by Dr Benjamin Cheah
As this article is being written, Micheal Schumacher, the 7-time world F1 champion, is fighting for his life. It is unfortunate that he has to hit his head on a rock going at high enough speeds to do the damage. It is likely fortunate that he had his helmet on. However, the concussion was likely strong enough to sever blood vessels in his skull.
The brain is situated in a confined space within the skull. Therefore any bleeding or swelling in the brain would have led to a quick build up of pressure within the skull. Reducing this pressure is of paramount importance. Otherwise it will cause a phenomenon called coning, where the brain will exit the skill from the base resulting in compression of other vital parts of the brain leading to irreversible damage and resulting death.
We know that Schumacher has underwent brain surgery to remove the blood clots and is now in a medically induced coma.
Removing the clot
Removing the clot is easier said than done. It all depends on where the clot has occurred. If it is fairly near to the skull, it can be removed with ease. If it sits within the brain or near to vital structures, then it will be impossible to remove. It is likely that Schumacher did not just have a bleed to one area but likely several areas. Removing a removable blood clot was only a stop gap measure to reduce the pressure to his brain.
Meanwhile, swelling is likely to occur within the brain. This is a natural phenomenon where inflammatory cells migrate to the damaged site in its effort at repair. However, this “healing” process is likely to do more damage than good in the short term. What neurosurgeons can do is to bore holes within the skull exposing layers of the brain, so as to relieve the pressure within the skull.
Sometimes a craniotomy may be needed i.e. parts of the skull removed, to further help in reducing pressure around the brain.
Medically induced coma
What Schumacher is going through now is a medically induced coma. First, mechanical ventilation can lower the partial pressures of carbon dioxide to a lower level. This has been shown to cause vasoconstriction, i.e. blood vessels becoming smaller, and thus lower the pressure in the brain much quicker. The use of medications, in particular, barbiturates, to induce coma, can lower the metabolism of the brain and lower the pressure surrounding the brain. Steroids would also likely have been given to reduce the swelling.
Some have suggested induced hypothermia and even removing some of the cerebrospinal fluid. I am sure all these are being considered as they attempt to stabilize Schumacher. As they fight to save brain tissue, doctors have to ensure that his other vital organs are kept healthy and working in good order. It is now hoped that the bleeding has stopped with no further buildup of pressure.
Our thoughts are with him.