An ex-Formula One doctor and a neurosurgeon discuss the prognosis for the retired racing driver, who is in a coma
Michael Schumacher's injuries – the doctors' view
An ex-Formula One doctor and a neurosurgeon discuss the prognosis for the retired racing driver, who is in a coma
The emergency
department at the CHU hospital in Grenoble, where Michael Schumacher is
being treated. Photograph: Robert Pratta/Reuters
The full impact of brain injuries such as those suffered by Michael Schumacher on Sunday can take months to diagnose.
Gary Hartstein, a former Formula One trackside doctor, said: "The brain's plasticity makes prognosis impossible to pronounce definitively for quite some time. Weeks to months."
The nature of Schumacher's treatment "suggests that something very serious has happened", said Chris Chandler, consultant neurosurgeon at King's College hospital in London.
"Certainly after blunt trauma, which is what you would term his injury, the brain does swell and that swelling contained within the rigid box of the skull can cause dangerous pressure on the vital structure to the brain," he told Sky News. "That brain swelling needs to be controlled. The fact that he was wearing a helmet simply means that it has minimised the severity of the injury but still it is possible to sustain a serious injury even with the helmet."
Chandler said the fact that Schumacher, 44, was in a coma meant he could have suffered a number of different injuries. "He could have suffered a diffuse injury to his brain, which can then result in brain swelling. He could have sustained some sort of brain haemorrhage and if there was a blood clot within his brain or on the surface of his brain underneath his skull, that might need to be removed."
"Sometimes there is nothing actually to remove but you put in an intracranial pressure monitor, which basically is an operation that requires drilling a hole in the skull and putting a fine probe inside. Or if there is diffuse swelling of the brain, sometimes surgeons remove a large piece of the skull … so there is space for the brain to swell to minimise the pressure on vital structure.
"It's not clear from the reports that I've heard exactly what the nature of this emergency operation was. But the fact that they undertook something almost immediately, that he was admitted to the surgical unit, suggests that something very serious has happened."
Hartstein said the fact that Schumacher was conscious and speaking immediately after the accident was common. "It's quite well known that extradural haematomas, a kind of cerebral haemorrhage, can leave a lucid interval after injury.
"Then as the haematoma forms, the increase in pressure causes sudden and dramatic symptoms. Pressure must be relieved rapidly," he said.He said the coma could be induced.
"Lets demystify it just a bit. Any severe head injury leads to a loss of co-ordination of tongue and throat muscles. This happens to some when they sleep – called snoring. But this is respiratory obstruction and causes carbon dioxide to rise and oxygen to fall," he explained.
"But the brain wants oxygen and hates CO2. So we put tubes in these patient's tracheas and use respirators. This protects the airway and gives excellent control of ventilation and oxygenation.
"But to intubate someone, he or she needs to be pretty deeply anaesthetised. So this is the usual 'artificial coma'. It is an induced coma, but in fact it's like a prolonged, protective, anaesthetic."
Gary Hartstein tweets as @former_f1doc. His responses were edited from his tweets.
Gary Hartstein, a former Formula One trackside doctor, said: "The brain's plasticity makes prognosis impossible to pronounce definitively for quite some time. Weeks to months."
The nature of Schumacher's treatment "suggests that something very serious has happened", said Chris Chandler, consultant neurosurgeon at King's College hospital in London.
"Certainly after blunt trauma, which is what you would term his injury, the brain does swell and that swelling contained within the rigid box of the skull can cause dangerous pressure on the vital structure to the brain," he told Sky News. "That brain swelling needs to be controlled. The fact that he was wearing a helmet simply means that it has minimised the severity of the injury but still it is possible to sustain a serious injury even with the helmet."
Chandler said the fact that Schumacher, 44, was in a coma meant he could have suffered a number of different injuries. "He could have suffered a diffuse injury to his brain, which can then result in brain swelling. He could have sustained some sort of brain haemorrhage and if there was a blood clot within his brain or on the surface of his brain underneath his skull, that might need to be removed."
"Sometimes there is nothing actually to remove but you put in an intracranial pressure monitor, which basically is an operation that requires drilling a hole in the skull and putting a fine probe inside. Or if there is diffuse swelling of the brain, sometimes surgeons remove a large piece of the skull … so there is space for the brain to swell to minimise the pressure on vital structure.
"It's not clear from the reports that I've heard exactly what the nature of this emergency operation was. But the fact that they undertook something almost immediately, that he was admitted to the surgical unit, suggests that something very serious has happened."
Hartstein said the fact that Schumacher was conscious and speaking immediately after the accident was common. "It's quite well known that extradural haematomas, a kind of cerebral haemorrhage, can leave a lucid interval after injury.
"Then as the haematoma forms, the increase in pressure causes sudden and dramatic symptoms. Pressure must be relieved rapidly," he said.He said the coma could be induced.
"Lets demystify it just a bit. Any severe head injury leads to a loss of co-ordination of tongue and throat muscles. This happens to some when they sleep – called snoring. But this is respiratory obstruction and causes carbon dioxide to rise and oxygen to fall," he explained.
"But the brain wants oxygen and hates CO2. So we put tubes in these patient's tracheas and use respirators. This protects the airway and gives excellent control of ventilation and oxygenation.
"But to intubate someone, he or she needs to be pretty deeply anaesthetised. So this is the usual 'artificial coma'. It is an induced coma, but in fact it's like a prolonged, protective, anaesthetic."
Gary Hartstein tweets as @former_f1doc. His responses were edited from his tweets.
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Schumacher fighting for life, doctors say
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- Schumacher's injuries: the doctors' view
- Doctors say former F1 world champion would not have survived accident in French Alps if he had not been wearing a helmet
- theguardian.com,
Michael Schumacher remains in a critical condition and fighting for his life after sustaining serious head injuries in an off-piste skiing accident at a resort in the French Alps, French doctors have said.
Schumacher, 44, was airlifted to Grenoble after falling heavily and hitting his head while skiing on an unmarked slope at the Méribel resort with friends and his 14-year-old son.
At a press conference in Grenoble, doctors said he was in a coma when he arrived at the hospital and had to be operated on immediately. They said his condition remained "extremely serious" and he was being kept in an artificial coma, but that it was too early to give an accurate prognosis.
"We cannot predict the future for Michael Schumacher," Professor Marc Penaud, the deputy director of Grenoble clinic, said. "It's too soon to talk about."
He confirmed that the former F1 champion had arrived at the clinic at around 12:40pm on Sunday with a severe brain trauma and immediately underwent an operation.
Jean Francois Payen, the clinic's head of anaesthetics, said Schumacher had suffered bleeding and heavy bruising on the brain. Since his arrival, the medical team at the clinic had focused on stopping the swelling, supplying the brain with oxygen and keeping the body at the recommended temperature at 34-35 degrees.
Payen said the impact had been on the right side of Schumacher's head and that it was clear that if he had not been wearing a helmet the former world champion would not have survived the crash.
The athlete had been conscious after the crash but didn't answer questions and was displaying "erratic" behaviour.
Overnight, various reports in the French and German media have claimed that Schumacher had been operated on twice after suffering a brain haemorrhage, but doctors said this was not the case.
Christoph Specht, a medicine journalist, told German TV that the fact that Schumacher's brain had been bruised increased the chances of long-term damage.
A leading brain surgeon from Paris, Gérard Saillant, rushed to the hospital to attend to the former grand prix driver. Saillant, an expert in brain and spine injury, is a close friend of Schumacher, having operated on him when he broke his leg at Silverstone in 1999.
Schumacher's wife and other family members are by his bedside. ESPN F1 also reported that Jean Todt, his former Ferrari team boss and now president of motorsport's governing body, the FIA, was at the hospital.
A skier with Schumacher's group raised the alarm within minutes of the accident, which occurred just after 11am in bright and sunny weather. "The skier alerted mountain rescue just a few hundred metres below where he fell," said the director of Méribel Alpina, Olivier Simonin, in charge of security and ski-lifts at the site.
Two rescuers arrived quickly and called in two others to help evacuate Schumacher. The racing driver was initially taken by helicopter to the nearest hospital at Moûtiers before being transferred to Grenoble, which has a specialised trauma unit.
The hospital announcement was the first since a terse statement on Sunday afternoon released by Schumacher's manager, Sabine Kehm. She confirmed the accident and said nobody else was involved in the fall.
"Michael fell on his head when he was on a private skiing trip in the French Alps. He was taken to hospital and is receiving professional medical attention. We ask for understanding that we cannot give out continuous information about his health," the statement said.
Méribel's director, Christophe Gernignon-Lecomte, had earlier described Schumacher as being "in shock, somewhat shaken, but conscious" when the emergency rescue team reached him. He also said Schumacher's head injury was "not serious", but a resort spokesman said later that Méribel officials were waiting for a more comprehensive medical report.
Gernigon-Lecomte said Schumacher owned a chalet in the valley and knew the resort and the pistes of Méribel well. "It was something habitual for him," he said.
Messages of support for Schumacher have been pouring in since the gravity of his condition became apparent on Sunday night.
A spokesperson for Angela Merkel said the German chancellor was "shocked" about the news and wished him and his family "strength and support".
Sebastian Vettel, the current Formula One champion, who is a close friend of Schumacher's, said: "I am shocked, and I hope that he will get better as soon as possible. I wish his family a lot of strength"
Fellow racing driver Romain Grosjean wrote on Twitter: "All our thoughts to Schumi and his family! Hope you will recover soon." .
Felipe Massa put a picture himself hugging the seven-time F1 champion on Instagram: "I am praying for you my brother!! I hope you have a quick recovery!! God bless you Michael."
Jenson Button tweeted: "My thoughts are with Michael Schumacher at this tough time. Michael more than anyone has the strength to pull through this."
Tennis legend Boris Becker, football star Lukas Podolski, tennis player Sabine Lisicki, , Dallas Mavericks' German basketball forward Dirk Nowitzki and cricketer Michael Vaughan were among the many athletes who also expressed their support.
German media have been mostly careful not to speculate on Schumaher's condition. One article in Die Welt speculated that the F1 driver may have misjudged the situation because he was racing his own son, but was criticised on social media by many, including fellow German driver Nick Heidfeld.
Several newspapers have reminded readers of Schumacher's lucky escapes in the past. Schumacher's first title-winning season was marked by the tragic death of Ayrton Senna, but the German often experienced near misses. He survived crashes unscathed in 1995 and 1998. In 2001, Schumacher broke his lower leg during a training accident in 2001. In February 2009, he had to postpone his comeback after a motorcycle crash, in which he fractured his skull.
Felix Gorner, a racing reporter from RTL television channel, said the latest accident could only be understood within the context of Schumacher's history as a F1 driver. "He wanted the adrenaline rush, he needed to test his own limits", he said, pointing out that the other hobbies Schumacher had taken up included motorbike racing and skydiving. His former manager Willi Weber had described Schumacher as an "adrenaline junkie".
French fans of Schumacher gathered in the afternoon outside the hospital as they waited in vain for news. Olivier Panis, a former Formula One driver from Grenoble, came to the hospital twice during the day but was unable to see the German driver.
When he fell, Schumacher was skiing close to one of the chic resort's most difficult pistes in the Three Valleys. He was skiing off-piste between the pistes La Biche and the more difficult runs of Mauduit, named after the former French skiing champion George Mauduit. The slope, devoid of trees, where he and his son were skiing, is at an altitude of 2,100 metres, close to the luxury resort of Courchevel. The pair were about 20 metres away from the marked slope when Schumacher tumbled, according to Simonin.- copy http://www.theguardian.com
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