Experts: Sharon not out of the woods
Doctors: Good chance leader will be disabled if he survives
By Peggy Peck
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Ariel Sharon's doctors say it could be some time before they can gauge the extent of his impairment.
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(MedPage Today) -- Medical experts predict a grim future for Israeli Prime Minister Ariel Sharon even if he defies the odds and survives the terrible trauma to his brain.
Doctors in Jerusalem said Sharon began breathing on his own as they slowly awakened him from a medically induced coma. Neurologists induced the coma to protect Sharon's brain after he suffered a massive hemorrhagic stroke last week.
Dr. Shlomo Mor-Yosef, director of the Hadassah Hospital, said Sharon is still connected to a ventilator to assist his breathing but "the prime minister is breathing spontaneously. This is one stage, a first stage."
Doctors on Tuesday said Sharon moved his left hand, and his right hand and right leg with more strength than before.
Movement of his left hand is significant because the left hand is controlled by the right side of the brain, which was damaged by the stroke Sharon suffered January 4.
"There is no immediate danger to the prime minister's life," said Sharon anesthesiologist Dr. Yoram Weiss. "Metaphorically speaking, we were right on the edge of the cliff. Now we are five meters back."
It's even odds whether the 77-year-old Sharon will survive the stroke -- in most studies of strokes caused by bleeding in the brain "half of the patients die within 30 days," said Dr. Robert Felberg, director of the stroke program at the Ochsner Clinic in New Orleans, Louisiana. Even with surgery about one in three pateints die, he said.
Doctors said they performed three operations on the right side of the 77-year-old prime minister's brain to stop bleeding and swelling.
Felberg said that hemorrhagic strokes on the right side of the brain are usually associated with long-term cognitive disability.
"The ability to think abstractly is usually diminished," Felberg said.
A stroke on the left side of the brain usually affects speech.
"The possibility of [Sharon] returning to the level of functioning that he had before this stroke is very, very small, and there is a good chance that if he survives he will be significantly disabled, meaning that he will be wheelchair-bound with cognitive deficits," Felberg said.
"Some patients do recover, but it takes months to years to achieve that recovery," he added. "If he does survive, he will also certainly be paralyzed on the opposite side of the body [from the bleeding]."
Hemorrhagic strokes occur when a blood vessel in the brain bursts and blood is leaked into brain tissue. Brain cells, or neurons, are rapidly damaged by blood. The brain reacts to the bleeding by forming a hematoma.
The presence of blood irritates brain tissue and causes it to swell. The swollen tissue and hematoma combine to drive up intracranial pressure and press the brain against the skull, which causes more damage.
Dr. Anthony Furlan, head of the section of stroke and neurocritical care at Ohio's Cleveland Clinic, said that neurosurgeons often place a shunt inside the brain to control swelling by draining fluid.
Sharon's doctors have not mentioned placement of a shunt.
Felberg said the brain is also damaged by surgery since surgeons often have to destroy healthy brain tissue to get at the source of the bleeding.
The Stroke Center at the U.S. National Institute of Neurological Disorders and Stroke in Bethesda, Maryland, suggests that physical therapy may benefit some recovering hemorrhagic stroke patients.
In addition, patients can undergo intensive speech therapy and occupational therapy to improve function.
Furlan agreed, however, that full recovery is unlikely.
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