How neurosurgeons size up brain injuries like Giffords'

January 10, 2011

Jon Hamilton

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With Rep. Gabrielle Giffords hospitalized in Tucson, Ariz., after Saturday's shooting, we checked in with some leading neurosurgeons for insights into her condition and what the future might hold.

You'll be able to listen to Jon Hamilton's report on Monday's All Things Considered and Tuesday's Morning Edition. Here are excerpts, edited for length and clarity, from interviews done for the pieces.

Dr. Keith Black, chairman of neurosurgery at Cedars Sinai Medical Center, Los Angeles.

Q: The trajectory of the bullet through Giffords' brain appears to have been higher than initially thought. Why would that be a good sign?

A: The language areas are lower down. There's one in the left temporal lobe, which is responsible for comprehension of language, and there's another area in the lower frontal lobe, off to the side, that's critical for expression of language. If the bullet is high, then it can avoid those two areas. The one caveat with the bullet being higher is that the motor areas can be high, particularly the motor areas that control the legs.

Q: What should we watch for in the next few days?

A: The maximum amount of swelling typically occurs three days after injury. Tomorrow (Tuesday) is going to be an important day to make sure she doesn't get into any increased swelling issues or any pressure issues. After that things should start to stabilize and improve. If she hasn't had any new bleeding by this time that's also a very positive sign. The next big step for her is going to be getting off the respirator. When they wake her up and see if she can support her respirations.

Q: Have you treated patients who have an injury like this and seen them walk out eventually in pretty good shape?

A: Absolutely. The fact she got immediate care, got to the CT scanner, and got neurosurgical attention right away is very positive.

Dr. Henry Brem, chief of neurosurgery at Johns Hopkins Hospital, Baltimore.

Q: What can you say about the course of care for patients with injuries like Giffords'?

A: When someone comes in and they're alert and following commands, there's the hope they survive the injury and get through successfully. The fact that the person is awake and alert coming into the emergency room is a very good prognostic sign.

Q: What's the most important factor?

A: It's all about what damage was done. Clearly what you hope for is that the bullet is as superficial as possible. The bottom line is the functions. If someone is able to talk or follow verbal commands then that means you have  understood spoken language, processed it and turned it into a function -- into doing something to follow that command. That, in and of itself, tests a great deal of the brain.

Q: What lies ahead for Giffords?

It's a terrible injury to have. But, given that, the longer that she's alive and the longer she has encouraging signs, the more encouraging it is for the future. The best predictor for how she's going to do is how these next few days unfold.

Dr. Jonathan Jagid, assistant professor of neurological surgery, Miller School of Medicine, University of Miami.

Q: What sorts of things are doctors treating Giffords looking for?

A:  Whenever you've got an injury to the brain or any part of the body it swells. The difference between your arm swelling and the brain is that the brain is in a closed compartment. Once the damage has been done from the bullet, the only thing you're trying to prevent from there on out is what's called secondary injury from swelling of the brain. Copyright 2011 National Public Radio. To see more, visit