Doctors at Arizona University Medical Center are"cautiouslyoptimistic" about Representative Gabrielle Giffords' recovery from thegunshot that struck her on Saturday.
Rep. Giffords (D-Ariz.) was shot in the left side of her head, wasresponsive to voice commands after the shooting and was in the operatingroom within 38 minutes, according to a statement from the MedicalCenter.
A person's chances of surviving such a trauma to the brain depend onthe areas of the brain that are struck, the velocity of the bullet andwhether the bullet exits the brain, said Dr. Keith Black, chairman ofneurosurgery at Cedars-Sinai Medical Center in Los Angeles.
If a bullet passes through both the right and left hemispheres of thebrain, instead of being confined to one side, as it was in the case ofRep. Giffords, then the damage is likely to be much worse, Black said.
"Thebrain is somewhat redundant- it can sometimes tolerate losing one half," Black said. Like atwin-engine plane that has lost one engine, he said, a person whosebrain was pierced by a bullet on only one side has a better chance thansomeone who has suffered injury to both sides.
It's also a positive sign if the bullet misses the brain's"high-value real estate," such as the brain stem and the thalamus, Blacksaid. These deepbrain structuresare crucial to consciousness and basic functions such as controllingbreathing and the heartbeat. And a person has a better chance ofrecovering if the bullet misses the major blood vessels that bringoxygen to areas where it's needed.
The left side of the brain, where Giffords was struck, controlslanguage and speech, so the fact that Giffords was responding to thosespeaking to her after her injuryshows that she may be able to understand and process language - a very good sign for her recovery, Black said.
A bullet that misses the brain's ventricles - the cavities within thecenter of the brain that are filled with cerebrospinal fluid - alsoleaves a person in better shape than one that strikes these regions. Ifstruck, the cavities may fill with blood, which may lead tocomplications such as hydrocephalus (a swelling of the brain), which canfurther endanger the victim.
The speed of the bullet as it travels through the brain makes a difference as well.
"A high-velocity bullet does more damage than a low-velocity bullet,"Black said. High-speed bullets, such as those fired by an AK-47 orother military weapon, do more peripheral damage to theregions of the brainaround their path as they pass through than slower-moving bullets, such as those fired by handguns.
And,"if it stays in the brain, it does more damage," Black said,than a bullet that exits the brain, as it did in Rep. Giffords' case.
A shooting victim stands a better chance if they don't stop breathingand if their blood pressure remains high enough - both functions areneeded to maintain an adequate oxygen supply to the brain. Arriving at aLevel 1 trauma center - the highest level and most prepared to providecare for such injuries - shortly after such a trauma can help maintainor sometimes restore these functions, Black said.
The medical team treating Giffords removed part of her skull, andBlack said this allows the brain to swell without becoming compressed.
"Inside the skull, the brain is like jello in a jar," Black toldMyHealthNewsDaily."If it doesn't have any place to expand, there can beeven more damage. Confinement can prevent blood flow."
Later, when the swelling subsides, the part of the skull that wasremoved is replaced, he said. Swelling often peaks on the third dayafter such an injury, but in Rep. Giffords' case, doctors may wait aslong as several months to replace the bone, he said.
"With a gunshot wound, they may be worried that the bullet brought inbacteria. They may want to make sure there's no evidence of infectionbefore they replace the skull," Black said.
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- Original Story:What Does It Take to Survive a Bullet to the Brain?
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