Posted on 03/23/2005 7:08:47 AM PST by Fury
THIS BRAIN IS NOT THAT BAD
Thanks to reader "primer" I've been directed to the University of Miami Ethics program website where they posted this image from a CT scan of Terri Schiavo's brain in 1996. The sentence attached to the link for this scan on the site says:
CT scan of Ms. Schiavo's brain, showing extensive cortical regions filled with spinal fluid.
If you go to this link you can see the scan in a larger reproduction.
A COURT OF MEDICAL LIGHTWEIGHTS WEIGH IN ON TERRI'S CT.
The Second District's first opinion in this case explained:
Since 1990, Theresa has lived in nursing homes with constant care. She is fed and hydrated by tubes. The staff changes her diapers regularly. She has had numerous health problems, but none have been life threatening.
Over the span of this last decade, Theresa's brain has deteriorated because of the lack of oxygen it suffered at the time of the heart attack. By mid 1996, the CAT scans of her brain showed a severely abnormal structure. At this point, much of her cerebral cortex is simply gone and has been replaced by cerebral spinal fluid. Medicine cannot cure this condition. Unless an act of God, a true miracle, were to recreate her brain, Theresa will always remain in an unconscious, reflexive state, totally dependent upon others to feed her and care for her most private needs.
First, I contest the theory that Terri's brain actively continues to degenerate as implied by the above statement. How could they gage serial brain degeneration without serial follow-up? And by what mechanism would her brain CONTINUE to atrophy? Second, Terri's cerebral cortex has not been replaced by fluid. That is inaccurate. The cortex is thinned and the sulci are enlarged. There is a difference.
Third, and most importantly, given the amount of atrophy on this image I disagree with the court's inadequately considered conclusion.
My Grandmother's Brain -- OK -- But Would I Stop Feeding My Grandmother?
First of all, the University of Miami's appellation for this scan is inaccurate. "Cortical regions" are not and can not be filled with spinal fluid. The sulci (spaces between cortical ribbons) are enlarged secondary to cortical atrophy and these sulci are filled with cerbrospinal fluid.
The most alarming thing about this image, however, is that there certainly is cortex left. Granted, it is severely thinned, especially for Terri's age, but I would be nonplussed if you told me that this was a 75 year old female who was somewhat senile but fully functional, and I defy a radiologist anywhere to contest that.
I HAVE SEEN MANY WALKING, TALKING, FAIRLY COHERENT PEOPLE WITH WORSE CEREBRAL/CORTICAL ATROPHY. THEREFORE, THIS IS IN NO WAY PRIMA FACIE EVIDENCE THAT TERRI SCHIAVO'S MENTAL ABILITIES OR/OR CAPABILITIES ARE COMPLETELY ERADICATED. I CANNOT BELIEVE SUCH TESTIMONY HAS BEEN GIVEN ON THE BASIS OF THIS SCAN.
The worrisome, no alarming thing, for me, was that I heard a bioethicist and several important figures on the major media describe Terri's brain as MUCH WORSE. One "expert" said that she had a "bag of water" in her head. Several experts described her as a "brain stem preparation"
These statements are wholly inaccurate. This is an atrophied brain, yes, but there is cortex remaining, and where there's cortex (?life) there's hope.
If you starve this woman to death it would be, in my professional and experienced medical opinion, the equivalent of starving to death a 75-85 year old person. I would take that to the witness stand.
All That Glitters is a SHUNT
Next mystery: Why is there a shunt in Terri's ventricle? This CT image is "flipped" (i.e. the CT scan is mirror-image backwards which is just an inconsequential error made when scanning the image into the computer), so the right side is LEFT and vice versa. However, everyone can see, easily, the ovoid white object sitting in the front of the big black butterfly in the center of Terri's brain, correct?
That shining object is the tip of a shunt. A shunt is a tube inserted into the brain to reduce pressure caused by build-up of cerebrospinal fluid (CSF) in the brain. That big black butterfly in the middle of Terri's brain is her ventricular system, which holds the CSF and in Terri's case, it is enlarged (dilated).
Now...why was Terri being shunted in 1996? First, if Terri's brain damage was due to oxygen deprivation, her enlarged ventricles would be by a passive mechanism -- which is not amenable to shunting -- not by obstruction of the egress of CSF. To me, the presence of a shunt indicates obstruction to the flow of CSF that needs to be circumvented. Obstruction to flow is hard to postulate given the mechanism of Terri's brain injury (oxygen deprivation).
It would NOT be hard to postulate, however, if she had BLOOD in her head at some point in the past. So did she? Was there a history of trauma? I would like to see the BONE SCAN taken of Terri that purportedly showed evidence of traumatic type osseous uptake!
It is quite unusual to see high-pressure hydrocephalus when the mechanism of brain injury was INFARCTION; and, more so six years after the event.
So
IS THIS REALLY TERRI'S CT?
IF it is then her atrophy is SEVERE, BUT not as bad as has been implicated by the press and the courts
IF it is then why did she have hydrocephalus six years after her non traumatic infarction
IF it is... why was she shunted...AND IS SHE STILL shunted? IF not, why was the shunt removed?
IF it is, why does the Second District Court NOT mention Terri's hydrocephalus in it's dissertation on Terri's woeful cerebral condition??
IF Terri DOES have hydrocephalus from ventricle blockage, was there trauma that caused bleeding that lead to hydrocephalus on the basis of a blood clot obstructing ventricular outflow?
IF so, what was that trauma?
IF Terri had hydrocephalus in 1996, she may still have hydrocephalus now; some patients with hydrocephalus respond to shunting with increased mental functioning!
IF THIS IS NOT TERRI'S CT THEN WHERE IS HER CT?
Based on this evidence Terri Schiavo should have a CT scan repeated. She should also have an MRI and a PET scan to gage the severity of her brain dysfunction.
IF THIS IS TERRI'S CT OF THE BRAIN, SOMETHING MAY BE VERY WRONG
An interesting read, but then I'm not an MD...
I repeat, when a "husband" finds another love and they produce children, he no longer should fit the legal guardian role. If anything comes of this, at least let's redefine what a spouse it. How would you like your soon to be ex spouse making this decision? I know of a woman who inherited several $100,000 when he husband was killed in an car accident. The divorce wasn't finalized, therefore, she received his life insurance, etc. Because he hadn't taken time to make changes. This could be such a case.
I saw this yesterday. It was a interesting read.
Just a suggestion we keep all information in perspective.
This CT is devastatingly abnormal. Make no mistake about it, grandmom's cortical atrophy looks nothing like this! Shunts are placed for a variety of reasons, not all for obstruction to flow.
No, no. Didn't you know? The new rules are that you are supposed to believe everything you read on the internet, but nothing you read in court documents.
As you said, there's no way to even know if there guy is a doctor.
I'm a vet and I don't appreciate the ignorance of your comment. It's incredibly tougher to get into med school than vet school - if someone flunked out of med school, they sure wouldn't get into vet school. Chump
that should read, "incredibly tougher to get into vet school than med school". I was so ticked off, I misstated it.
"About Me
Contact Website:
One-Line Bio
An M.D. holding defibrillator paddles at the emergency CPR of American health care.
Biography
An M.D. graduate of Columbia University College of Physicians and Surgeons.
After a medical internship and a year in the emergency room at Jacobi Hospital in the Bronx, did a four year Radiology residency at The New York Hospital-Cornell Medical Center.
Spent the last 15 years as a 24/7/365 inpatient radiologist in South Florida."
Now that's what I call informative Doc.
We have only seen one film, is that correct? Where did it come from? How do we know it's authentic. Can a diagnosis be made on having one 'slice' of the brain?
Facts, schmacts.
Oh please...
I know one person (not sure where he went to medical school), but he went to Ross and obtained his DVM.
I use the services of DVM's for my business and some of THEM joke about vet school vs. med school. That does not make THEM chumps - maybe they just have a sense of humor.
I agree, trusting that is even Terri's CT scan is a leap of "Dan Rather" type faith. I won't trust any data that is not from a team in a reputable hospital..
You're an anti-vetite!
Apparently. The DVMs I work with have saved the lives of many animals. I'm also appreciative that they are personable...
I was a legal assistant for 17 years, most of it in Florida. If you had a person of diminished capacity, the VERY first thing a judge would do is order the appointment of a guardian ad litum even if family had all the appropriate powers of attorney and were otherwise appointed guardian. MS has other interests that present a possible conflict with Terri's best interests. The fact that the judge has failed to appoint a permanent guardian ad litum to avoid the very appearance of conflict baffles me every time I think about this situation.
Our legal system has two parts (i) law and (ii) equity. The "equity" part if where we get some of the flakier legal rulings that stretch the law to improbable limits. In this case "equity" would seem to indicate that Terri should have a guardian ad litum to represent her until the day she dies (hopefully by natural means) and beyond until her estate is settled. This judge's rigidity and blindness are frightening.
Bump for later
GO ILLINI!
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