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Pigwidgeon (1000+ posts) Mon Mar-21-05 03:01 AM
Response to Original message
143. Terri Schiavo's brain
From what I can determine -- based on the same publicized information that everybody else has -- here's my synopsis.
(By the way, no griping about my credentials. I worked as a neurology tech in both clinical and scientific fields for about a decade. I also had to make the "pull-the-plug" decision about family members three times since 1996, and had to sign the "Do Not Resuscitate" forms before my mother went into surgery last March. The next person who tries to be clever and call me a Nazi will get flamed.)
1: Schiavo's cerebral cortex does not function. It has atrophied to about 25% of its original size and mass. The remaining space is filled with cerebrospial fluid. This is usually the case in even brief episodes of anoxia, such as with strokes and TIAs. What tissue remains is certainly de-vascularized and poorly suffused with blood. She does not have a reduced capacity to think -- she has none whatsoever.
An EEG would show a greatly attenuated, disorganized delta rhythm with brief, intermittent bursts of activity, probably from the lower centers of the brain -- and that would be a very high level of EEG activity. The use of nasopharyngeal electrodes (basically, electrodes stuck about 4 inches into the nose and back to the top of the throat) would possibly show more activity from the functioning remains of the midbrain. No substantive cortical activity would be recordable, however.
2: Her midbrain, or "limbic system", is damaged. The exact damages have not been released. But with complete cortical loss, it is not likely that they are healthy. The midbrain carries impulses between the cortex and brainstem in a healthy person. It is also the "seat" of what we consider primitive, reflexive, and patternable reactions. It is probable that some of these reactions are seen in the famous video of her "responding" to her parents. Since atrophy and hypoxia proceed "downward", this may explain why more recent evaluations have shown decreasing responsiveness.
3: Brainstem is fairly intact. Breathing and other basic body functions are OK. I would suspect some damage at random; a Brainstem Auditory Evoked Response test would probably show delays in Wave 3 onward.
4: No information on her cranial nerve function. I suspect that they are OK but a little sluggish, consistent with the brainstem test mentioned above, which also tests the acoustic cranial nerve.
5: She has been bedridden for a decade and a half, and her bones have probably lost upwards of 75% of the calcium they had when she entered this state. She has severe osteoporosis which has been determined clincally. It is certain that she has suffered broken bones as a result. She may have had decubitis ulceration, although if that had happened, the press would surely have pinned it on Michael. Also as a result of the confinement to bed, her heart has probably weakened greatly, and I would not be surprised if she is in middle-to-late-stage heart disease. Given the electrolyte imbalance and anoxia that nearly killed her, the heart probably sustained damage back then, too; bulimia is well-known as a cause of heart damage.
That's what I get from reading the reports. Her situation is grim, and death from heart failure becomes more likely as time passes. However you think this case should proceed, such is the state of her health, and barring a miracle, it will only get worse.
The editorial part: the people who would keep her alive, in absence of any effective therapy for cortical death, are the ones putting her through long-term torture.
--p!
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