Q: My uncle has a clot on the left side of the mid brain. He is in the ICU for the past 5 days. His condition is not improving. How much time will he take to recover? What are the possible chances of his recovery?

A:Your uncle has suffered ischaemic stroke involving right side of his midbrain. Mid brain (upper part of stalk of brain) is a vital structure of brain linking the two hemispheres (two big brains) to the lower stalk and two cerebelli (little brains) and spinal cord. It contains tracts that carry information, from and to the brain. It also has tracts, which carry information for wakefulness and sleep. Also, it has certain special cells, which control the functions of our eye movements and eyelid functions. Further, all these structures are tightly packed within a small area (midbrain is pretty small compared to other parts of brain). Therefore, a small area of infarction (dead brain cells due to lack of blood supply resulting from clot cutting the supply off) can cause significant impairment of functions. However, these depend upon many factors like age, rapidity of infarction, general body conditions and haemodynamic factors like blood pressure and cardiac status at that time. It is difficult to predict the time for recovery and degree of recovery. A rough estimate can be derived by noting the clinical condition and all other variables as described above. Within 3 hours of having ischaemic stroke, agents can be given to melt the clot. However, once the infarction is established, supportive treatment to take care of general condition, preventive treatment for occurrence of subsequent stroke and prevention of complications are the mainstay of treatment.