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    Gabrielle Giffords' Brain Injury: FAQ

    Giffords Recovering from Point-Blank Gunshot to Head

    How bad is Giffords' brain injury?

    It's a very, very serious wound. About 90% of people shot in the head do not survive, David Langer says.

    But there is much reason for hope in Giffords' case.

    Giffords' neurosurgeon, Michael Lemole, MD, says his patient is able to understand simple commands -- such as "Show me two fingers," and "Wiggle your toes" -- and to perform these tasks.

    This is heartening news, says Eugene S. Flamm, MD.

    "The fact that she is being described as able to follow commands, when they lighten up on her medications, that is encouraging," Flamm says. "But I don't know whether this injury means she is paralyzed on the right side: That is a very important issue. If she is not moving her right side, that makes it hard to imagine good recovery."

    It now appears that Giffords can indeed move the right side of her body, although the extent to which she is able to do this remains unclear.

    The biggest issue facing Giffords is that she has suffered what Flamm calls "sort of the ultimate traumatic brain injury."

    Brain tissues bruised by the force of the bullet continue to swell for days after the original injury. Such swelling can kill even more brain cells than those destroyed by the original injury.

    "The problem with swelling in the brain is it is inside the skull, a closed cavity. If the pressure from the swelling reaches the arterial blood pressure, you no longer get blood flow to the brain and the brain is starved of blood," Black says. "Then you get collateral death of tissues surrounding the bullet wound itself."

    This swelling, Flamm says, continues for about five days -- and usually is worst on the third day after the injury.

    To reduce the swelling:

    • Giffords' doctors removed a section of her skull.
    • Giffords' doctors put her into a medically induced coma.
    • Steroids can be given to reduce swelling.
    • A concentrated sugar solution can be given to draw fluid out of the brain.
    • Hyperventilation via a respirator can keep brain cells from starving of oxygen.

    These efforts appear to have been extremely successful. Giffords is no longer in critical condition and has survived the critical period for brain swelling.

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