THE VIRGINIAN-PILOT
Copyright (c) 1994, Landmark Communications, Inc.
DATE: Friday, September 2, 1994 TAG: 9409020748
SECTION: SPORTS PAGE: C1 EDITION: FINAL
SOURCE: BY BOB ZELLER, STAFF WRITER
LENGTH: Long : 149 lines
As Ernie Irvan continues to recover from his critical lung and brain injuries at an encouraging pace, brain surgeons and doctors who are familiar with hundreds of similar severe head injuries say that most patients are left with some form of permanent disability.
``There are very few patients who have a severe head injury who are 100 percent normal,'' said Dr. Michael Williams, assistant professor of neurology at Johns Hopkins School of Medicine in Baltimore. ``It would be extremely unlikely, but possible. I learn to never say never.''
Irvan, who was injured in a crash during practice on Aug. 20 at Michigan International Speedway, may defy the odds. Athletes in general are tremendously motivated people with above-average recuperative abilities, the doctors said. Further, Irvan's treatment started almost immediately after he was injured - an extremely important fact.
But NASCAR racing fans should be prepared for the possibility that he will never be able to race again, the doctors said.
``Most people have a permanent disability from a severe head injury,'' said Williams, who was an intern at Methodist Hospital in Indianapolis under Dr. Steve Olvey, noted for his treatment of drivers.
``There are some people who regain functionality of their arms and legs, but if you're asking me would I expect him to regain the skills necessary to be a race car driver again, I would say probably not.
``To be a race car driver requires an exquisitely quick mind and exceptionally good arm and hand and eye coordination skills,'' Williams said.
``To be quite honest, I don't know if there is ever a complete 100 percent recovery,'' said Dr. Anthony Marmarou, professor of surgery at Virginia Commonwealth University in Richmond and director of the American Brain Injury Consortium. Marmarou is also closely affiliated with the National Traumatic Coma Data Bank based at the college.
``There are so many complications - post-traumatic epilepsy, some atrophy,'' Marmarou said. ``I don't wish to paint a black picture, but a complete recovery in my
view is if that individual returns to his previous line of work and performs well.
``There are cases where the quality of life may be very good, but do you retain any deficit which will prevent you from performing the way you previously had? That is the question.''
Marmarou said that from the continuing news reports on Irvan's condition he is ``just amazed at his recovery up to this point. But I believe we should be very cautious and not expect too much until it actually happens.''
Irvan, meanwhile, continues to convalesce at St. Joseph Mercy Hospital in Ann Arbor, Mich., at the ``slow and progressive'' pace that his doctors predicted. Still in serious but stable condition, he remains on a respirator in intensive care. But the swelling of his brain continues to recede, according to a hospital statement issued Thursday.
Irvan's adopted hometown of Charlotte was abuzz Thursday when radio stations reported that he had briefly sat in a chair.
Brian VanDercook, publicist for Irvan's Texaco Havoline race team, confirmed the report and said he was encouraged by it, but said: ``None of us can lose sight that this may be a slower recovery than any of us want. We just don't know.''
VanDercook visited Irvan Tuesday. Of the visit he said: ``I saw differences that I interpreted to be positive,'' such as good skin color, small smiles and greater responsiveness to different people in his room.
While the hospital has had two press conferences and continues to issue updates, Irvan's doctors are not granting individual interviews at the request of his family, St. Joseph's media relations coordinator Margo Burrage said.
Both Burrage and VanDercook questioned whether the doctors quoted in this story would have enough information to give informed opinions.
Williams and the other doctors were asked to comment in general terms about their experiences with patients who suffered the same type of critical head injury as Irvan - a fractured skull with swelling of the entire brain, including the brain stem.
Of the 450,000 head injury victims admitted to American hospitals each year, about 10 percent are classified as severe, Marmarou said. Of the 45,000 people with severe head injuries, 50 percent die and 15 percent are left in a vegetative state or with severe disabilities.
The other 35 percent, Marmarou said, ``will have a good, moderate recovery. But . . . could you go back to what you were doing before? That is the major question.''
Three months, Marmarou said, is a ``reasonable plateau'' for doctors to determine the extent of permanent injury, ``but the final plateau will be in six months.''
As far as a patient's recovery, it is ``largely thought to occur within 18 months post-injury. That's when the individual will regain most of the functions they are going to regain,'' said Dr. Ella Pecsok, who is with Neurology Specialists in Norfolk and is on the staff of Sentara Norfolk General Hospital.
``One of the most significant factors is called post-traumatic amnesia, and that's the time at which memory returns after an injury,'' she said. It's not so much the memory of events before the injury, or the ability to remember who one is, but the ability to remember things from one day to the next after the injury occurs, Pecsok said.
The general rule is that if there is post-traumatic amnesia and it lasts more than two weeks, the chance for permanent problems is greater.
``But usually people who are resourceful prior to the injury, or highly motivated or bright, are better'' at recovering, Pecsok said.
Bobby Allison, who suffered a severe, career-ending concussion in a crash at Pocono in 1988, said he feels he is about 80 to 85 percent recovered. Unlike Irvan, Allison needed surgery to release pressure from the swelling of his brain. But he was responding to commands less than 24 hours after the crash, according to news reports.
Allison is able to live a largely normal life, but has a slower gait and wears a special patch under his ear to prevent dizziness and vertigo.
``I feel like most of my memory loss is from 1988, but occasionally I realize it's not just 1988,'' he said.
Allison recalls his post-traumatic amnesia this way: ``I had too much confusion. I was really fortunate that I knew who Judy (his wife) was. But I didn't know anybody else.
``Six weeks after my injury I was moved to Lakeshore (Rehabilitation Hospital in Alabama). And two and a half weeks after I was moved to Lakeshore, I realized I was somewhere.''
Permanent disabilities can take many different forms, Williams said.
``For example, (patients) may lose their ability to communicate effectively or use language. They may actually have cognitive deficits. That's a loss of the logic and reasoning skills and thinking and memory that you and I use in everyday life to do our jobs.
``It could take the form of impaired use of arms and legs. And that might range from out-and-out paralysis to just clumsiness and uncoordination.''
One of the most optimistic bits of news on Irvan's condition came the day after the accident, when his doctor, Errol Erlandson, said he and other physicians saw ``no other areas of the brain which have suffered irreversible injury.''
Marmarou, however, said current technology cannot fully diagnose whether there is irreversible injury ``because the damage could be to the axons (cables) and neurons themselves, which is undetectable. Not all of the damage is evident on a CAT scan.''
At the same time, the fact that Irvan was regaining consciousness and was able to respond to simple commands only four days after the accident was ``excellent,'' Marmarou said. ``The time to respond to commands for that degree of injury is extremely short.''
But Marmarou and Williams said if Irvan is able to recover well enough to drive a race car again, his chances of recovery from another severe head injury would be far slimmer.
``If you take somebody who has a severe head injury and they recover consciousness from that, they have had a number of brain cells that have died,'' Williams said. ``And so they would have less reserve from which to bounce back if they were injured again.
``It is going to be harder for a person to recover from a second one just because they have less brain to work with.'' ILLUSTRATION: ASSOCIATED PRESS COLOR PHOTOS
Doctors said that athletes such as Ernie Irvan belong to a highly
motivated and recuperative class of patients, but that odds don't
favor Irvan regaining all the skills he had before his Aug. 20
crash.
by CNB