Dei'ah veDibur - Information & Insight

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11 Teves 5766 - January 11, 2006 | Mordecai Plaut, director Published Weekly










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PM Shows Positive Signs As Anesthesia Reduced; Previous Treatment Contributed to Problem Due to Undiagnosed Ailment

by Mordecai Plaut and Yated Ne'eman Staff

Prime Minister Ariel Sharon remains in serious condition, even as his doctors reduce the drugs given to him and he shows signs that his brain is working. On Tuesday Ha'aretz reported that after examining CT scans taken during his current stay, doctors concluded that he was suffering from cerebral amyloid angiopathy (CAA), a disease of the blood vessels in the brain. Someone with this problem would not usually be given anticoagulant drugs, as Sharon was given after his first stroke on December 19. The blood- thinning medication causes a great risk of severe hemorrhaging for someone with this condition.

As doctors gradually reduced the drugs given to him, Sharon began to breathe spontaneously and also moved his right hand and right leg "slightly but significantly" in response to a pain stimulus. Some reports said that he was also responding to voices and conversation and he moved his left side as well.

The anesthesia drugs administered to Sharon have kept him in a state of induced coma to help his brain recover from three bouts of surgery performed last week to stop the hemorrhaging. Soon after the first reduction, Sharon began to breathe by himself, although he remains connected to a hi- tech ventilator that takes over automatically if he does not breathe properly for himself. The prime minister's vital signs of blood pressure, breathing rate, pulse and intracranial pressure remain "within the normal range."

Prof. Felix Umansky, head of Hadassah's neurosurgery department who participated in the three lifesaving brain operations performed on Sharon and who has been with him "24 hours a day," said that it would still take days or more until it became clear how much brain damage he suffered in his right hemisphere or elsewhere. It is too early to predict his cognitive abilities, the neurosurgeon added. Progress, he said, is different in each patient.

Asked when it could be said that Sharon was out of danger, Umansky replied: "It's hard to say. Surely when he can speak to us, when he is conscious, when he can sit and all systems work and there is no infection or complication."

Another expert said that it can take weeks for brain edema to go down and days to know about his brain functioning. Medicine is not an exact science, and neurological improvement is slow.

The chances that Sharon will survive his massive stroke are "very high. He is a very strong man, and he is getting the best care," Dr. Jose Cohen, the neurosurgeon who has performed three operations on Sharon, said.

Cohen warned, however, that the prime minister remained in serious condition, and noted: "He will not continue to be prime minister, but maybe he will be able to understand and to speak."

Sharon's secretary said he had been working more than the recommended four hours before his second stroke and part of that was writing thank you notes to well-wishers from his first stroke.

According to a senior medical source, in some instances CAA is a genetic disorder, while sometimes its origin is unknown. The disease is diagnosed by means of interpreting CT and MRI scans, or by performing a biopsy on a small sample of the brain. However, the disease is very difficult to diagnose, and can sometimes be detected only following a brain hemorrhage.

Critics have raised numerous questions since Sharon's hospitalization regarding his medical supervision over the past two weeks; the administering of the blood-thinning medication; the dosage administered; the medical and laboratory supervision in the wake of administering the blood- thinning medication; and the decision to perform the cardiac catheterization as well as its timing.

Rabbi Nosson Grossman wrote that just before the stroke which took place on January 4, Yoel Marcus of Ha'aretz wrote a column for the "new year" about how difficult it is to foresee events. He noted that no foresaw that Gush Katif would be evacuated without a drop of blood being spilled or any really serious conflict, that Netanyahu would resign from Sharon's government, that Sharon would leave the Likud that he founded, that Tzachi Hanegbi and Shimon Peres would leave their long-time political homes and find themselves together in Kadima, or that the healthy, powerful Sharon would suffer a stroke that would cast a shadow on his abilities. Marcus ended with a flourish: "No part will get the number of mandates now predicted for it. But one thing is clear: Sharon will be the next prime minister!"

Less than 48 hours later, Sharon even ceased to serve as the current prime minister. Hakol beyedei Shomayim.


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