Sharon shows no sign of consciousness

Israeli doctors expressed growing concern Friday that Prime Minister Ariel Sharon still has not shown any signs of consciousness more than a week after suffering a major bleeding stroke on the right side of his brain.

For someone incapacitated by a severe stroke, time is the enemy, according to experts interviewed about the prospects for improvement for such patients. The longer it takes for significant signs of recovery to appear, they said, the poorer the prognosis.

The most critical period is the first month after a massive stroke, when doctors can assess how much brain damage has occurred through a patient’s responses – opening the eyes, becoming conscious, following commands, and breathing and moving on his own.

“If he doesn’t have any voluntary movement three or four weeks from the onset, that’s a really poor prognosis,” said Dr. Richard L. Harvey, medical director of the stroke rehabilitation center at the Rehabilitation Institute of Chicago. “At that point you figure that he’s probably not going to become a very functional person.”

Sharon has been unconscious and on a ventilator since suffering a hemorrhagic stroke nine days ago, despite recent efforts to bring him out of his medically induced coma. He was listed in stable but serious condition, and his life continues to be in danger.

On Friday his doctors also were considering a tracheotomy, in which a hole is made in the neck for a breathing tube. The procedure is done to wean a patient off a ventilator, which can cause serious problems with prolonged use.

The longer Sharon remains in his condition, the graver the outlook, said Dr. Demetrius Lopes, a Rush University Medical Center neurosurgeon.

The brain has amazing recuperative powers, and people with milder strokes often return to normal or near normal function. But recovery depends on such factors as the age of the patient, the degree of brain damage caused by the stroke, and how quickly rehabilitation is started.

All of that appears to be creating uphill battles for Sharon, 77, who had to undergo two operations to relieve excessive bleeding and dangerous pressure in his brain.

Complicating Sharon’s prognosis is the coma he was put in to reduce damage to his brain caused by swelling. Doctors at the Jerusalem hospital where Sharon is being treated are attempting to discontinue the anesthesia infusions that induced the coma.

Sharon’s doctors earlier had reported some preliminary positive responses, including moving an arm when pinched, an increase in his heart rate when his son spoke to him, and brain scans showing that the blood that had pooled in his brain had been absorbed.