Doctor: Autopsy unlikely to end dispute

Published March 31, 2005

The scars of the day that changed Terri Schiavo's life will show as soon as a medical examiner peers inside her brain, doctors say.

Doctors expect an autopsy to confirm some of the same damage than brain scans have shown: that most of her cerebral cortex, the thinking center of the brain, has atrophied and been replaced by spinal fluid.

But other damage will be more apparent in an autopsy. How many neurons, or nerve cells, remain? What happened deep inside Schiavo's brain?

"What the CT scans can't tell you are how many neurons are remaining," said Dr. Walter Bradley, neurology chairman at the University of Miami Leonard M. Miller School of Medicine. "I would guess there are very few islands of neurons remaining ... then the question is what are they connected to, and it may be nothing."

Dr. Jon Thogmartin, medical examiner for Pinellas and Pasco counties, said earlier this week that he will conduct an autopsy after Schiavo's death.

Bradley, however, said he doesn't expect an autopsy to necessarily settle the dispute for those who believe Schiavo is not in a persistent vegetative state, the diagnosis of most doctors who have examined her.

There's no single indicator, no clear division, in an injured brain that defines the difference between someone in a persistent vegetative state versus someone who is "minimally conscious," or has slight interaction with their surroundings, Bradley said.

"I think it's more what science and society will learn with regard to what changes are in the brain in somebody who's been in a persistent vegetative state for a long time," Bradley said.

But Dr. Ronald Cranford, a neurology professor at the University of Minnesota Medical School who has examined Schiavo, believes the autopsy will settle any doubts about Schiavo's condition.

"It will unequivocally show what we've been saying all along," he said. "What we're seeing is the most extreme atrophy possible ... the atrophy couldn't be any worse than it is."

The neurons would have died away as the minutes ticked by without delivering blood and oxygen to Schiavo's brain. The autopsy also is likely to show extensive scarring in the brain, said Cranford and neuropathologist Dr. Mark Cohen, a pathology professor at Case Western Reserve University and University Hospitals of Cleveland.

In such scarring, glial cells, the support cells for neurons that are sometimes called the "glue" of the brain, take over as neurons die, filling in the space where the neurons were.

Schiavo's brain might also show deeper damage, in the thalamus, an important pathway that transports messages to other parts of the brain, Cohen said.

"We sometimes see that and we sometimes don't," Cohen said, but such damage is more common in people who are young and healthy when they suffer severe brain injury, as Schiavo did.

On Wednesday, Schiavo's 13th day without a feeding tube, Cranford pointed to Nancy Cruzan, who also was at the center of an end-of-life battle. Cruzan lived 12 days after her tube was removed.

"The vast majority die between 10 and 14 days," Cranford said. "I would expect her to die in the next day or two."

Still, Cranford has had patients survive more than two weeks after the removal of a tube.

What is more remarkable is that Schiavo has lived 15 years since her heart stopped for five minutes in 1990, Cranford said.

In 1994, Cranford co-chaired a task force that examined patients in vegetative states. The group, which estimated there were somewhere between 14,000 and 35,000 vegetative patients in the U.S., said that most of them die within 10 years, Cranford said.

Still, there are exceptions. Cranford knows of a few patients who have lived more than 30 years that way. And the longest known survivor remained alive for 47 years.