Was Terri S. brain-dead or wasn't she?

[republicansareevil]

And why could the MSM never clarify even this basic fact? The definition of brain-dead I read is that it's having a flat EEG. That described TS. But Al Franken corrected himself the other day and said he MIGHT have misspoken when he said she was brain-dead. I have no medical background but I wouldn't expect "brain-dead" to be that hard to define. Any MDs or RNs on DU who can answer this very basic question?

[Liberal Veteran]

1. No. She was in a persistant vegetative state.

Brain dead is a different diagnosis.

[beyurslf]

2. I believe the only part of her brain functioning was the brain stem

which runs involuntary reactions.

[rocktivity]

3. When I learned that there is fluid where her brain should be

I figured that was as brain dead as one could get.

:shrug:
rocknation

[Canuckistanian]

4. From what I heard, she did have a flat EEG

And that, by any definition, is brain-dead. She had only a working brainstem, which gives no EEG reading.

[XemaSab]

11. One of the docs here

said that the fluid around her brain could muffle EEG signals.

[w8liftinglady]

5. re;brain death

Terri suffered severe brain damage,but wasn't brain dead,not in the medical sense.Brain death is usually defined as absence of brain function on an eeg,as well as lack of respirations and spontaneous movement.These are the criteria we use when determining if someone is suitable as an organ donor.

[MissMarple]

8. Welcome to DU, w8liftinglady!

:D

[Lindacooks]

6. She had a flat EEG because the brain stem doesn't produce

electromagnetic activity. Her brain stem was still functioning - that controls the smooth muscles, heart, lungs, some reflexes. Because her brain stem was still functioning she wasn't clinically brain dead, but in a persistant vegetative state.

[msmcghee]

24. Are you sure ?

I thought that the brain stem was responsible for sending signals through neurons and synapses to the muscles in the heart, lungs, etc. to provide for those organs functioning.

I think perhaps since those signals go south and originate well below the cerebral cortex that perhaps an EEG won't record those signals - it would be wrong to say that they don't exist.

Can any neuroscientists or other pros help here?

[moobu2]

7. Terri Schiavo was cognitively brain dead, meaning,

The part of her brain that allowed her to be cognizant was dead...she was in a state of wakeful unconsciousness because she had a living, functioning brain stem which controles basic reflexes and auto functions like breathing heart rate and blood pressure etc...

[Guaranteed]

9. No. She had lower brain function.

Her higher brain function, which is what gives consciousness, was severely deficient. But her lower brain, which controls the autonomic body systems, was intact.

[Deep13]

10. No.

I'm not a doctor, so I do not speak as an expert, but I got a crash-course on the matter when my father had a stroke and died six years ago.

Brain dead means no brian functions and that life is sustained through artificial processes only. In Schiavo's case (as with my father), the parts of the medula necessary for respiration and and other basic functions was still operating, but all congnitive function was gone. There was no chance of regaining consciousness. In my father's case, swelling following the stroke compressed the brain to a point where the cerebral cortex and eventually the brain stem became damaged beyond repair. (We "pulled the plug" but it was a superfluous act since pressure on the medula ultimately caused heart failure after a few hours.) In the Shaivo case from what I understand from the corporate media, much of her cerebral cortex had been liquified. She could live without artificial support as long as she was fed and hydrated, but had no chance of ever waking-up and, in fact, was not much more than a robot. Awareness, consciousness or perception of any kind was not physically possible. Nevertheless, the continuing function of the purely automated parts of the brain meant that she was not actually brain dead.

[Warpy]

12. Brain dead refers to a flat EEG, which means no brainstem activity

that would allow a patient to breathe without mechanical ventilation. It is a clinical definition used to determine death so that families can be approached for organ donation. Life support is typically discontinued in such cases, whether or not the family agrees, since it has been legally determined that brain death = death.

Schiavo had no activity in her cerebral cortex but her brainstem was still functioning. Brain damage typically proceeds from outer to inner and top to bottom. The brainstem is a knob at the top of the spinal cord, and it's typically the last to die.

Everything Schiavo was as a person was dead and gone 15 years ago. Her body was still able to draw breath, and stabbing a hole into her abdomen and inserting a tube allowed force feeding to sustain the process artificially. The inventor of the gastrostomy tube has said it was a terrible misuse of the technology he developed.

She was not brain dead, clinically and legally speaking.

[marew]

13. According to my undersatnding...

the only part of her brain that was functioning was the brain stem which controls involuntary functions, eg. heartbeat, breathing, some reflexes, etc. Saw an xray of Terri's brain compared to one from a healthy 25 year old last night on some program. The entire center of her brain xray was completely dark. It will be interesting to hear the autopsy results. Worked in a setting years ago as a social worker where a child was being maintained by tube feeding and, of course, in a wheelchair and bed. This child had actually been born without a brain, only a brain stem. This poor child would grimace, his eyes moved but he could not see, etc. His skull was actually hollow, only filled with fluid. He looked a lot like what that poor young woman looked like. Don't know what ever happened to that poor child. The right to lifers would want such a sad case maintained forever. How crazy and how sad!

[DeposeTheBoyKing]

14. She was NOT brain dead

Her brainstem was still functioning, controlling respirations, circulation and metabolism. Her cerebral cortex, controlling reasoning, thought and awareness, was basically liquified and replaced by spinal cord fluid. Anything she appeared to "do" was reflexive, not purposeful.

[republicansareevil]

15. thanks everyone

I knew she was in a persistent vegetative state. I didn't know whether that was mutually exclusive with being brain-dead. Guess I shouldn't rely on dictionary.com for my medical definitions. :)

http://dictionary.reference.com/search?q=brain%20dead

[vpigrad]

16. If she was brain-dead...

did that make her a republican? Is that why they were trying to save her? ;)

[marew]

17. Excellent Point!!! n/t

[tjwash]

18. See for yourself...

Basically the gray matter is gone and replaced with spinal fluid. Brain tissue does not grow back, that is a scientific fact. The part of the brain that controls the autonomic bodily functions are intact. The heart beats, the lungs breathe, etc. However, there was no cognitive function at all. Everything that the person was, disappeared forever with that part of their brain.

Analogously, think of it as a PC that you take the hard drive out of. Its going to power up, but that's about it.

[JackRiddler]

21. brain tissue does grow in adulthood

as many studies are now establishing. Brain activity encourages brain growth!

However, this brain - cortex flooded with fluid - wasn't going to be growing back.

Now everyone: imagine Schiavo still had a rudimentary awareness somewhere at the back - completely crippled, frozen, unable to respond or control anything, unable to make anyone know it, but still somehow awake. Blind, deaf and without feeling in her body, certainly. And trapped. Just a spark in a darkness somewhere.

Would you want to live like that for 15 years?

Now imagine even the potential of an eventual recovery. Within a decade or two, she might chew her own food and get a few words out (impossible, but let's pretend...)

Having once lived as a fully conscious and healthy person, would you want to live like Schiavo did for 15 years -- plus another 10, so that if you get lucky after sufficient experimentation as a doctor's guinea pig you can enter your 50's as a full-body cripple?

Isn't that an argument to PULL the feeding tube?

[Ferry Fey]

22. But it looks like about 25% of it is still there?

I'm confused by the explanations that have been offered.

I'm assuming that the light blue stuff in Terri's brain is the equivalent of the grey stuff that fills the skull uniformly in the black and white image? If so, there would seem to still be islands of light blue cortical matter left. While it is by no means a substantial amount, it seems to take up about a quarter of the cross-section visible.

Are you saying that the brainstem does not keep the autonomous functions such as breathing and circulation running with any electrical impulses whatsoever?

If it doesn't utilize electrical impulses, how does it run its functions? And if those processes do use electrical impulses like the rest of the body, why would they not register on the EEG?

[Roland99]

23. Discussion about those CAT scans that should end all future argument

http://www.amptoons.com/blog/archives/2005/03/18/terri-schiavo-news

But there’s something being lost in this discussion of brain imaging methods. The fact that an MRI would give a better structural picture of Terri Schiavo’s brain does not at all mean that the existing CAT scan isn’t good enough for present purposes. I see much serious armchair scan-reading in this thread that signals ignorance of the subject. Let me tell you: if you are sufficiently familiar with brains and brain images, you do not need an MRI to tell you how severely the brain in the pictured CAT scan is damaged, nor do you need to see more slices than the one depicted here. This single image shows a very severely damaged brain. The large “blue blobs” in the middle are ventricles, also present in healthy brains (you can see the two little dark crescent shapes in the brain on the right) that have expanded to such a large size because the overall brain volume is so low. Cranial space that would otherwize have been filled by gray matter is now filled with cerebrospinal fluid. And yes, that’s what the blue space is: cerebrospinal fluid that is filling up space left behind by necrotic brain tissue that has been scavenged and removed by the body. The white squiggly things are white matter - connective tracts that have the loose, uncoiled look about them that they do because, again, the grey matter that once compressed them is no longer there, so they “float” loosely in CSF. The gigantic ventricles, expanded white matter, and undifferentiated blue space in that scan all point to the same thing: massive loss of grey matter in the cerebral cortex. You don’t need an MRI to tell you that, it’s clearly visible in the CAT scan.

It is true that given the poor resolution of this image, it’s possible that some cortical tissue has been spared. But that doesn’t matter. Whatever wisps of cortex we might be missing in this image are not enough to sustain behaviors that could differentiate Terri Schiavo from any other vertebrate. All the neural equipment you need to do ocular following and emotional responses is subcortical. All the neural equipment you need to be a self-aware, reasoning, behaving human being is cortical. And since i gather this image was made some time ago, the present condition of the brain can only be worse.

There is no way any qualified brain doctor or scientist could look at this image and suggest that significant recovery of function is possible. The fact that we could have all this discussion on the subject is a triumph of politics over science. Tragic for Terri Schiavo, and really for us all.

http://binarycircumstance.typepad.com/bc_blog/2005/03/terri_schiavos_.html

UPDATE 03/29/05: Dan Abrams interviews Ronald E. Cranford M.D. who was one of the neurologists who examined Terri Schiavo for The Abrams Report. This report includes pictures of Terri Schiavo's CAT scan and Dr. Cranford comments on the extent of her brain damage.

ABRAMS: Let's talk about the CT scan. You actually have the CT scan.

CRANFORD: Yes, this is a CT scan of Terri Schiavo taken in 2002, the most recent CT scan done on her, 2002.

ABRAMS: Tell us what it means.

CRANFORD: Well it shows extremely severe atrophy. Where those black areas are, that should be white. That should be cerebral cortex, and so really there is no cerebral cortex left. It's just a shrinkage of the cerebral cortex. It's a thin band of white on the outside and any neurologist or any radiologist looking at those CT scans will tell you that her atrophy could not be more severe than it is. So even if she were mentally conscious, which she's not, she's irreversible. She's been like this for 15 years, Dan, and that CT scan shows the most extreme severe atrophy of the higher centers of the brain.

Neurologist Cranford confronted Scarborough, MSNBC daytime anchor: "ou're asking me if a CAT scan was done? How could you possibly be so stupid?"
http://mediamatters.org/items/200503290005

[leftofthedial]

19. no

and I stayed at a Holiday Inn Express last night, so I should know

[rocktivity]

20. The MSM did a TERRIBLE job of educating the public about her condition

They were too busy pushing the political and "soap opera" angles.

Once I saw Terri's brain scan, I understood that the part of Terri's brain that made her Terri had been replaced by fluid, and that all the feeding tube was doing was keeping her brain stem functioning. What people saw on the videos were involuntary reflexes, NOT "life." How different this all would have been if the MSM had bothered to explain that!

On Edit: Thanks for coming up with the scan, Tjwash

:headbang:
rocknation