Sunday, March 27, 2005

What if the CT Brain Scan Isn't Terri's?

Online Medical Discussion Board Concludes 1996 CT Brain Scan Is Likely A Hoax

[This post will be updated to fix facts or update conclusions as needed with informed consensus. Assertions will be withdrawn as they are refuted.]

Analysis and discussion on the award-winning medical blog CodeBlueBlog are casting suspicion on the single 1996 CT scan that has provided the entire basis of evidence - apart from Dr. Cranford et al's since-discredited testimony - for Terri's diagnosis of PVS and the claims of massive cortical atrophy (the so-called "liquefying brain"). From Dr. Martin on CodeBlueBlog:
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I have seen many CT scans looking like ["Terri's"] as well ... The single image from this particular scan shows SEVERE loss of cortical tissue. The PATIENTS who go along with CT scans like that are for the most part in advanced demented states, nonverbal, often contracted into the fetal postition, unable to follow any instructions or engage in purposeful movements.
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The conclusion that the 1996 CT scan shows severe brain damage and almost no hope for meaningful recovery was echoed by Dr. Sanjay Gupta, CNN's medical correspondent and a trained neurosurgeon himself, who reportedly based his opinion on this scan and the (disputed) EEG report. Dr. Martin's assertion above - that this scan may not even be Terri's - is either a five-alarm scandal in the making or a fantasy driven by collective "false hope".

Yet the consensus building on the discussion thread's medical participants indicates: The 1996 CT scan is a hoax.


Why we reached this conclusion is an excellent question. There are several reasons to consider.

First: Like Dr. Martin, Dr. Bell at Wake Forest and other respected neurologists in the field have collectively concluded that the two different exhibits being used to justify Terri Schiavo's diagnosis of persistent vegetative state or PVS - the CT brain scan ("Exhibit A") and the 10- to 45-minute patient exams by 3 doctors ("Exhibit B") - point in two entirely different directions. To a large degree they may even contradict each other.

That does not address the question of whether or not Terri has PVS. What it means is, the two exhibits gathered to "diagnose" Terri contradict each other. It means that at least one of the exhibits - Exhibit A or Exhibit B - must be false.

Which is it (or is it both)? Competent neurologists believe it is both, for reasons that will become clear shortly.

EXHIBIT B - Testimony of Dr. Cranford et al

First: there is reason to doubt Exhibit B independently. Exhibit B consists of testimony from three doctors - two for Michael Schiavo and a tie-breaker - that all agree she has "PVS". This is ludicrous for the following reason: Every neurologist (besides Dr. Cranford et al) who has examined Terri in person has found immediate and solid evidence of her cognitive abilities. Though this evidence was swished away as "irrelevant" by Judge Greer on every occasion (for reasons known only to him), they have found Terri to be alert, conscious, able to feel pain, and trying to speak. That falsifies Exhibit B - testimony that has been discredited by the eyewitness reports and even her own medical records - on its face.

[Ed: There will be more credible and irrefutable problems and contradictions that will impeach Exhibit B in a future post.]

While they have noted some obvious disabilities in Terri - partial blindness is one of them - they all realize she continues to hear well and respond. Why this hasn't been entered into evidence in Judge Greer's court is a mystery he has yet to answer for.

EXHIBIT A - 1996 CT Brain Scan

And now to the question of the hoax. If the flimsy provenance of the Exhibit B diagnosis has not put you in doubt about the entire case, then this may not stand for much to you. But there is serious reason to doubt the origin of Exhibit A on at least three grounds:

1.  Dr. Austin's argument that a patient with this degree of hydrocephalus (fluid in the brain) and cortical atrophy (diminishing brain matter) would not correlate to the patient history seen here and here is a compelling one, and one shared by the eminent neurologists quoted by Robert Johansen.

2.  If Exhibit A is to be believed then we must also believe that the deterioration in her brain was unusually rapid from 1993 to 1996, yet so slow between 1996 and 2005 that not only did she not die, but she remained sufficiently cognitive to appear in these videos, recognize music and express her wish to live. Whether or not it is called "PVS", it is doubtful the physicians could provide a viable explanation as to how the brain managed to retain those abilities in the face of such massive brain injury.

3.  Most patients who have PVS have almost-normal CT brain scans. This CT brain scan is considered anything but normal. It is a patient with late-stage hydrocephalus (whether it shows an acute or congenital problem depends on the patient's medical history).


A word on brain scans and PVS: Their consensus opinion is that a CT brain scan of a typical PVS patient may not look much different from a scan of a healthy brain. That's one of the reasons why doctors assert a CT scan of the brain does not diagnose PVS (a point the judge failed to understand when he admitted it into evidence). They DO, however, diagnose hydrocephalus of this advanced stage quite easily. The diagnosis reached on the brain scan is late-stage acute hydrocephalus (an acronym which I'll call AHC until a doctor is disgusted with it ;) and does NOT have a normal-looking brain scan.

Exhibit A and Exhibit B contradict each other because they defend entirely different diagnoses, and those diagnoses contradict each other. Dr. Cranford succeeded in moving both diagnoses toward the middle, but for reasons I will post in a follow-up, that interpretation can't be sustained either.

People with the kind of massive brain evisceration shown on the CT Scan would look like the patient described at the top, and not like the PVS patient that they claim Terri to be. We know that Terri Schiavo is neither of those (for reasons that were never submitted into evidence): she is much healthier and more able than either of those diagnoses permit, as her medical chart clearly demonstrates. All protestations to the contrary from 3 doctors and ONE image of dubious provenance, it simply cannot be explained how EITHER exhibit can be linked to Terri Schiavo.

Realize that if:

(1) the "liquefied brain" claim is based ONLY on the scan and not the "PVS" diagnosis that used the famous "balloon" video;
(2) her "PVS" diagnosis is based ONLY on the testimony of the three doctors (which now appears to be in some doubt) and NOT the scan showing massive cortical atrophy;
(3) each diagnosis contradicts the other; and
(4) Terri is reported by witnesses not to have the classic symptoms of either one, then we can conclude only one of two things:

1. Every clinician who has reported Terri's real symptoms other than the three appointed by the Greer / Felos partnership - which includes:
are all incompetent, delusional or lying. OR:

2. Both chains of evidence are phony.

Note that to date NO clinician who has actually treated Terri - whether a nurse or a doctor - from 1993 to the present day - has believed she was in a persistent vegetative state. Nor a helpless state of the sort implied by the brain scan - an even more horrific diagnosis than the PVS.

And it's also absurd that a doctor would allow competing and contradictory evidence to form the basis of a single conclusion (that fits neither one of the diagnoses these exhibits actually represent). The responsibility for a travesty of this magnitude is shared by Dr. Cranford regardless of whether or not the obtained the fraudulent evidence himself.

[This is not a proof, it's an argument. I'm working on a proof. It's longer. Stay tuned!]

And one thing more about the alleged brain scans:

There is a shunt clearly visible on the scan, yet Terri never had one installed.

Either an unauthorized shunt was installed into Terri Schiavo's head and then removed - for no particular reason or benefit (which is highly doubtful since Michael Schiavo forbade all medical treatment from 1993 onward) - or else the brain shown on the CT scan is not Terri's.

That should raise alarm bells.


On the subject of the shunt, there are a couple of things to note:

1. There was initial disagreement on the board as to exactly what the CT scan reveals. Consensus appears to be established however.

2. There is a thalmic implant that was installed earlier in her recovery and not removed. A dissenter had this to say:

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It still seems far more likely that this is a thalamic implant.

"How could they gage serial brain degeneration without serial follow-up?"

Are you really suggesting that 1996 is the only time anyone did a CT?

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Perhaps there's never been one performed. And the rebuttals - and the consensus - are quite clear:
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That is the tip of a venticulatr shunt which we are only seeing on one scan slice (because that's all we have). It was placed there to relieve increased intraventicular pressure which can have 2 causes: overproduction of CSF or obstruction to CSF outflow (= "communicating" and "noncommunicating" hydrocephalus).
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Regarding the possible existence of a "thalamic shunt":
A shunt is a device employed to drain CSF out of the ventricles when the body's natural mechanism of doing so has failed. If somebody placed a shunt into the thalamus, he basically has bad aim. It's a no-no to put shunts into the thalamus. People get sued for putting shunts into the thalamus. Stimulators, on the other hand, have for many years been placed in the thalamus in an effort to treat movement disorders.

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There can be considerable debate about the meaning of these anomalies, but the total set of contradictions are too overwhelming to sustain. And for reasons to be clarified in a follow-up post, the brain scan was both the pivotal piece of evidence that put Terri away - and kept the media incurious - and introduced a trojan horse (more on that later) that may unravel the chain of evidence.

Now here's the entire excerpt from Dr. Martin on CodeBlueBlog:
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I have seen many CT scans looking like ["Terri's"] as well ... The single image from this particular scan shows SEVERE loss of cortical tissue. The PATIENTS who go along with CT scans like that are for the most part in advanced demented states, nonverbal, often contracted into the fetal postition, unable to follow any instructions or engage in purposeful movements. (There are exceptions to this of course, but based on reports of her condition Terry Schiavo is not one of them.)

In addition [to contributing a misleading and incorrect analysis], it is irresponsible to contribute to the debate based on a scan that is possibly and even probably not from her.

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I call "shenanigans" on the medical evidence being used to convict Terri to death.

More to follow. I will have both a more coherent point-by-point explanation, a detailed logical analysis of WHY the brain scan is a hoax (will need help from the CBB), why it may have been picked over another by the perpetrator, and what contradictions it buried into the chain of evidence. There might also be a trojan horse buried inside (that will unravel the chain) that even Judge Greer can't exclude because it's already been admitted into evidence.


Blogger Maggie said...

Are you aware that the only nurse testimony accepted by Greer is that of Nurse Death Adams who testified that she never saw Terri move.

3:26 AM  

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