The families of my patients admitted to the Neurosurgical ICU often ask me how much brain damage the patient can survive. The short answer is – a lot. A more specific answer – well, it depends, of course.

In reality, most people are able to physically survive massive brain damage. With current technology, we are able to keep “alive” even the patients declared brain dead. What really matters, though, is not physical survival, but the extent of the neurological recovery.

The neurological recovery is more like a spectrum of possibilities. The best outcome would be a complete recovery with a return to the baseline functional capacity. The worst case scenario is for the patient to remain in a comatose state. It is not always possible to reliably predict the extent of the recovery for any given patient. When asked about the prognosis, I often give the family a range of likely possibilities. The most likely outcome in many cases is somewhere in the middle of this spectrum.

Also, when talking about recovery, it is important to look at things from the patient’s perspective. A good recovery in many cases would be for the patient to be responsive and able to communicate, yet not being able to care for him/herself. In most cases this means an admission to a Nursing Home with 24/7 care. This “favorable” outcome is considered unacceptable by many patients. If the patient was fully functional and independent before the admission, being dependent on somebody else’s help with the activities of daily living is a huge compromise to their quality of life. I often hear from the families that their loved one would never want to be in a Nursing Home.

Once we start talking about placing a tracheostomy tube or a feeding tube, the discussion gets even more complicated. The presence of some kind of tube to keep the patient alive is often considered “life support”. Once it becomes clear that the patient would need a tracheostomy tube to breath or a feeding tube to receive nutrition, it often changes the tone of the discussion. Being unable to eat naturally, for example, and, thus, require a feeding tube is a major set back in the quality of life for many patients.

Physicians look at multiple factors while trying to predict the likely neurological outcome for any given patient. I often tell the families of my patients that everybody is different and such is the outcome. The mechanism and the extent of the brain injury are the most important factors to consider. Head injured trauma patients have a relatively good prognosis, depending on the severity of the injury, of course. The patients surviving an anoxic brain injury (brain injury due to a lack of blood flow and oxygen supply to the brain) after a cardiac arrest have worse prognosis. Other factors like the patient’s age and the preexisting conditions affect outcome as well.

In conclusion, when discussing the extent of the brain damage and the possibility of the recovery, it is important to look at things from the patient’s perspective. Recovering some brain function and regaining consciousness would be considered a very good recovery after a massive brain injury. From the patient’s perspective, though, anything less than a completely independent living is often unacceptable.