In early January in Tucson, Arizona, a madman shot Congresswoman Gabrielle Giffords in the head. Although the bullet passed through her skull, the doctors managed to save the politician’s life, and the rehabilitators give her a chance to walk and talk. How is this even possible?
The brain (correctly the brain) is located within the skull and surrounded by three meninges, between which there is the cerebrospinal fluid that absorbs shocks and blows. It consists of two hemispheres, the cerebellum and the brain stem. All stimuli from the body reach him and the information on all vital functions and human activities comes out.
What exactly are the functions of each part of the brain? Let’s start with the trunk. It consists of: medulla, bridge, midbrain and diencephalon. It is surrounded by the meninges that separate the trunk from the cranial cavity. The brainstem in front is connected to the hemispheres of the brain, from the top to the cerebellum, its lower part passes into the spinal cord.
In the brain stem there are key centers responsible for the maintenance of vital functions, including circulation, respiration, body temperature. It is also responsible for the integration of auditory and sensory stimuli as well as reflexes of sight and hearing. The brain stem reticulum is responsible for wakefulness and consciousness.
The cerebellum, the second largest part of the brain, receives information from the organs of movement, vision, hearing, balance and the skin. It controls motor coordination, muscle tone, balance and learning motor behavior.
Finally, the cerebral hemispheres – left and right. The left part controls the right part of the body, the right controls the left part. The cerebral hemispheres are covered with the cerebral cortex, i.e. gray matter. Both hemispheres are divided into four lobes. The frontal lobe is responsible for motor actions, planning and making decisions, analyzing and controlling emotional states, predicting the consequences of one’s own actions and social behavior. The temporal lobe is responsible for speech, hearing, odor analysis, object recognition and verbal memory. Thanks to the parietal lobe, we can integrate movement, feeling and sight, and understand abstract concepts. It is also responsible for spatial orientation, feeling, among others. pain, temperature and touch. In turn, the occipital lobe is responsible for vision, color analysis, movement, depth and visual associations.
8% chance of survival
If our brain is such a precise tool, why did Gabrielle Giffords survive? According to American statistics, 85% of headshots victims die immediately or up to three hours after the incident, another 7% die a few days later, and only 8% of victims have a chance of survival!
The degree of damage to the brain and its severity are important, but it seems that the location of the damage is critical. Destruction of the brain stem means immediate death – this is where the centers of key importance for our functioning are located.
Craniocerebral injuries are traditionally divided into open (e.g., gunshot) or closed (concussion and the resulting contusion of the brain). The former are quite obvious. The bullet pierces the bones of the skull and damages the brain directly. The most important question here is how large parts of the brain are destroyed.
What are closed injuries? During such an event, the fragile brain moves limp inside the skull. It hits it, rupturing blood vessels. The blood begins to pour out uncontrolled into the space around the brain closed by the bones of the skull, and, having no place for a free outlet, it presses on the delicate structures of the brain, causing further damage to it. This condition is called a brain hemorrhage. If a hematoma develops from the spilled blood, it may also rupture unexpectedly, not necessarily immediately, but over time, which will lead to another hemorrhage and, as a result, death.
Brain contusions are almost always accompanied by swelling. The skull, limited by immobile bones, does not change its volume, and a swollen brain swells. This causes hypoxia (which increases the swelling) – and without medical intervention, this means certain death.
All of these factors: brain damage, bleeding and swelling very often go together and can all be deadly.
A blessing in disguise
Gabrielle Giffords was fortunate enough to have the bomber firing at her from the front. So the bullet only passed through the left side of her brain, not both. The second piece of a happy puzzle: her personal doctor was standing right next to the congressman. He immediately started stopping the hemorrhage, which probably saved her life. Giffords was immediately taken to the local university hospital, where a fragment of her skull was removed to prevent the growing swelling from causing further brain damage. It worked – both bleeding and swelling were controlled in this way. After two weeks, she was taken to a hospital in Houston, where physical rehabilitation began.
A marathon, not a sprint
What’s the prognosis? In early March, doctors described her progress as “excellent”. They also argued that Giffords can say what he wants, recognizes the family and realizes that she has been shot. She also began to walk. However, they also added that rehabilitation will be a “marathon, not a sprint” …
What do the experts say? The very good news is that the bullet only passed through the left hemisphere of the brain. If it were flying at an angle, piercing both hemispheres, then the most important centers of the brain could be damaged, including sight. Paradoxically, a gunshot in this case is more beneficial than, for example, a trauma caused by a car accident. – The damage after shooting is more focused than with heavy hits, because it is limited to the projectile’s trajectory. The chances of rehabilitation are growing – explains Dr. Mark Brooks, a neuropsychologist at Glancy Rehabilitation Hospital in Duluth, Georgia, to Webmd.com. At the same time, however, Dr. Nina Zeldis, a rehabilitation specialist at Tel Aviv University, enumerates that the congresswoman is at risk of problems with speaking and understanding speech, difficulties with reading, worse emotional control and greater impulsiveness, problems with coordination of hands and eyes (e.g. when writing) and loss of planning and problem-solving skills.
It is too early to talk about what Gabrielle Giffords will achieve during rehabilitation. Your politician’s brain will recover from a traumatic shock for up to a year and a half. The Congresswoman will go into the hands of a psychiatrist, neuropsychologist, speech therapist and physical therapist. By hard work, he can re-learn everything that has been destroyed by the missile. The brain can not only regenerate (until recently it was considered nonsense), it also has another feature: neuronal plasticity. This means that the undamaged parts of the brain can partially take over the functions of the damaged areas. And rehabilitation helps with that.
Unfortunately for Gabriella Giffords, we are unable to support the regeneration of nerve cells or to additionally stimulate the brain to improve or accelerate the takeover of functions. The American politician is doomed to hard work.
The bullet only passed through the left hemisphere of Gabrielle Giffords’ brain. If he had pierced both, the most important parts of the brain could have been destroyed.
Text: Paweł Dąbrowski