Bullet’s path is key to Giffords’ recovery

By Lauran Neergaard
Associated Press / January 10, 2011

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TUCSON — Recovering from a gunshot wound to the head depends largely on the bullet’s path, and while doctors were optimistic yesterday about the prospects for Representative Gabrielle Giffords, they said it can take weeks or months to tell the damage.

Doctors said the bullet traveled the length of the left side of the Arizona congresswoman’s brain, entering the back of the skull and exiting the front.

Fortunately, it stayed on one side of her brain, not hitting the so-called “eloquent areas’’ in the brain’s center where such wounds almost always prove fatal.

Giffords was responding nonverbally to simple commands in the emergency room — such as “squeeze my hand.’’

That implies “a very high level of functioning in the brain,’’ said Dr. Michael Lemole of Tucson’s University Medical Center, Giffords’ neurosurgeon.

Now her biggest threat is brain swelling. Surgeons removed half of her skull to give the tissues room to expand without additional bruising, Lemole said. That bone is being preserved and can be reimplanted once the swelling abates, a technique the military uses with war injuries, added his colleague Dr. Peter Rhee, a trauma surgeon.

Adding to Giffords’ good prospects is that paramedics got her to the operating room in 38 minutes, her doctors said. Now she is being kept in a medically induced coma, deep sedation that rests her brain. It requires a ventilator, meaning she cannot speak. Doctors periodically lift her sedation to do tests and said she continues to respond well to commands.

The brain’s left side does control speech abilities, and the movement and sensation of the body’s right side, Lemole noted.

The amount of disability depends on how much damage is done to what region of the brain. A bullet that crosses into both sides, or hemispheres, can leave extensive lasting damage.

Lemole wouldn’t speculate on lasting damage, saying, “we’ve seen the full gamut’’ in such trauma.

That’s the mystery of brain injury: There’s no way to predict just how much disability a wound will leave, because our neural connections are so individual.

“The belief is if you get shot in the head, you’re dead, but it isn’t like that,’’ said the University of Miami’s Dr. Ross Bullock, chief of neurotrauma at Jackson Memorial Hospital. He cared for a man shot in the head with an AK-47 who, two years later, is back to work full time and “a normal person.’’

“Every patient is an individual, and more so with a gunshot than anything else,’’ he said.

There are few statistics, but doctors agree that well over 90 percent of gunshot wounds to the head are fatal.

Doctors can’t reverse the bullet’s damage, just remove fragments to fight infection and swelling. Giffords’ surgeons said they didn’t have to remove a lot of dead brain tissue.