Prognosis after a spear through your brain?

So, this poor kid took a fishing spear through his brain: http://www.bbc.co.uk/news/world-us-canada-18509408

Evidently, he was conscious when he arrived at the hospital, and is expected to survive. MediDopers, what sort of recovery would you expect from this kind of injury? Does this teen have a chance at remaining more-or-less intact mentally?

Depends on where it goes through.

Phineas Gage.

Well, I knew my scrapbook of weird newspaper photos would come in useful someday:

http://i297.photobucket.com/albums/mm228/vashbul/crowbarhead.jpg

This picture is from the Boston Globe, sometime in the early 80s. I don’t know what happened to this patient, but the surgeon pictured, Dr. L. Joseph Ordia, appears to be still practicing and Googleable. I will write him a note and see what he has to say.

And more recently Gabby Giffords.

What’s always boggled me is the fact that Phineas Gage even survived his injury. How would that have even been possible using 19th century, pre-antibiotic technology?

Ha! What a wuss. :dubious:

Here’s the reply I got to my inquiry:

Dear Mr. M___:

You certainly have sharp memory, and I thank you for remembering the injury and for caring about the gentleman.

I thank God for giving me the privilege of taking care of two wonderful persons with impalement injury of the brain.

You are correct that I am constrained from giving more information, due to respect for privacy. However, I am pleased to send you the attached scientific publications, which more than answer your questions. (Well I shall send full seven year…paper later, but he was clearly alive at 7 years). Please note that they are copyrighted and should not be republished. However, feel free to give out these links to the PubMed site where people can read the abstracts.

Neurologic function seven years after crowbar impalement of the brain.

Brain impalement by an angle metal bar.

Regards.

Joe Ordia, M.D.

As runner pat already said, but it bears re-emphasizing, the effects of an injury like this depend very much on which particular parts of the brain get damaged (and, of course, how much of it). Different parts of the brain do Different things (and, what is more, they are arranged slightly differently in Different people) so without knowing precisely which parts of this poor boy’s brain it is impossible to say exactly how he will be affected, and even his own doctors, who do know precisely where the spear went, will not be able to say exactly what the effects will be yet.

He will certainly be mentally impaired, but in what sort of ways it is impossible for anyone to say yet. Some of the effects of brain injuries can be downright weird. Looking at the X-ray, I would guess that it is unlikely that he will be able to live independently, like Phineas Gage did, but that is only a guess. Gage’s injury was pretty much confined to his frontal lobes, sort of like a getting a lobotomy, whereas it looks as though in this case it goes through the frontal lobes, through the middle of the brain and out through the occipital or parietal cortex (which means his vision and/or his sense of spatial relations, and his personallity, will probably be affected, amongst other things, no doubt). Fortunately, much of the middle part of the brain is just fluid filled cavities anyway, and much of the rest is white matter (cables rather than processors) so it does not matter quite so much as the cortex (outer surface) where most of the processing goes on. But some cortex has clearly been destroyed, and cables are important too. The mid-brain and brain stem, which are responsible for basic functions that keep you alive, seem to have been missed altogether, which is good.
As runner pat already said, but it bears re-emphasizing, the effects of an injury like this depend very much on which particular parts of the brain get damaged (and, of course, how much of it). Differnt parts of teh brain do differnt things (and, what is more, they are arranged slightly differntly in differnt people)

Dr. Ordia kindly sent a me .pdf of the article he wrote about the crowbar guy he treated.

One thing he mentioned, which makes a huge difference in how severe an injury like this can be, is the velocity of the object piercing the brain. A bar traveling at a high speed will create shock waves in the soft brain tissue, and this amplifies the potential damage.

In the case he treated, the patient was driving a car and hit a lamppost, and, a 7-foot long, 1-inch diameter crowbar with a chisel tip slid from the back of the car and through his head. It traveled at a relatively low velocity, so the shock wave effect was minor.

Considering the circumstances, his patient did pretty well - he was able to walk with little help after a week, and was discharged to his home after 2 months. After seven years, he could live independently but had speech and reading impairment, and weakness in his right arm.