Tuesday, February 08, 2011


Giffords case shows remarkable healing of the brain

Over the past several weeks, the world has been witnessing a remarkable example of modern trauma care, neurosurgical treatment and rehabilitation.

On Jan. 8, Arizona congresswoman Gabrielle Giffords was the victim of an assassination attempt. The assailant shot her in the head at close range. This was followed by a succession of medical interventions that continue to unfold.

The gunshot entered the skull and went through the left side of the brain before exiting. The trajectory of the bullet avoided many of the major blood vessels that are more vulnerable when the projectile moves from side-to-side.

Rapid emergency response to the scene allowed for control of blood loss and maintenance of respiratory function. Amazingly, Ms. Giffords was reported to have been in the operating room only 38 minutes after being shot. This short transition time from site of injury to OR is because she was brought to a trauma center where protocols have been designed and rehearsed that allow for rapid care and make the necessary neurosurgical resources immediately available.

Many of the protocols used today have been developed in response to battlefield injuries from various explosive devices.

The two biggest challenges in a penetrating head injury are bleeding and swelling. In response to any trauma, tissue swells. An example would be a sprained ankle. The accumulation of fluid at the site of injury causes the surrounding skin to expand. When swelling occurs in an enclosed space like the skull, pressure builds and forces the brain downward toward an opening in the base. This “herniation” often results in death.

In addition to the use of diuretics, the most immediate way to relieve a potentially life-threatening increase in intracranial pressure is by removing the skull over the area of injury. This allows the brain to expand freely. After the swelling is controlled, the skull can be replaced at a later time.

Despite the remarkable emergent treatment received by Ms. Giffords, the rapid introduction of rehabilitation in the first week after injury and transfer to a rehabilitation facility within three weeks of injury is astonishing.

Recent studies have shown that the early establishment of physical, occupational and speech therapy programs for neurologic injuries is imperative for successful recovery. The brain possesses an incredible ability to redirect nerve fibers and networks. This process, known as neuroplasticity, can help resume function previously performed by nerve cells that were destroyed.

The early institution of rehabilitation is an important first step down a long road to recovery after brain injury. The world will be closely watching as Congresswoman Giffords makes this journey.

To learn more about this topic visit www.backushospital.org/multimedia. Anthony G. Alessi, MD, is Medical Director of The William W. Backus Hospital Stroke Center and in private practice at NeuroDiagnostics, LLC, in Norwich. If you want to comment on this column or others, visit the Healthy Living blog at www.backushospital.org/backus-blogs or e-mail Dr. Alessi at aalessi@wwbh.org

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