Terry Schiavo Report of Autopsy, Full Text as Released by Medical Examiner

Pinellas County Medical Examiner's Office via St. Petersburg Times ^ | June 13, 2005 | Jon R. Thogmartin, MD

[FairOpinion]

Cause of Death: Complications of Anoxic Encephalopathy.

Manner of Death: Undetermined

The persistent vegetative state and minimally conscious state, are clinical diagnoses, not pathologic ones.

(these are all statements from the report)

[tutstar]

Thank you!

[Smartaleck]

Another insult to the brain that can cause injury is anoxia. Anoxia is a condition in which there is an absence of oxygen supply to an organ's tissues, even if there is adequate blood flow to the tissue. Quick Facts about: Hypoxia
A very strong drive resulting from a deficiency of available oxygen in the blood and bodily tissues (short of anoxia)Hypoxia refers to a decrease in oxygen supply rather than a complete absence of oxygen. Without oxygen, the cells of the brain die within several minutes. This type of injury is often seen in neardrowning victims, in heart attack patients, or in people who suffer significant blood loss from other injuries that decrease blood flow to the brain.

Many patients emerge from a vegetative state within a few weeks, but those who do not recover within 30 days are said to be in a Quick Facts about: persistent vegetative state
Quick Summary not found for this subjectpersistent vegetative state (PVS) . The chances of recovery depend on the extent of injury to the brain and the patient's age, with younger patients having a better chance of recovery than older patients. Generally adults have a 50 percent chance and children a 60 percent chance of recovering consciousness from a PVS within the first 6 months. After a year, the chances that a PVS patient will regain consciousness are very low

and most patients who do recover consciousness experience significant disability. The longer a patient is in a PVS, the more severe the resulting disabilities will be. Rehabilitation can contribute to recovery, but many patients never progress to the point of being able to take care of themselves.
http://www.absoluteastronomy.com/encyclopedia/T/Tr/Traumatic_brain_injury.htm

Chances of recovery after a year if at all don't sound very good?

[kozachka]

Smartaleck, I agree. Marmema, I was a bit hasty and absolute in a previous declaration. Your quoted articles do not really apply to the Schiavo situation, though (the first is about misdiagnosis, the second is about traumatic VS, and the third I couldn't find to check on, but applies to small children, not adults, who have much less plastic brains).

This is what the best review article I could find (from the NEJM, and reviewing hundreds of case studies in the literature) on the subject had to say:

Verified and Unverified Late Recovery

Few patients in a persistent vegetative state have undergone a verified recovery of consciousness more than 12 months after a traumatic injury or more than 3 months after a nontraumatic injury. One patient recovered 30 months after a traumatic brain injury; four patients recovered 8 to 22 months after a hypoxic-ischemic or cerebrovascular injury. An additional six patients, described in the study by the Traumatic Coma Data Bank, were reported to have recovered consciousness beginning one to three years after injury. Further investigation of these six patients suggests that only half recovered awareness after one year; one was moderately disabled, and the others had severe disabilities. Two recent studies in adults and children have also reported that a few patients with traumatic and nontraumatic injuries recovered consciousness after the expected intervals. The task force knows of no other cases of verified late recovery.

Several reports in the popular media have described dramatic recovery from a persistent vegetative state. In most reports, recovery of consciousness and function occurred within the time frames noted above. Unusual cases in the medical literature or popular media are poorly documented, the nature of the patients' neurologic condition is unclear, or the timing of the entry into the vegetative state is extremely atypical. A tabular summary of these cases is available from the task force. Several of these reports have been investigated by members of the task force, and it appears likely that, although the patients were not directly examined, a late recovery of consciousness did occur. The total number of such patients is extremely small, however, considering the estimated prevalence of the persistent vegetative state, and all were apparently left with severe disability.

Probability of Recovery

On the basis of the data in the series noted above, we have estimated the probability of recovery of consciousness in adults and children who were in a vegetative state one month after an acute traumatic or nontraumatic injury. The outcome probability at 12 months was determined in patients who remained in a vegetative state at 3 months and at 6 months. In addition, the probability of functional recovery was determined for two possible outcomes: good recovery or recovery with moderate disability, and recovery with severe disability. On the basis of these probabilities, a persistent vegetative state can be judged to be permanent 12 months after a traumatic injury in adults and children; recovery after this time is exceedingly rare and almost always involves a severe disability. In adults and children with nontraumatic injuries, a persistent vegetative state can be considered to be permanent after three months; recovery does occur, but it is rare and at best associated with moderate or severe disability.

[daylate-dollarshort]

Easy there. Einstein's brain weighed 1230 grams. 1300 grams falls into the range of a normal brain. Therefore Einstein's brain was 90- to 95% of normal not three quarters or 75% of normal.

[MarMema]

And your opinion is from related experience, reading on the internet....what?

[bjs1779]

Easy there. Einstein's brain weighed 1230 grams. 1300 grams falls into the range of a normal brain. Therefore Einstein's brain was 90- to 95% of normal not three quarters or 75% of normal.

Yes, but what everyone wants to know is what would Einstein's brain weigh after 13 days of dehydration?

[MarMema]

Your quoted articles do not really apply to the Schiavo situation

Agreed. However you simply asked for instances of recovery.

[bjs1779]

No one ever said she had NO cerebral cortex, did they?

Now that you mention it, they did.

"Dr. Ron Cranford, a neurologist at the University of Minnesota, assessed Schiavo's brain function in 2001 as part of a court-ordered examination. His exam showed that Schiavo's cerebral cortex had been completely destroyed and replaced by cerebrospinal fluid. "

Cranford exaimination

[Smartaleck]

"Few patients in a persistent vegetative state have undergone a verified recovery of consciousness more than 12 months"

I couldn't find it, but another article I read was similar to yours and my previous. In short, if not in 12 months the chances are zip, especially so when it comes to oxygen deprvation, if I have to summarize.

Accordingly, the diagnosis of PVS for Teri was correct and is born out in the autopsy. IMHO

[RedwineisJesus]

"""Einstein's brain weighed 1230 grams. 1300 grams falls into the range of a normal brain. Therefore Einstein's brain was 90- to 95% of normal not three quarters or 75% of normal."""


Kozachka[sp] said that .... "Einstein's brain weighed 1,230 grams, which is less than the average adult male brain (about 1,400 grams)," .... which is somewhere in between your figure and mine, but I let's not squible.

The fact remains that if you took out 75% of Einstein's itsy-bitsy brain, his brain function would still probably be better than both of ours put together.

[Saundra Duffy]

So Terri had half a brain. She was able to breathe on her own and had normal sleep patterns. She was incapable of being mean and nasty; she was better than all of us. She was a joy to her mother and she was the apple of her father's eye. And they killed her. Bottom line.

[Saundra Duffy]

Calling Jim King a liberal - you are much too kind.

[RedwineisJesus]

"""So Terri had half a brain. She was able to breathe on her own and had normal sleep patterns. She was incapable of being mean and nasty; she was better than all of us. She was a joy to her mother and she was the apple of her father's eye. And they killed her. Bottom line."""

I couldn't agree more.

[kozachka]

And your opinion is from related experience, reading on the internet....what?


Medical degree.

What's yours?

[tutstar]

LOL I agree but don't want to ruin my own reputation by using a bad word.

[bonfire]

"Medical degree."

that's gonna leave a mark!

[Smartaleck]

"No one ever said she had NO cerebral cortex, did they?
Now that you mention it, they did."

Not sure where your link got their Crawford analysis/words but here is his direct court testimony and he goes in to quite a bit of detail to describe what he's seeing. He doesn't say it's completely gone but does indicate there isn't much there. What IS there he gives his opinion.
http://home.comcast.net/~trinity_tx/cranfordfelos.htm

cross, recross and other testimony is here
http://home.comcast.net/~trinity_tx/2002transcripts.htm

[bjs1779]

From your first link, I noticed that the court ruled that he was not even qualified to read CT scans which sort of makes his opinion not relevant anyway. Hmmmm...

Considering the amount of talk about her cerebral cortex at the time of Terri's impending death sentence, I would think the M.E. could of been way more specific about the matter. Basically, he just said she had water on the brain ("Hydrocephalus")which is what Doc Hammesfhar said years ago. A not uncommon condition that is very treatable, but her caregivers chose not to intervene.

[bjs1779]

And they killed her. Bottom line.

Nobody can they didn't Saundra. Bottom line.

[bjs1779]

add "say" to my sentence.