Polybius, I hope you don't mind but I think your comments are most instructive to the layman. I work in the diagnostic imaging flield and had not seen her CT before. My impressions from reading about it were that it was much worse than this image implies, though she obviously has major loss. But at this level, wouldn't PET and MRI be indicated before making life and death decisions?
Thanks for a good post.
To: neverdem; Servant of the 9
The dark area is supposed to be liquid, gone, missing Is there someone on here who really knows how to read this thing?
IIRC, one of you is a radiologist. Can you offer any opinion from one slice of Terri Schiavo's CT scan?
Sorry for the late reply. I did not log in on Saturday.
The "dark areas" are the CT density of Cerebral Spinal Fluid (CSF).
The larger butterfly-shaped area in the center is CSF within the right and left lateral ventricles. The other serpiginous areas are CSF in the subarachnoid space collecting in the sulci and in the fissures of the brain.
The amount of fluid in the vetricles is increased indicating Hydrocephalus.
The bright area within one of the ventricles would be expected to be a portion of a Ventriculoperitoneal Shunt to alleviate the hydrocephalus.
The brain tissue also shows cortical atrophy which increases the potential space between the brain tissue and that space is the filled up with CSF.
The degree of atrophy increases with age and all of us who actually lived through the 60's have some degree of cortical atrophy. The degree of cortical atrophy, however, is definitely abnormal for a woman her age
Be that as it may, you really can't make any clinical judgments as to her mental capacity just by the degree of hydrocephalus and atrophy.
I often see patients with that degree of hydrocephalus with a ventriculoperitoneal shunt in place that are doing just fine.
In addition, many elderly patients with that degree of atrophy that are doing well for their age.
Grandma might not be the sharpest pencil in the family box anymore once she gets to that degree of atrophy but you would be killing off trainloads of Grandmas if you used that degree of cortical atrophy to decide when to end their lives.
I'm glad you brought this up, here's a big dilemma nobody wants to talk about. When my mother was in the hospital, she was very ill. My mother is 80 years old. It turns she had some big infections which were treated. After they did the brain scan, one of the Doctors approached me and told me he suspected hydrocephalus and he explained the shunt procedure and told me he performed one on a 90 year old person the month before.
We thought about it, and with her situation, our family Dr. and I decided it wasn't a good idea for her.
My mother, like all 80 year olds, is covered by Medicaid. If 80-90 year olds start getting this procedure, how on Earth can this country sustain the costs. I'm assuming it's a very expensive operation. I know this isn't a popular thing to talk about, but it's necessary. Just because we can doesn't mean we should.
Polybius, I hope you don't mind but I think your comments are most instructive to the layman. I work in the diagnostic imaging field and had not seen her CT before. My impressions from reading about it were that it was much worse than this image implies, though she obviously has major loss. But at this level, wouldn't PET and MRI be indicated before making life and death decisions? Thanks for a good post. Those of us in the diagnostic imaging field know what the cerebral cortex looks like after it is lost from infarct.
CT scan showing a massive infarct within the brain territory supplied by the right middle cerebral artery. (The "Right" on an X-Ray is on the left-hand side as if you are facing the patient.)
There has been much simplification of this case in the news media and from politicians who have no clue as to what they are talking about.
I have no idea what her actual condition is. All I know is that you can't make a rational clinical decision on an incomplete medical workup and on medical data that is a decade old.
In the absence of cortical destruction as seen in the above CT, no single radiologic test will be the final say in this case. A neurologist would be better able to say which battery of tests would give the most accurate assessment. However, it needs to be a neutral neurologist and, preferably, a team of neurologists, without a dog in this fight who would treat Terri as he would treat any other brand new patient under their care.
What you have to realize about legal medical opinions is there are "Doctor Whores" who will, for an appropriate fee, testify for or against whatever medical opinion you want to hear.