Landov
April 22, 2015 07:35 PM

In the nearly three months since Bobbi Kristina Brown was found unresponsive in her bathroom, the medical details surrounding her condition have been murky – particularly as her family offers conflicting accounts of her current state.

On Monday, Brown’s grandmother, Cissy Houston, told PEOPLE that her 22-year-old granddaughter has "global and irreversible brain damage". The statement followed recent comments by Bobby Brown that his daughter was "awake" and “watching” him.

To bring clarity to Brown’s case, PEOPLE spoke to Dr. Subhashini Ramesh, an assistant professor of neurology at Georgia Regents University. Dr. Ramesh, who has not treated Brown, is a neuro-critical care specialist. With each passing day, Brown’s chances of making a “meaningful” recovery diminish, says Dr. Ramesh. “If she has irreversible brain damage, it’s unlikely she will ever live an independent life and have some ability to care for herself.”

What does "global and irreversible" mean in regard to brain damage?

Global refers to motor function, eye movement, vocal response, all of that. Usually the longer the patient remains in this type of state, it’s less likely they’re going to make any meaningful recovery. That’s what it all boils down to: If [Bobbi Kristina] has irreversible brain damage, it’s unlikely she will make a meaningful recovery.

What type of brain injury might she have sustained?

It’s possible she suffered cardio-pulmonary arrest with what’s called hypoxic ischemic brain injury. It’s a lack of blood supply and oxygen to the brain. Even just for a few seconds, that lack of supply can be very devastating. It usually results from either cardiac arrest, poisoning or sometimes head trauma.

Do patients with this type of brain injury usually survive?

In the past, say 20 or 30 years back, we didn’t have this kind of life support. But now that resuscitative techniques and artificial life support has improved, we have patients who’ve survived but have varying degree of brain injury.

Cissy Houston said her granddaughter is no longer in a medically induced coma. What does that mean?

She may have been hypothermized as part of new guidelines in the past 10 years or so. There has been a move toward cooling these patients down to about 32 degrees centigrade [about 89 degrees Fahrenheit], which is supposed to protect the brain. No one wants to be aware of being that cold, so when patients are hypothermized, they have to be sedated. It’s called “medically induced coma” when you are on sedative medication.

If she is no longer in the medically induced coma, it means they no longer have to give medications to sedate her. She probably only has a tracheostomy in her neck and a feeding tube in her gut.

Can a patient have a tracheostomy but no longer require a ventilator to breathe?

Yes. Patients may breathe on their own through the tracheostomy incision in the neck. But we have patients come off the ventilator who are still not able to make a recovery from a coma.

What are the different types of comatose states?

Coma means unarousable and unresponsive. Those two words define coma. From a comatose condition, patients usually progress to either a minimally conscious state with increasing independence or to a persistent vegetative state.

In a vegetative state, you can be still be wakeful but have no awareness. Your eyes may open but you remain unaware of yourself and your environment. That’s possibly what [Bobbi Kristina] is. There is an absence of any sign of conscious perception. If it goes on for more than three months, it’s called a permanent vegetative state.

In a minimally conscious state, there’s minimal but clear evidence of some awareness of yourself or your environment. You might follow simple commands or issue a response. There can sometimes be purposeful behavior. In these patients, improvement is more likely. From what I’m gathering, I don’t think [Bobbi Kristina] is in a minimally conscious state.

Who makes medical decisions for a loved one in a vegetative state?

When you are in a coma, the initial concern is if you will progress to brain death. If you progress to brain death, nobody makes a decision. The patient is disconnected from the ventilator by law because they are essentially declared dead.

But once you don’t meet the brain death criteria, as time goes on and the patient is still alive, the decision to continue care depends on the medical power of attorney: first spouse, then parent, then sibling.

How long can someone remain in a permanent vegetative state, and is it possible to "wake up" from such a state?

It can go on for years. Typically, you don’t just go from a permanent vegetative state to waking up the next day.

If she were to "wake up," what would her chances be of making a full recovery?

Even if [Bobbi Kristina] were to wake up and show some awareness, she’s still going to have significant effects from this. It’s unlikely she’s going to make any meaningful recovery or be able to lead an independent life.

What are the long-term care options for patients in a permanent vegetative state?

Typically families will recognize this is not the quality of life your loved one would want. In other words, if your loved one could make the decision themselves, they would not want to live like this, and given the choice, you want to keep them comfortable.

At that point you could consider hospice, where the philosophy is to be comfortable. Even food in the gut is considered uncomfortable. So they would stop these life-sustaining measures, including fluid and a feeding tube. If a patient is struggling for air, they do morphine and a little bit of oxygen at most. It’s comfort. If they have excess drooling, they’ll give them medications to reduce secretions. The objective is to keep the patient comfortable.

If Bobbi Kristina’s family decides against hospice, where might she end up?

Eventually if she doesn’t show any signs of recovery, she would have to go to a nursing home, but this family is a little different because they have resources. They could maybe even take care of her at home with 24-7 aides. She could remain that way for years.

More on Bobbi Kristina Brown:

Bobbi Kristina Brown’s Aunt Claims People ‘Lust’ Over Her Niece’s Fortune and Want to Do Her Harm
Bobby Brown on Daughter Bobbi Kristina’s Condition: ‘God Is Hearing Our Prayers’
Cissy Houston: Bobbi Kristina Brown Has ‘Irreversible Brain Damage’ and ‘Remains Unresponsive’
Bobbi Kristina Brown’s Condition ‘Has Not Changed,’ Says Source
Bobby Brown Tells Crowd: Bobbi Kristina ‘Is Awake’Bobby Brown Rushes Back to Bobbi Kristina’s Bedside Following First Public Appearance
Bobby Brown Acknowledges ‘Rough Times’ in First Appearance Since Bobbi Kristina’s Hospitalization
Bobbi Kristina Brown’s Boyfriend Nick Gordon ‘Is Responding Well’ to Rehab, Source Says
Bobbi Kristina Brown: Inside the Family’s Plan for the Future
What Bobbi Kristina Brown’s Life Is Like Now
Cissy Houston Breaks Silence on Bobbi Kristina: ‘There’s Not a Great Deal of Hope’
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