Corey was sent for another CAT scan today. Dr. Long, her neurologist here at Bryn Mawr, reviewed the results with us.
To recap, 10/2 among other injuries Corey was diagnosed with traumatic brain injury. Specifically, a diffused axonal injury. This means that the force of the impact she sustained moved her brain front/back/left/right/and twisted within her skull. There was a global sheering of the brain. The axons, small fibers that hold the brain to the skull, were torn. The brain has two hemispheres and several lobes that divide the brain. Corey was struck from the right therefore causing the most damage to the right side of the brain. But, keep in mind we are looking at the damage caused to the entire brain, both sides and each lobe, hence the global injury. Once the axons are torn, they die. The brain then tries to “refire” and “reconnect” what is left as it heals. Unfortunately, there is no way to know what will be restored. Swelling of the brain and ventricles plays a large part of this process.
10/3 the craniectomy was necessary to remove the “bone flap” from the right side of her skull. This relieved the pressure building within the skull as the brain swelled from the injury. A week later, her swelling was not decreasing due to hydrocephalus (increased cervical fluid in the ventricles of the brain). The VP shunt was implanted in the 3rd ventricle to help Corey’s brain move the fluid from her ventricles through a catheter to her stomach. The fluid from the brain is flushed to the stomach and is then excreted naturally.
12/10 the cranioplasty, replacing the “bone flap” to the skull. At this time, the neurosurgeon decided to turn the shunt off because the CT’s showed that the ventricles looked good and it appeared that Corey was managing her cervical fluid on her own.
1/3 we shared that the neurosurgeon was pleased with Corey’s alertness, movement and improved CT scans. It was his thought that the shunt remain off due to her progress since the cranioplasty with the possibility that it could be removed.
This brings us to today. Corey’s progress hasn’t hit a plateau but it’s not progressing at the rate everyone would hope it would since 12/10. Yesterday, Corey’s vomiting was a concern to the Doctor, therefore he ordered today’s CT to check that it wasn’t the result of increased brain swelling or a resurgence of the hydrocephalus.
The good news, each CT continues to improve. The midline of the brain is shifting back towards center. The swelling continues to decrease, yet the ventricles are a little larger than a normal 18 year old. (Definitely due to the accident) Dr. Long has a call into the neurosurgeon to discuss today’s CT. The thought is if we turn the VP shunt back on, it may initiate progress to assist Corey to increase alertness, deliberate movement, increased command responses and hopefully communication. Again, it is not prognostic and it may not…but it might be worth having the discussion to at least try it. It’s wonderful to have a programmable shunt so it can be “tweaked” as needed and it’s not an invasive procedure.
Corey, you are not alone. You have an amazing team doing everything possible to give you every opportunity to heal, recover and advance through this process. Your doctors, therapists, friends and family are here questioning, pushing, praying and cheering for you honey! It’s difficult not to expect immediate results. It’s frustrating to wait for each movement. The most important thing to remember is that you ARE making those movements. Time is nothing we have control over. Just for today, we can see that you continue to heal. It’s amazing news that each CT scan continues to show improvement. You’re better today than you were yesterday, than a month ago and you’re definitely better than you were on 10/2! We are so proud of your hard work and so thankful for your body’s ability to heal. Be patient honey, it will happen. Happy dreams, xoxo