Hartstein reflects on press conference


Gary Hartstein, the former Formula One Medical Delegate, who succeeded Professor Sid Watkins, looks at today's press conference at the hospital treating Michael Schumacher.

Writing on his blog, the American, who was controversially dropped by the FIA in 2012, and who (unforgivably) once prevented editor Chris Balfe from getting a ride in a two-seater McLaren (long story), writes: "First off, this press conference was rather more reassuring than what I expected. I'll admit that I feared an announcement of a second operation for persistently elevated intracranial pressure (ICP), and the fact that that's not been needed is good.

"Besides keeping Michael deeply asleep, they've also slightly lowered his body temperature," he continues. "This is part of the strategy to optimise the brain's metabolic state. Along with increasing the delivery of "good stuff" to the brain, reducing the temperature reduces the brain's need for stuff. Therefore the supply: consumption relation is rendered more favourable.

"We've been told that Michael has bilateral lesions. This mean the brain is wounded in both hemispheres. That shouldn't surprise us. This was a hard hit. What kind of "lesions"? While we haven't been told exactly, we can assume a mix of three types. First, the hematoma itself. This is a collection of blood that can be evacuated. That's been done, and Michael will be examined and scanned regularly in order to detect the formation of any new hematomas, or re-accumulation of the original one.

"Next are contusions. These are basically black-and-blue marks in the brain. They result from blunt forces, and consist of areas of swelling and blood that's seeped out of the vessels into the tissues - just like when you hit your arm. In the brain, as elsewhere, that blood gets absorbed, and the damage heals. Usually fine, but sometimes leaving small cavities behind.

"The third type of lesions are at the microscopic level. They consist of damage to the bundles of "cables" (axons) connecting groups of brain cells. This type of damage isn't readily visible using standard imaging, but is often associated with "poor neurological outcome". These lesions aren't treated specifically; rather, they are managed by classic neuro-intensive care principles - maximise brain happiness and avoid brain unhappiness."

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Published: 30/12/2013
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