Giffords’ Brain Appears Functional, Recovery May Take Months

Rep. Gabrielle Giffords probably will recuperate without part of her skull as brain swelling eases, but doctors won’t know for sure until she’s off a respirator and speaking whether she has lost any brain function.

The Arizona Democrat was among 20 people shot, six fatally, at a Jan. 8 meeting she was conducting with constituents in Tucson. The bullet tore through the left side of her brain, probably entering at the back of the head and exiting through the front, said Dr. Peter Rhee, chief of the trauma department the University of Arizona’s University Medical Center in Tucson.

Luck, training, and a quick-thinking congressional intern probably combined to save her life. Paramedics were able to get Giffords to the hospital and onto an operating table within 40 minutes, Rhee said

“Paramedics got her to us quickly,” Rhee told reporters Sunday.

The intern, Daniel Hernandez, had volunteered to help Giffords run the constituent meeting outside a grocery store. Seeing the congresswoman fall, he rushed to Giffords’ side, staunching the flow of blood from her head with smocks from the store, ABC News reported.

“The other part of it is also luck and what the bullet actually hit,” Rhee said.

The parts of Giffords’ brain most likely affected deal with speech recognition and speaking, and with motor functions on the right side of the body, said Dr. Keith Black, chairman of the Department of Neurosurgery at Cedars-Sinai Medical Center in Los Angeles. That she hasn’t shown any physical weakening, according to Rhee and Dr. Michael LeMole, who operated on her, was a sign she probably hasn’t been paralyzed, Black said.

Surviving pieces of Giffords’ skull may be kept inside the fat layer under her abdomen to keep them sterile, Black said. Alternatively, a new skull could be constructed of resin or titanium mesh, once the swelling has subsided.

Giffords, 40, was shot by Jared Lee Loughner, 22, who pushed past a group of people waiting to speak with the lawmaker and shot her from only a few feet away, federal officials said. Among the fatalities were a 9-year-old girl and Arizona-based U.S. District Judge John Roll, 63.

Surgeons at the Arizona hospital performed a decompressive craniectomy on Giffords, said Dr. Geoffrey Manley, chief of neurotrauma at San Francisco General Hospital. That involves taking off pieces of the skull to relieve brain swelling. Use of the technique and reflects lessons learned from injuries to soldiers fighting in Iraq and Afghanistan, Manley said.

As the brain swells as a result of injury, it needs someplace to go, Manley said. “Otherwise, brain swelling pushes the brain through the bottom of the skull, what’s called a cerebral herniation, and the patient bleeds to death.”

“This is about as good as it is going to get,” Rhee said in discussing Giffords’s wound. “When you get shot in the head and the bullet goes through your brain, the chance of you living is very small and the chances of you waking up and actually following commands is even much smaller than that. Hopefully it will stay that way.”

Giffords may suffer effects that could surface long after her physical wounds have healed, Black said.

“She has a scar from the bullet wound going in, so she’s at risk of having seizures and if there is massive injury to the frontal lobe, one can rarely see things like personality changes, but that’s very uncommon,” Black said.

Giffords may be able to resume normal activities within two to four months, assuming there is no significant injury or setback, said Black, who noted that his information is based only on published news reports.

“She can probably get back to doing a few hours a day and increasing that over six months to a year,” Black said. “One can’t completely evaluate that until she comes off the respirator, but they haven’t reported that she’s weak or paralyzed on one side, and that’s very positive.”