Doctors: Sharon’s brain x-ray shows slight improvement, but he’s still critical

Hadassah University Hospital director Shlomo Mor-Yosef said Saturday evening that the latest scan of the brain of Prime Minister Ariel Sharon, performed Saturday, shows a slight improvement, but his overall condition remains critical. Sharon, who suffered a massive brain hemorrhage Wednesday night, was taken for a procedural CT scan Saturday morning to check for internal bleeding and examine intra-cranial pressure following surgical intervention the day before. „The prime minister is currently in intensive care. During the Sabbath, he underwent a scheduled CT scan,” Mor-Yosef told reporters outside the hospital. „Intra-cranial pressure is normal, pulse, blood pressure are normal. These measurements indicate stability,” he added. Mor-Yosef emphasised however, that the current treatment is aimed at keeping the prime minister alive. „It’s still critical for the life of the prime minister,” he said, „and all of our acitivies [are] to save the life of the prime minister at the moment.” He said that the hospital’s specialists in various fields wil meet Saturday morning to discuss when to bring Sharon out of the medically induced coma. Sharon remained heavily sedated and on respirator in intensive care unit Saturday , a day after he underwent his third operation in two days aimed at relieving intra-cranial pressure. On Friday evening, Professor Mor-Yosef said that an earlier CT scan showed that there was no active bleeding in the brain and that intra-cranial pressure has returned to normal. An official determination on Sharon’s condition will likely take place on Sunday, when doctors plan to wean him off the drugs that are keeping him in what they said is a medically induced coma. Sharon’s doctors are working to reposition the catheter in the brain. Mor-Yosef added that most of the blood clots in the prime minister’s brain have been drained. Haaretz Writers: Perspectives on Sharon „After the operation, we transferred the prime minister to the CT scan unit to determine the state of his brain,” Mor-Yosef told reporters. „I can say that in comparison to his previous CT scans, there has been a substantial improvement in the way the brain looks to Hadassah neurology experts.” „Despite the improvement, which in our opinion is substantial, the prime minister’s condition is serious but stable,” Mor-Yosef said. Doctors rushed the prime minister to the operating room to perform the second surgery after a CT scan Friday morning revealed an increase in cranial pressure. The brain scan also showed some bleeding in his brain, a slight expansion of one of his brain lobes and a rise in his blood pressure, said Mor-Yosef. Aides of Sharon, who is fighting for his life after suffering a severe stroke and cerebral hemorrhage this week, rushed to the hospital to be with him during the surgery. „It was decided to bring the prime minister to the operating room in order to deal with these two issues, to drain the bleeding and to decrease the intracranial pressure,” said Mor-Yosef. The medical term for Sharon’s condition is severe hydrocephalus. The doctor said this complication is to be expected, and is caused by the massive hemorrhage in Sharon’s brain. The more ominous information to emerge from the prime minister’s CT scan, however, is the renewed bleeding, said the doctor. „The first operation was already purely heroic,” on the part of the surgeons, he said, adding that „most patients are not even operated on in such a condition.” Hadassah doctors did not elaborate on Sharon’s prognosis, but an aide to Shimon Peres said his staff was told that Sharon’s situation is „not good.” Dr. Avi Cohen, director of the neurovascular unit at Soroka Medical Center in Be’er Sheva, said the prognosis was poor. „It certainly does not forecast good things regarding [Sharon’s] … ability to recover,” Cohen, who is not a member of Sharon’s medical team, told Channel 2. The cranial pressure and lobe expansion are caused by a blockage in the brain, said Dr. Yair Lampel, the deputy director of the Beilinson Hospital neurological department. „The blockage damages the functioning of the brain,” he said. „That could be fatal, so it must be dealt with quickly.” Before the surgery, doctors said they were planning to keep Sharon sedated and on a respirator at least until Sunday, to give him a chance to recover. „The logical scenario is that we won’t even try to wake him up before Sunday,” said Dr. Shmuel Shapira, deputy director of Hadassah. „This sedation has very important significance. The goal of the sedation is to lower the oxygen needs of the brain and to allow the brain … to rest. So certainly until Sunday, and it’s possible beyond that, he will be sedated.” Early Friday morning, Mor-Yosef reported that Sharon’s condition had remained stable overnight. „The night passed without change,” Mor-Yosef told reporters shortly after 7 A.M. „All the parameters that we are measuring… are stable.” He said then that Sharon’s cranial pressure was steady, adding, „This is again a positive sign.” However, Sharon’s doctors acknowledged Thursday night that Sharon has probably suffered irreversible brain damage that would preclude his ever resuming office. The official statement released Thursday by Hadassah said merely that Sharon was in serious but stable condition after suffering a cerebral hemorrhage on Wednesday due to the rupture of an artery wall. That statement, issued by Mor-Yosef, said that Sharon is under sedation on a respirator and paralyzed, that he is likely to remain under sedation for up to 72 hours, and that it is impossible to know what his condition really is until he emerges from sedation. Mor-Yosef added that predictions for the future are almost impossible to make. „We can’t know what the results of the surgery will be, whether it will have influenced his motor skills or his ability to think. Only after he comes out of the induced coma will we be able to make an assessment.” „We are fighting for the life of the prime minister, with no compromise,” Mor-Yosef said this week. Unofficially, however, Sharon’s doctors echoed the assessment given to Haaretz earlier by other senior doctors who had not personally examined the premier, but were relying on media reports of his condition. These doctors told Haaretz that the prime minister appeared to have suffered extensive and irreversible brain damage. Depending on the amount of blood he hemorrhaged and where exactly in his brain the hemorrhage occurred, this damage could range from impaired physical and mental functioning to spending the rest of his life in a permanent vegetative state – if he survives at all, the senior doctors said. But based on the information publicly available, the chances that he will survive appear to be low, they added. Following his first stroke, which was caused by a blood clot, Sharon was put on blood-thinning medication to try to prevent a recurrence. However, such drugs increase the risk of hemorrhaging, and a brain hemorrhage in someone on blood-thinning medication is almost always fatal, the senior doctors explained. The fact that doctors at Hadassah operated on Sharon for about nine hours also indicates that they had great difficulty stopping the bleeding and that the damage was extensive, the senior doctors added. „The chances of him waking up anytime soon are close to zero,” one senior neurosurgeon told Haaretz. „They would not even have performed brain surgery on most people in the condition in which Sharon arrived at the hospital.” Nevertheless, he added, surgery was the proper decision in Sharon’s case, since every effort ought to be made for a prime minister. After the sedation period, doctors hope to gradually waken the prime minister. Mor-Yosef said doctors had not received a „no resuscitation order,” which would bar them from trying to revive a patient whose heart or breathing has stopped. He said Sharon’s pupils were responding to light, „which means the brain is functioning.” The hospital chief also defended the decision to take Sharon to the Jerusalem hospital, a journey of an extra 30 minutes, rather than drive to the nearer medical center in Be’er Sheva. He said that it was better for the prime minister to have been treated at the hospital that knew his case. Other doctors, not involved in Sharon’s treatment, also expressed understanding with what they said were tough decisions about Sharon’s care. „There are problems when you treat a figure who is a political persona or a VIP,” said Dr. Gabi Barabash, the director of Ichilov Hospital in Tel Aviv. „Treatment of a VIP adds stress to the judgment system, and stress is unproductive.” „I don’t think they made a mistake,” Barabash said of the decision to take the premier to Jerusalem, rather than to the closer Soroka hospital in Be’er Sheva. The two hospitals are just half an hour apart, the medical staff at Hadassah is familiar with his case, and Soroka doesn’t have a magnetic resonance imager, used in brain scans, he said. „If there is an ambulance that is available at the door to the house that can leave immediately and a helicopter that still takes time to arrive, it is preferable to get moving,” Dr. Zeev Feldman, a neurosurgeon at Tel Hashomer Hospital outside Tel Aviv, told Channel 2 TV. „Generally speaking, it’s best to come faster,” said Dr. Itzhak Fried, a professor of neurosurgery at Ichilov and the University of California at Los Angeles. „But I’m not sure that with such massive bleeding, and the time difference of 10 to 20 minutes that they’re talking about … would have been significant.” Mor-Yosef said the operation on Sharon had focused on the right side of his brain, and that he was paralyzed during the procedure. „The paralysis was a paralysis that we, the doctors, created,” he said.