Gabrielle Giffords: Surviving a Gunshot Wound to the Head

Most are fatal, but not all

How exactly does someone survive being shot in the head? It comes down to good timing, excellent medical care and a bit of luck says Michael Alexander, M.D., director of the Neurovascular Center at Cedars-Sinai Medical Center in Los Angeles.

Arizona Rep. Gabrielle Giffords was shot in the head at point blank range outside of a grocery store in Tucson, Ariz., where she was leading a Saturday morning meeting with her constituents. Six others were killed in the shooting rampage and 12 were injured.

Timing was one of the greatest factors so far in Giffords’ recovery -- she was in the operating room 38 minutes after the bullet tore through her head. That meant the medical team was able to control her breathing and quickly relieve dangerous pressure buildup in the brain.

With a bullet wound, “first you have the tearing injury,” says Alexander. “Then you have the shock wave through the rest of the brain. That wave can cause injury to other neurons.”

The “shock wave” causes swelling, but the rigid skull doesn’t leave any wiggle room for an expanding brain. Swelling can injure more neurons, causing further brain damage. “That’s why surgeons took off part of her skull,” says Alexander. “That allows the brain to swell without it being life threatening.” The skull fragmented is inserted into her abdomen, where it is safe from infection and can be replaced once the swelling is gone.

For now, doctors are keeping Giffords heavily sedated and have her on Propofol, a medication used to control the swelling. (If it sounds familiar, it’s also the medication Michael Jackson was using as a sleep aid prior to his death.) She will continue to receive hourly neurological exams while doctors decrease the dose of Propofol and ask her simple questions like, “Can you wiggle your toes?” (She previously held up two fingers and gave the thumbs-up on command). These regular exams help doctors determine if Giffords’ brain injury is healing or worsening. If she suddenly can’t perform an action she did an hour ago, that’s a sign of a complication, like bleeding in the brain.

“Certainly it’s a promising thing that she can follow some commands, but she’s in for a rough road ahead,” says Alexander. The injury was reportedly on the left side of Giffords’ brain, so she could have weakness on the right side of her body and her vision, speech and memory might also be impacted. But the extent of the damage, if any, won’t be known anytime soon.

“The thing that’s really in Giffords’ favor is she’s relatively young at 40 years old,” says Alexander. “The best thing for doctors to see now is that she continues to follow commands.”

Giffords is fortunate that the bullet did not hit the brain stem, which controls breathing and heart beat, and that only one side of the brain was damaged. After reviewing X-rays doctors agree it’s likely the bullet entered the front of the head -- when a bullet goes through the side of the head it is more likely to cause bleeding into the ventricles at the center of the brain, which is almost always fatal.

Though she is now breathing on her own, a breathing tube remains in place to prevent infection and pneumonia. Once the breatehing tube is removed, doctors will see if she is able to speak. Then she’ll begin the slow recovery process which could take six months to a year.

“Whether she’ll be able to go back to work or not, you can never predict that. She might have some cognitive issues,” says Dr. Alexander. “She has a long road ahead of her. But she has a really good prognosis at this time.”

Do you know anyone who has survived a brain injury? Chime in below.

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