Doctors at the hospital where Arizona Congresswoman Gabrielle Giffords is being treated for a gunshot wound to the head say they continue to be optimistic about her condition.
Dr. Michael Lemole Jr. told reporters at the University Medical Centre in Tucson, Arizona Monday morning that Giffords continues to respond to "basic commands," such as gripping a hand or wriggling toes, and that CT scans show there has been no "progression" of swelling in her brain.
"At this phase in the game, no change is good -- and we have no change," Lemole said.
"With that in mind, we're going to proceed over the next few days to see how she does," he said, adding it's still too early to measure how well Giffords is functioning psychologically.
Giffords, 40, was rushed to hospital Saturday after being shot at point blank range at a public event in Tucson. Not long after, doctors treating her reported the congresswoman was conscious and responsive.
For now, Giffords is being kept in a medically-induced coma, meaning medications are keeping her sedated, to give her brain time to rest. She is likely on a ventilator, and doctors will periodically lift the sedation to do tests.
Five of other victims of the shooting spree remain in serious condition, said Dr. Peter Rhee. Two more are in fair condition.
Giffords has already defied the odds by surviving the gunshot, says a Toronto-area brain surgeon, but it will be a long time yet before the full extent of her injury is known.
"Generally, with gunshot wounds to the head, approximately 90 to 95 per cent people die almost immediately," Dr. Todd Mainprize, a neurosurgeon at Toronto's Sunnybrook Health Sciences Centre, told CTV's Canada AM Monday morning.
He says while it's rare to have fared as well as Giffords already has, the odds of survival and the chance of long-term damage are determined by the trajectory the bullet took as it travelled through the brain.
In Giffords' case, her doctors reported Sunday that the bullet entered through the back of the head, went through the left side of the brain, stayed on the left side and went out the front of her head.
Mainprize says the fact that the bullet didn't travel across her brain, from one hemisphere to the other, is good.
"That's very important, because once it crosses midline is when the survival drops precipitously," he said. "The fact that reports say she was awake and obeying commands right after the injury puts her in a category where her chances of survival and recovery is significantly better."
Giffords underwent two hours of surgery Sunday in which doctors removed debris from the gunshot and a small amount of dead brain tissue. They also removed nearly half of Giffords' skull to accommodate swelling, preserving the skull bone for later replanting.
Mainprize says removing part of skull is a common procedure for either penetrating or blunt force brain trauma.
"If there's a significant injury to the brain, the brain takes on water and swells," he explained. "The skull is a fixed box and if the brain expands, the pressure goes up. If the pressure goes to high, then blood can't flow to the brain and people start to develop strokes.
"So one way to compensate for that is to enlarge the capacity of the skull by removing a large part of the skull. It's called a decompressive craniectomy. That will lower her brain pressure, and allow blood flow to the brain and oxygenation and give the brain the best environment to repair itself and limit the secondary damage."
As for predicting how well Giffords will recover, Mainprize and Giffords' own surgeons say it's far too early to tell. It will be months before the brain is able to heal itself and until then, the brain will undergo all kinds of changes.
Reports suggest that so far, Giffords isn't able to talk but can respond in other ways and seems to comprehend what was asked of her. Mainprize says that's likely because it was the left side of her brain that was injured.
"The left side, for her, sounds like it's her dominant side, because speech seems to be a problem," he said.
"There are two major speech areas in the brain and in a right-handed person, they're most likely found on the left side. It sounds that her one speech area is affected if she couldn't articulate what she wanted, but it sounds like her comprehension is intact, from the reports."
With files from The Associated Press
