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Neurosurgeon: Something very serious has happened

NEWS STORY
30/12/2013

A leading neurosurgeon has admitted that the treatment given to Michael Schumacher suggests his injuries are very serious and worse than first thought.

"Following blunt trauma, which is what you would term his injury, the brain swells and that swelling contained within the rigid box of the skull can cause dangerous pressure on the vital structure to the brain," Dr Chris Chandler, consultant neurosurgeon at King's College Hospital told Sky News. "That brain swelling needs to be controlled.

The fact that the German is in an induced coma suggests a number of possible scenarios. "He could have suffered a diffuse injury to his brain which can then result in brain swelling," said Chandler. "He could have sustained some sort of brain haemorrhage and if there was a blood clot within his brain or on the surface of his brain underneath his skull, that might need to be removed.

"Sometimes there is nothing actually to remove but you put in an intracranial pressure monitor, which basically is an operation that requires drilling a hole in the skull and putting a fine probe inside. Or if there is diffuse swelling of the brain, sometimes surgeons remove a large piece of the skull so there is space for the brain to swell to minimise the pressure on vital structure.

"It's not clear from the reports that I've heard exactly what the nature of this emergency operation was," he admitted. "But the fact that they undertook something almost immediately, that he was admitted to the surgical unit, suggests that something very serious has happened."

Dr Gary Hartstein, who was officially appointed Prof Sid Watkins assistant by the FIA in 1997, and succeeded Watkins as Formula One Medical Delegate following his retirement in 2005, has used Twitter to keep fans informed.

"The brain's plasticity makes prognosis impossible to pronounce definitively for quite some time. Weeks to months," he admitted.

Referring to the fact that Schumacher was fully conscious and talking (though agitated) in the wake of the accident before deteriorating, he wrote: "It's quite well known that extradural haematomas, a kind of cerebral haemorrhage, can leave a lucid interval after injury. Then as the haematoma forms, the increase in pressure causes sudden and dramatic symptoms. Pressure must be relieved rapidly.

"Let's demystify it just a bit," he continued. "Any severe head injury leads to a loss of co-ordination of tongue and throat muscles. This happens to some when they sleep – called snoring. But this is respiratory obstruction and causes carbon dioxide to rise and oxygen to fall. But the brain wants oxygen and hates CO2. So we put tubes in these patient's tracheas and use respirators. This protects the airway and gives excellent control of ventilation and oxygenation.

"But to intubate someone, he or she needs to be pretty deeply anaesthetised. So this is the usual 'artificial coma'. It is an induced coma, but in fact it's like a prolonged, protective, anaesthetic."

Responding to a fan's question of whether Schumacher can survive, Hartstein, whose contract was controversially not renewed by the FIA in 2012, replied: "In answer to the question 'can Michael survive' the answer is a resounding YES. Remember that for the moment things are still very dynamic.

"Without knowing more than what we know now survival without sequelae is certainly possible. Severity can ofc extend right to... you know.

"In the run up to the press conference (scheduled for 10:00 this morning), every good doc knows a bit of luck, or a wink from a guardian angel, whatever, is always useful," he added. "So, everybody cross fingers say prayers light candles. All of it. For Michael & all the other head injured patients brought in somewhere yesterday.

"Rumours of a 2nd operation would ofc not be welcome news," he admitted. "Will actively repress that thought until later if necessary. Were this to be true, it would imply that the intracranial pressure remained dangerously high. So let's assume these are just rumours."

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READERS COMMENTS

 

1. Posted by Bowman, 30/12/2013 18:56

"Apart from being conscious or not (his Glasgow Scale figures, better), I would be more interested in finding sympthoms of decerebration or decortication (any special rigid posture of arms). Decerebration being much worst. I wonder if there's any comment on this point from witnesses..."

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2. Posted by Kismet, 30/12/2013 10:13

"Michael kept himself physically fit and healthy. Hopefully that will help tip odds in his favour. Crossed fingers, prayers and candles ..."

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