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News of the Day ... In Perspective

12/12/2005

Neurointensive care gains adherents

One year after devastating bilateral strokes that left him in a “vegetative state” with the supposedly hopeless “man in the barrel” syndrome, Dr. Mark Ragucci walked into neurologist Stephan Mayer’s office and introduced himself.

“It was at that point I realized that we knew absolutely nothing about the recuperative power of the brain,” Dr. Mayer said. “Doctors are telling people there’s no hope when, in fact, there is.”

More aggressive than most in treating brain-injured patients, Dr. Mayer had deemed the patient to be nearly hopeless because he had suffered 24 minutes of cardiac arrest during surgery to repair an aortic aneurysm. Despite being informed of the grim prognosis, Dr. Ragucci’s family insisted on all life-saving measures. His case was one of the first in which Columbia University physicians had used a device called the Arctic Sun to cool the brain.

Although his life was out of danger upon discharge from the neurointensive care unit five weeks after the event, Dr. Ragucci recovered consciousness only very slowly.

At age 35, Dr. Ragucci is now practicing rehabilitation medicine. He said he was aware that doctors and nurses were talking about him in the past tense, even when they could perceive no brain activity. He tried to tell them to “stop it” when they painfully squeezed his toe.

Dr. Mayer believes that the brain’s recuperative capacity is underestimated because “we never saw any long-term outcomes, because we always let them die assuming the outcome would be terrible.”

Authors of a 2001 study on hemorrhagic stroke published in Neurology found that as many as one-third to one-half of the neurologists they surveyed would have given up on patients who ended up alive six weeks later (Wall St J 11/23/05).

Additional information:

“The Perilous Vegetative State” by Lawrence R. Huntoon, M.D., Ph.D., J Am Phys Surg, summer 2005.

“Frogs, Crabs, and the Culture of Death: Lessons from the Schiavo Case” by Madeleine Pelner Cosman, Ph.D., Esq., J Am Phys Surg, summer 2005.

“Late Treatment of Severe Brain Injury with Hyperbaric Oxygenation” by Richard A. Neubauer, M.D., et al, J Am Phys Surg, summer 2005.

 

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