19 hours ago
Monday, August 2, 2010
Medical Mondays: Meet Phineas Gage
Hello! This week's question is from Jessica, a.k.a. the Alliterative Allomorph. She asks:
Is it possible to be shot in the head, survive, lose all long term memory, but still function like normal, and retain all short term memory from rehabilitation onward?
Well, in researching this answer, I found Phineas again. I'd learned all about Phineas Gage in medical school, but his case is so extraordinary (and relevant to today's topic) that I thought it was high time you all met him.
Before reading, I must warn you THERE ARE SOME REALLY GROSS THINGS COMING so if your stomach is weak, look away my friends.
Here he is. Isn't he handsome?
Phineas was an American railroad worker. In 1848, the 25 year-old was doing his usual job of tamping down explosives into a hole with his iron rod when he neglected to add the buffering sand between the explosives and his rod. As a result, the explosion shot the iron straight through his skull as in the diagram above.
The 13 pound iron bar landed 80 feet away. Amazingly, he was able to sit up and talk. He was conscious all through the examination by the physicians later. He did, however, vomit once, and in doing so, a half a cup of brains leaked out of his skull and fell on the floor.
Sorry. I had to add in that gross-out. I didn't learn that one in med school.
Anyway, after spending over a a month in coma as his brain swelled and became infected, he eventually recovered and was able to work. He died 12 years later from complications of a seizure disorder (epilepsy) due to his head trauma.
So. How does this relate to today's question?
Well, in penetrating head injury such as bullets and knives, the mortality is incredibly high, well over 90%. But, as in Mr. Gage's example, people can indeed survive.
Gunshot wounds to the head are particularly traumatic. The higher the velocity of the missile, the worse the damage is. Not only do they destroy brain tissue as they tunnel their way through the skull, but they also cause shock-waves and often destroy tissue in areas well beyond the simple path of the bullet.
As for memory problems? In my earlier post on amnesia, we learned about anterograde and retrograde amnesia.
For this character, they'd need loss of long term memory but retention of short term memory. This is definitely possible. This person would have retrograde amnesia, meaning loss of memory before the accident. The can remember things after the accident, but even then, may have problems converting short term memories (lunch with a friend today) into long term memories (a week or year later, no memory of that lunch).
The great thing about memory loss is that different combinations of memory loss can occur with severe injuries. In the world of fiction writing and head trauma (which seems to be a common occurence!), you have plenty of room to make it work out for your character the way you want it to.
Hope this helps, and hope I didn't gross you out too much!