Doctors see signs of hope for Giffords's recovery

Washington Post Staff Writers
Monday, January 10, 2011

Rep. Gabrielle Giffords was fighting for her life Sunday after being shot through the head, but doctors said the passage of the bullet through only one side of her brain and her initial responsiveness give hope she could survive and even possibly recover.

Giffords, however, has entered a crucial 48-hour period when swelling from the trauma of the bullet blast could cause as much damage to her brain as the initial wound, possibly triggering a major deterioration of her condition. The Arizona Democrat also faces many additional risks, including possible infections, more bleeding, and a long period of rehabilitation to limit permanent disabilities.

While most people who are shot in the head or suffer other severe head trauma do not survive, there have been remarkable cases of victims who have come back- such as Jim Brady, President Ronald Reagan's press secretary, who survived a gunshot wound to the head during the 1981 assassination attempt. Brady lost the use of his left arm and leg, but largely recovered otherwise.

"It's hard to say anyone is ever really completely okay after being shot in the head, but [Giffords] has a good chance of being able to walk away from this," said Arthur Kobrine, a professor of neurosurgery at Georgetown University Hospital who treated Brady's injuries. "She has the chance to move around and laugh and walk and cry and talk and maybe even return to Congress."

Brady's injury was much more serious than Giffords's, yet he made a "miraculous" recovery, Kobrine said. Still, doctors said there is no way to predict Giffords's prognosis.

"Everyone is cautious about calling it, but I am optimistic," said Peter Rhee, trauma medical director at the University Medical Center in Tucson, whose team got Giffords into neurosurgery within 38 minutes after first seeing her.

"This is about as good as it gets," Rhee said. "When you get shot and the bullet goes through your brain, the chances of your living are very small."

The shot, allegedly from 22-year-old Jared Loughner, was fired at close range, entered the congresswoman's brain at the back and exited from the front, which suggests she was turned - or turning - away from him as the shot was fired.

The bullet traveled through a significant portion of Giffords's brain, Rhee said, but fortunately did not cross from the left hemisphere to the right hemisphere, or vice versa. When a bullet passes across a brain, it is much more likely to do more devastating damage, including to life-sustaining areas such as the brain stem.

"The people who tend to do best are the ones who have gunshots that do not cross through the midline," said Christopher Kalhorn, associate professor of neurology at Georgetown University Hospital. "When gunshots cross the midline, the prognosis is much poorer."

In Giffords's case, only the left side of the brain was damaged by the bullet. An intact left or right hemisphere means a victim can retain significant functioning even with the other side severely damaged.

Damage to the left hemisphere, however, can be more serious than damage to the right. The left side of the brain controls movement on the right side of the body and, for all right-handed people and most lefties, is also largely responsible for speech and the ability to understand speech. Doctors said this makes the congresswoman's responsiveness to basic commands remarkable.

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