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Gabrielle Giffords' Brain Injury: FAQ

Giffords Recovering from Point-Blank Gunshot to Head

How bad is Giffords' brain injury? continued...

"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.

Why was part of Giffords' skull removed?

After removing bone fragments from Giffords' brain, her doctors also removed a large section of her skull. This was done to give her bruised brain some room to swell.

If the bone had not been removed, the pressure inside her head might have built up to the point where it starved the brain of blood.

"You take the skull up, but you still have the scalp covering the brain," Black says. "Then once the swelling goes down you can go back and put in an artificial skull plate or even the skull piece itself. But most of the time in a head injury you don't keep the bone, because it is contaminated with hair and bullet. So you come back about four weeks later and replace it with acrylic bone plates."

What would be the signs that Giffords' condition is getting worse?

In the short term, brain swelling was Giffords' most serious threat. That threat now is greatly reduced.

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