Update on Giffords's Condition
While MedPage Today reported yesterday that Gabrielle Giffords remains in a Houston ICU because of a ventricular drain (due to, presumably, obstructive hydrocephalus), the hospital implies today that she will be moved to a rehab center imminently. Clarifying details should be provided this afternoon by the Congresswoman's doctors at Memorial Hermann, who will discuss her condition and progress at a press conference.
When Giffords's ventricular drain was placed is unclear from news sources, but logic and experience suggest that it was inserted either 1) at the time of Giffords's initial brain surgery, immediately after her injury as a prophylactic measure or 2) while she was in the Tucson ICU, because of developing hydrocephalus detected by a routine pressure monitor and/or follow-up brain images. [01/27/11 update: ABC News indicates that the drain was placed sometime last week.]
At Houston, surgeon John Holcomb emphasized to MedPage Today that the drain would either need to be removed or replaced with a permanent shunt before Giffords moved to a rehab facility. The anticipated move suggests that the issue of the shunt has been resolved or is about to be.
On seeming cue, neurosurgeons at the University of Alabama at Birmingham published a retrospective study this month in Neurosurgery of risk factors for conversion to a permanent ventricular shunt after traumatic brain injury (TBI). A minority of 71 TBI patients, about 22%, required a permanent device during hospitalization. The risk of a permanent device was elevated more than 5-fold if a patient had to undergo craniotomy within 48 hours of admission (as Giffords did) or showed bacterial contamination of spinal fluid (which is unknown in Giffords's case). However, the requirement for a permanent shunt did not appear to affect the disposition at discharge. [01/27/11 update: In an interview with one of Giffords's Houston doctors, ABC News reveals that there have been "no signs of infection."]
As far as Giffords's neurologic deficits are concerned, news reports (taken collectively) indicate some type of preserved vision (eg, aversion to shined light per her doctors, possibly watching television per her husband) and flaccid paralysis of her right arm. She is reportedly able to follow commands with her left body (indicating comprehension or a receptive speech capacity), but she has demonstrated no or minimal attempts at speech (suggesting a significant productive speech deficit).
These signs have traditionally been categorized as Broca's or expressive aphasia (in contradistinction to Wernicke's or receptive aphasia); although such a diagnosis is probably far too simplistic—especially without other details about her speech capabilities or disabilities. Moreover, it is really too early to guess at her speech deficits until she has spent considerable time in rehab and has reached a medical plateau.
01/27/11 update: News sources covering yesterday's press conference (like ABC News) report that Giffords ventriculostomy was removed 3 days ago (Monday) and that she was transferred to rehab. Futhermore there have been "no signs of infection," presumably referring to the ventriculostomy. Although not stated explicitly, it is also presumed that Giffords did not require a permanent VP shunt.
