Doctors Monitor Rep. Giffords' Brain For Swelling

Doctors treating Rep. Gabrielle Giffords say they have been encouraged by her progress so far. They say it appears the bullet that passed through the left side of her head did not damage the most critical parts of her brain.

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And now for an update on Congresswoman Gabrielle Giffords. Doctors treating her say they have been encouraged by her progress so far. They say it appears the bullet that passed through the left side of her head did not damage the most critical parts of her brain. NPR's Jon Hamilton reports that neurosurgeons watching the case say Giffords has a chance of recovery if she remains stable for just a couple more days.

JON HAMILTON: During a press conference at University Medical Center in Tucson yesterday, doctors said Giffords' condition hadn't changed, and that was a good thing. Dr. Michael Lemole is one of the surgeons who operated on Giffords. He says she was continuing to respond to the sort of simple commands that test a patient's ability to communicate.

Dr. MICHAEL LEMOLE (University Medical Center): It could be showing us their thumb, perhaps two fingers, gripping a hand, wiggling toes. All of those are simple commands that she can do even though, for example, she has a breathing tube in place that would preclude more complex communication.

HAMILTON: That's remarkable with the type of injury that's usually fatal.

Neil Martin, the chairman of neurosurgery at UCLA, says it means the initial damage from the bullet wasn't nearly as bad as it could have been.

Dr. NEIL MARTIN (UCLA): You know, there are about as many favorable signs so far as one could have when dealing with a gunshot wound to the brain.

HAMILTON: But Martin says that in public remarks the doctors treating Giffords have avoided addressing certain questions.

NEIL MARTIN: What we have not heard is whether or not she has any movement in the right arm or hand. That is critically important, because the right arm and hand control centers are close by, adjacent to the critical language centers in the left cerebral hemisphere, and that apparently was the area impacted by the bullet.

HAMILTON: Martin also says that Giffords is still in the time period when patients with brain injuries can get worse quickly.

Dr. MARTIN: Although the prognostic signs for survival are good, there still is a possibility that despite the best possible medical care, some serious complication could arise and be very, very critical.

HAMILTON: The biggest concern is usually swelling of the brain.

Henry Brem, the chief of neurosurgery at Johns Hopkins Hospital in Baltimore, says that can cause two different problems.

Dr. HENRY BREM (Chief of Neurosurgery, Johns Hopkins Hospital): The swelling in and of itself could be a problem because if it's compressed in a thick skull then it can cause damage to the brain. But even more significantly, if the brain swells, then it can have difficulty getting enough blood and then you can have secondary strokes.

HAMILTON: The doctors treating Giffords have tried to head off these complications by temporarily removing a part of her skull. That gives her brain some room to swell. But Brem says there are other risks too, including bleeding, blood clots, infection and seizures.

Dr. BREM: Seizures can occur in any surgery. Any kind of injury to the brain there's a 4 or 5 percent risk of having a seizure.

HAMILTON: That's rarely a fatal problem, though.

Jonathan Jagid, a neurosurgeon at the University of Miami, says what happens to Giffords next will depend largely on her doctors' ability to keep their patient stable for at least another couple of days.

Dr. JONATHAN JAGID (Neurosurgeon, University of Miami): The strategy now is just to very aggressively keep the pressure inside the skull at a normal level.

HAMILTON: Until the risk of swelling begins to go down.

Dr. JAGID: As long as they can keep that under control, that in conjunction with her initial exam being as good as it was, I think it's likely that she can make a very reasonable recovery from the injury.

HAMILTON: But neurosurgeons say a reasonable recovery rarely means a complete recovery. Most people who suffer gunshot wounds to the head and survive have some long-term problems. These may include memory lapses, difficulty with speech, loss of vision, and weakness or paralysis on one side of the body.

Jon Hamilton, NPR News.

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