Traumatic brain injury Permanent damage

Various complications threaten the life of Michael Schumacher despite noticeable improvement

03/01/2014

For four days, Michael Schumacher has been in a coma with a traumatic brain injury (SHT). His chances of survival increase, but the risk of permanent damage to the brain remains. Despite a helmet accident, the former Formula 1 world champion had a bad head injury and then fell into a coma on the way to the clinic.

In the fall Schumacher had hit his head against a rock and had suffered a severe cranial brain trauma. Although the former Formula 1 driver initially remained conscious until the arrival of the rescue service, he subsequently fell into a coma and has not since woken up again. Computed tomography of the skull showed, according to the doctors clearly bruises and bruises in both hemispheres of the brain. Although the doctors were able to stabilize the condition of Schumacher in two surgeries and they already reported a slight improvement in his condition, yet no all-clear can be given. In addition, permanent damage and disability in such severe brain injuries are not uncommon.

Rising chances of survival
Neurosurgeon Andreas Pingel, Senior Physician of the Center for Spine Surgery and Neurotraumatology at the BGU in Frankfurt, told the news magazine „Focus“, that „the first three to five days the most critical“ and therefore it is still too early to make a prognosis. But Schumacher's chances of survival would rise every hour. However, a longer coma could also cause additional complications. For example „by the long-term ventilation the risk of pneumonia. It can also damage the nerves in the arms and legs“, explained Pingel. Patients who have been in a coma for more than two weeks also increase the risk of muscle atrophy and increase the risk of disturbed nerve circulation. The latter could result in the brain chambers filling with water.

Long-term damage in traumatic brain injury
At the clinic of the physician, according to the „Focus“ Every year around 2,000 patients are treated with traumatic brain injury, with about a quarter of them being cases as severe as Schumacher's. Of those affected, just under a third did not survive the severe traumatic brain injury. Also, patients who survive the acute condition, then often show severe damage and disability, the neurosurgeon continues. Pingel speaks of only „ten to 30 percent of the survivors“, which can then live on with tolerable restrictions. „As a rule, patients start from scratch and have to relearn the simplest things, such as eating and drinking“, stressed the expert. Given the drastic consequences that such skull injuries can bring, physicians generally recommend wearing a safety helmet for sports that pose a risk of serious falls. In the case of Schumacher, he also made it possible for him to make it to the hospital. Without a helmet Schumacher would have probably died directly at the scene of the accident, according to the doctors.

Coma the consequence of bleeding and edema in the brain
In about 25 percent of patients with such severe injuries as in the case of Schumacher, according to the expert after the acute phase, a wake coma sets in, in which patients open their eyes, but show no signs of conscious perception and not communication in are able. This condition can theoretically last indefinitely. It is also typical for severe craniocerebral traumas that the patients are initially responsive immediately after the accident and only lose their consciousness at a later stage, as was the case with Schumacher, explained Pingel. The coma is the result of bleeding and edema in the brain. In view of the lack of space in the skull, these increasingly press on the brain, and those affected fall into a persistent unconsciousness. As with Schumacher, in such cases the skull must be opened immediately to relieve the pressure on the brain. Corresponding cerebral hemorrhages and edema may also occur with a significant delay in the event, so even in the lighter forms of SHT, clinical monitoring over several days is recommended. (Fp)