Regarding The CAT Scan Of Terri Schiavo's Brain

[I’m “promoting” this comment left by “Cerebrocrat” in the Terri Schiavo News thread. –Amp]

CT scan of Terri Schiavo's brain.

Cerebrocrat wrote:

But there’s something being lost in this discussion of brain imaging methods. The fact that an MRI would give a better structural picture of Terri Schiavo’s brain does not at all mean that the existing CAT scan isn’t good enough for present purposes. I see much serious armchair scan-reading in this thread that signals ignorance of the subject. Let me tell you: if you are sufficiently familiar with brains and brain images, you do not need an MRI to tell you how severely the brain in the pictured CAT scan is damaged, nor do you need to see more slices than the one depicted here. This single image shows a very severely damaged brain. The large “blue blobs” in the middle are ventricles, also present in healthy brains (you can see the two little dark crescent shapes in the brain on the right) that have expanded to such a large size because the overall brain volume is so low. Cranial space that would otherwize have been filled by gray matter is now filled with cerebrospinal fluid. And yes, that’s what the blue space is: cerebrospinal fluid that is filling up space left behind by necrotic brain tissue that has been scavenged and removed by the body. The white squiggly things are white matter – connective tracts that have the loose, uncoiled look about them that they do because, again, the grey matter that once compressed them is no longer there, so they “float” loosely in CSF. The gigantic ventricles, expanded white matter, and undifferentiated blue space in that scan all point to the same thing: massive loss of grey matter in the cerebral cortex. You don’t need an MRI to tell you that, it’s clearly visible in the CAT scan.

It is true that given the poor resolution of this image, it’s possible that some cortical tissue has been spared. But that doesn’t matter. Whatever wisps of cortex we might be missing in this image are not enough to sustain behaviors that could differentiate Terri Schiavo from any other vertebrate. All the neural equipment you need to do ocular following and emotional responses is subcortical. All the neural equipment you need to be a self-aware, reasoning, behaving human being is cortical. And since i gather this image was made some time ago, the present condition of the brain can only be worse.

There is no way any qualified brain doctor or scientist could look at this image and suggest that significant recovery of function is possible. The fact that we could have all this discussion on the subject is a triumph of politics over science. Tragic for Terri Schiavo, and really for us all.

(Please see the comments for Cerebrocrat’s description of his background).

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417 Responses to Regarding The CAT Scan Of Terri Schiavo's Brain

  1. 401
    ginmar says:

    Well, I was going to respond to Robin’s comment about the pro death movement or whatever, but then I saw this:

    I found this story interesting.
    I think it is important to note, as well, that it is from Fox News, who has been accused ( right or wrong ) of being right wing.

    Faux News is not just right wing, they are the right wing’ s publicity arm. They’re so right wing that they make moderate conservatives embarrassed. They twist, spin and mutilate the news to give it a right wing slant. Anybody who thnks Faux News is fair and balanced has pretty much demonstrated their sourcing standards. Watch ‘Outfoxed’. But expect to get asked for a different source if you cite Faux News.

    Amp, is there any way you can do something like ‘go to last read’ on threads like this? This thread is so long you need to stop for food and water on the way to the bottom.

  2. 402
    Ampersand says:

    Some people have made a big deal of a supposed contadiction between statements that Terri Schiavo should be feeling no pain and the reports that she has been given morphine (apparently small doses, twice).

    Could one of the participating medical professionals discuss this? Someone told me that it was for breathing distress, rather than pain. Is that correct?

    From an article in the New York Post:

    Some Schindler family supporters condemned the use of morphine. “If Terri’s death is painless, why is she on morphine?” read one sign held by a man outside the Woodside Hospice yesterday.

    Schiavo has received two small doses of the opiate since the feeding tube was removed … not for pain, but to ease convulsions, according to medical experts.

  3. 403
    Brad says:

    My point on the Fox News story was that it is taking the opposite side from what Fox has been charged with taking all along.

    I am not argueing whether or not they are fair and balanced.

  4. 404
    Ampersand says:

    Amp, is there any way you can do something like ‘go to last read’ on threads like this? This thread is so long you need to stop for food and water on the way to the bottom.

    No, I can’t, not at my (nonexistant) level of programming skill.

    I could close this thread and create a new thread for continuing discussion. Would that do?

  5. 405
    Susan says:

    I’m repeating myself too much on this thread.

    However, one more try. Terri wanted that feeding tube disconnected. A court of law has found that, by “clear and convincing evidence.” That court has been sustained on appeal on occasions now beyond count. Properly speaking, Michael Schiavo has nothing to do with it now: everything that is happening is happening by court order because:

    1. Terri wanted it this way, and
    2. Our legal system is prepared to honor her wishes in this matter. Regardless of what her parents think, by the way.

    This is not a new legal doctrine. The right to refuse medical treatment, even essential and life-saving medical treatment, comes down to us from the deeps of time in this culture.

    Those of you disagree with this action in Terri’s case should explain – now, before you go back to telling us what evil eyes Michael Schiavo has, and such nonsense – why you think your opinion should be followed whereas Terri’s opinion should be ignored.

  6. 406
    Barbara says:

    Robin, I appreciate your experience, but as to whether I am “begging” to be left in Terri’s condition because I trust my husband, let me say, that if I were in Terri’s condition, and if I could, I would affirmatively beg my husband to do what Michael Schiavo has done. I am glad that you survived your medical battles, and if you were diagnosed as PVS, it was clearly a mistake. I am not saying that I feel no discomfort with the outcome in this case, just that any outcome at all makes me feel uncomfortable, mostly for the reasons you state — we can’t know with 100 percent certainty what Terri would want had she the cognitive and communicative ability to let us know. I was baptized and attend a Catholic church, and I don’t consider myself bound by Church doctrine on much of anything. Terri did not attend church regularly. I don’t even want to ask whether she used birth control, but if I had to bet, it would be that she did. This is just a factor, and not a very decisive one.

    Reading the record can be helpful because it makes clear that the courts bent over backwards to give the Schindlers an opportunity to make their case.

    But if you are saying, as it seems to me that you might be, that Terri has a duty to live that transcends what she would have wanted, then I clearly disagree with you. As with citing international declaration of human rights to food and water, all I can say is that there are also human rights to be free of unwanted state intrusion.

    I am not in a position to comment as a general matter on whether one should trust nurses over doctors, like all things, I am sure that it depends on the circumstances. I have had encounters with nurses and technicians who thought they knew much more than they actually did.

  7. 407
    Robin says:

    AMP – No, I can’t, not at my (nonexistant) level of programming skill.

    You don’t need a ton of programming skill to do this. If you are running on a Linux/Unix machine there is a simple way to write a server side redirect in a text editor that is a single line. Windows – can’t help ya there other than to sugget that you move :)

    Otherwise, just put the link to the new page at the very top of this old one. Just go way up the code in the same way you take out the quote tags until you get to the first page tag and write the link directly after.

  8. 408
    Doug says:

    Amp, it looks like another block quote was left open beginning with Dr. Ted’s Msg No 391. Thanks.

    And by the way, thanks for the excellent, informative blog.

    [Thank you! And thanks for letting me know about the open blockquote tag - I've fixed it! --Amp]

  9. 409
    Ampersand says:

    IMPORTANT NOTICE FROM AMP: At 8:30 am Pacific Time, I will close comments on this thread.

    I’ve begun a new thread for continued comments. If you want to add a comment or respond to a comment, please follow this link and continue the discussion there.

  10. 410
    Susan says:

    Thank you, Barbara, for your clear formulation.

    It seems to me that the people who want that feeding tube re-connected take one of two positions, and sometimes both:

    1. They think Terri has a duty to live that transcends what she would have wanted, as you say, or in the alternative, a duty to follow the speaker’s position on this instead of her own, and/or

    2. They think the court was wrong about what she wanted, for a variety of reasons, either that Judge Greer is a vulture or that Michael Schiavo has evil eyes or whatever.

    Both positions can be defended, but I’d like to see a defense up-front.

    As for thinking the court was wrong, I donno. I disagree with a lot of court decisions (especially when I lose!), but that’s the way we do things here, and for obvious reasons we don’t re-litigate things just because the loser is unhappy with the outcome. All the appellate courts are convinced that Judge Greer did a responsible job. I’d invite skeptics to read the Second District’s first opinion (available at abstract appeal, cited above) on this matter. What’s the theory here? That all the state and federal judges who’ve reviewed this are vultures? This wades us deep into conspiracy theory, deeper than I personally wish to go.

    If you think Terri has a duty to live regardless of what she thinks, or that your opinion is to be preferred to hers, I’d be interested in hearing why.

  11. 411
    Sally says:

    I think the difference, Susan, is that I have less faith than you do in the courts’ ability to determine Terri Schiavo’s wishes. The court is relying on eyewitness testimony about conversations that happened many years ago. People’s memories are notoriously selective, not because they’re consciously distorting anything, but because we remember things by slotting them into certain narratives, and we tend to select out the memories that don’t fit into those narratives. Michael Schiavo and his brother and sister-in-law believe that Terri would want to die, and it seems likely that they’d select out any memories that would contradict that narrative.

    I realize that all we have to go on here is hearsay, but it makes me nervous. It would make me nervous in any court case: I’m really wary of convictions based only on eyewitness testimony, too.

    And secondly, the courts don’t float above society: they’re subject to the same prejudices as everyone else. And one of those prejudices is a widespread belief that some lives are not worth living, that some people are just empty husks who are a burden on society, that medical care is a zero-sum game, and if we keep those people alive, we’re taking treatment away from someone more deserving. When judges weigh evidence, they have those prejudices in the back of their minds. I don’t have a lot of faith in the courts as neutral actors here. And given that they are biased, in the ways that everyone is biased, I tend to think we should err on the side of not killing people.

  12. 412
    Ampersand says:

    Emmetropia left a comment here, which I have moved to the new thread.

    Comments on this thread are closed, because the thread has gotten too long. If you want to make further comments, or reply to something you’ve read here, please do so on the new thread. Thanks.

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