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Brain fluid buildup delays Giffords' move to rehab

| Monday, Jan. 24, 2011

HOUSTON -- The Houston medical center treating Rep. Gabrielle Giffords said yesterday that her condition is improving daily, but gave no update on the buildup of brain fluid that has kept the Arizona congresswoman in intensive care.

A medical center statement said Giffords will continue to receive therapy in the intensive care unit "until her physicians determine she is ready for transfer" to a nearby center where she will begin a full rehabilitation program.

They said the next medical updates will be provided when that happens.

Giffords was flown to Memorial Hermann-Texas Medical Center on Friday from Tucson, where she was shot in the forehead Jan. 8 while meeting with constituents.

At a news conference shortly after Giffords' arrival in Houston, doctors said she had been given a tube to drain excess cerebrospinal fluid. Everyone makes such fluid, but an injury can cause the fluid not to be cleared away as rapidly as normal. A backup can cause pressure and swelling within the brain.

"It's a common problem" occurring in 15 to 20 percent of people with brain injuries or those who have had brain surgery, said Dr. Reid C. Thompson, chairman of neurological surgery at Vanderbilt University Medical Center in Nashville, who is not involved in Giffords' care.

Another possible reason for a drainage tube: "After a gunshot wound to the head and brain where there is a lot of soft-tissue injury, it is common to develop a leak of spinal fluid. This raises the risk of meningitis and slows down wound healing," he said.

The tube is a short-term solution that doctors usually don't use for longer than a week or two because of the risk of infection, said Dr. Steve Williams, rehab chief at Boston Medical Center and Boston University School of Medicine.

If the problem persists, this temporary catheter can be converted to a permanent one called a shunt. That involves an hourlong surgery to tunnel a thin tube from inside the brain down the neck and under the skin to the abdomen, where the fluid can drain and be dispersed in the belly, Williams said.

That is less than ideal -- the tubes can clog over time, requiring medical attention.

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