old documents are prefixed with "OLD".