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Jules Bianchi Suffers Severe Head Injury in Rainy Japanese GP

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Just a brutal, brutal impact. I'm sad for him.


Dr. Gary Hartstein on Diffuse Axonal Injury:
Diffuse axonal injury
When we talk about “severe” head injury, as I mentioned Sunday, we’re talking about a classification that’s done CLINICALLY. That means the Glasgow score is assigned without taking into account exactly what the injuries are. Eyes, verbal, motor. That’s it.
We’ve spoken quite a bit about hematomas – collections of blood either outside of the membranes protecting the brain (“extradural” hematoma), within those membranes (“subdural”), under them (“subarachnoid”) or in the brain substance itself (“intracerebral”). Hematomas cause damage by compressing and displacing brain tissue, but also by increasing the intracranial pressure (see earlier posts about this).
When we take a patient to the CT scanner to see what the injuries are, we’re sometimes surprised to see that our (very) comatose patient has a shockingly “normal” looking scan. When the scan shows essentially generalised swelling with no significant focal neurosurgical lesions (i.e., bruises and hematomas), we talk about diffuse axonal injury, or DAI. We HATE when this happens. We have a scan that’s remarkably . . . pristine, with a patient who is seriously comatose.
Let’s look at the terms just a bit:
DIFFUSE: unlike hematomas, which by definition occur at a given location, using conventional imaging, DAI doesn’t show any SPECIFIC location for damage. This obviously isn’t particularly good news, because it precludes systematisation of the patient’s symptoms, makes rehabbing harder, etc.
AXONAL: the axons are the cable part of the nerve cell. They’re insulated cables, to conduct nerve impulses faster, so they’re covered in a fatty membrane, making them whitish. When you group lots of axons together you get white matter. The cell bodies of the nerve cells (neurons) are greyish . . . so when you put a bunch of nerve cell bodies together, yep, there it is, grey matter.
DAI seems to damage the white matter of the brain. The cabling. Once again, this isn’t really great, as the cabling is what allows higher-level information processing by hooking up the various brain areas (e.g., visual and auditory. I SEE you talking, HEAR your words, but actually it’s associative areas of my brain that fuse the information and integrates it into my experience of YOU TALKING. That kind of processing is easily interrupted with DAI.
This will often be associated with brain swelling, at least initially.
I’m totally gutted, sickened, by having to ask you to go back to December and January’s posts for more about ICP if you’re interested. I don’t have the heart to go through this again. Not for another of our guys. Jeez.
DAI is usually associated with a somber prognosis. Jules is young, strong, and is being cared for by a superb team. C’mon Jules. Go for it.



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Bianchi Family Statement:

The following statement is provided by the family of Jules Bianchi, in conjunction with the Mie General Medical Center, and is distributed on their behalf by the Marussia F1 Team.
“This is a very difficult time for our family, but the messages of support and affection for Jules from all over the world have been a source of great comfort to us. We would like to express our sincere appreciation.
Jules remains in the Intensive Care Unit of the Mie General Medical Center in Yokkaichi. He has suffered a diffuse axonal injury and is in a critical but stable condition. The medical professionals at the hospital are providing the very best treatment and care and we are grateful for everything they have done for Jules since his accident.
We are also grateful for the presence of Professor Gerard Saillant, President of the FIA Medical Commission, and Professor Alessandro Frati, Neurosurgeon of the University of Rome La Sapienza, who has travelled to Japan at the request of Scuderia Ferrari. They arrived at the hospital today and met with the medical personnel responsible for Jules’ treatment, in order to be fully informed of his clinical status so that they are able to advise the family. Professors Saillant and Frati acknowledge the excellent care being provided by the Mie General Medical Center and would like to thank their Japanese colleagues.
The hospital will continue to monitor and treat Jules and further medical updates will be provided when appropriate.”



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