September 14, 2009

Thugs left man with half a head

I don't often read tabloids, but I noticed this intriguing report in The Sun lately:

Thugs left man with half a head


Published: 11 Sep 2009

VICIOUS thugs who punched this man so hard he was left with HALF A HEAD have got off scot free.

Horrified Steve Gator had to have the front of his skull removed by stunned surgeons after his head was smashed against a pavement in the sickening attack. And now the 26-year-old has been told that the teen attackers who disfigured him will escape justice after his case was dropped.

Steve, of Romford, Essex, was attacked after confronting one of the yobs who had been taunting him about his cousin. Another of the violent louts hit him so hard that he was sent flying and struck his head on the path. Steve plunged into a coma for two weeks as his shattered mum and distraught family kept a bedside vigil at Queen's Hospital, Romford.

His brain quickly began swelling and surgeons were forced to remove the front half of his skull just hours after he was admitted.

Grief-stricken mum Nina Gator was warned her son had just a terrifying 15 per cent chance of survival. Two days later cops charged a pair of teenage boys with the savage attack which shocked the neighbourhood. Steve, who has had to quit his job, was left seriously brain damaged and now suffers frequent seizures, has difficulty talking, and his memory is seriously impaired. Mrs Gator, who is his main carer, last night blasted the shock move. The 47-year-old said: "I can't believe it. Everyone is entitled to their day in court."

CPS lawyers claim they needed more proof before going ahead with the case. But Mrs Gator stormed: "Our boy is walking around with half a head - what more evidence do they need? "His sparkle is totally gone. He used to be so independent but he can't work any more and he can't drive." She added: "He's got half a head and he's completely lost his confidence. There's absolutely nothing protecting his brain now it's just under his skin."

Just from looking at the picture, it seems obvious that with this traumatic brain injury (TBI) his frontal lobes are practically destroyed and quite possibly the front parts of his midbrain. The frontal lobe is an extremely important structure responsible for a variety of functions. It is the 'Command HQ' for emotions, and controls and regulates functions such as memory, language, movement, and problem-solving. It is also responsible for more subtle things like judgment, planning, reasoning, spontaneity or impulse control, and some effects on social and sexual behaviour. As such, the frontal lobe administrates much of our very personality and sense of identity. It is also the largest 'lobe' structure, meaning that there is more of it to carry a greater risk of damage. As the story mentions, Gator's "sparkle is totally gone". It is tempting to draw parallels with the tale of Phineas Gage, another individual dubiously famed for frontal lobe damage.

A friend, The Neurocritic, pointed out that Gator may need several cranioplasties in order to rebuild his skull, and highlighted a recent Neurosurgical Focus literature review that discusses the types of post-operative complications associated with the surgical procesure underwent by Gator. Known as a decompressive craniectomy, and consisting of a partial removal of the skull in order to allow the swelling brain to expand without being squeezed, we start with contusion blossoming; the surgery leaves massive bruises which can be observed via pre-op and post-op CT scans.

Lesions - a mass lesion may develop on the opposite side of the brain to the injury or elsewhere in the brain. As Gator's frontal lobes were destroyed, it is possible that a lesion may develop around the back end and possibly affect the parietal lobes, which deals generally with perception, orientation and recognition.

Herniation - a small protrusion (or more) of neural tissue may remain in the early period after swelling subsides, sometimes through the cranial defect as is observed with 'normal' skin hernias. Gator has no such defect though, as the front of the skull was smashed.

Subdural Effusions - a collection of pus beneath the outer lining of the brain. This condition usually results from bacterial meningitis, but because craniectomies affect the circulation of cerebrospinal fluid (CSF) it is possible that buildups may accumulate. Similar to blood clots. Hygromas may also occur, which are buildups of CSF without blood. To counteract these, a craniectomy should be accompanied with a duraplasty, a reconstructive operation on the dura mater, the outermost and fibrous membrance covering the brain and spinal cord. Duraplasties have been observed to lower the incidence of subdural effusions occurring.

Infection - this may seem a rather obvious effect of any medical procedure, to guard against, but craniectomies (bone removal) will necessitate cranioplasties (bone reconstruction). As such, opening old scars and exposing the brain upto or after a month after the incident runs the risk of contracting infection and delaying healing. The review suggests a minimum wait of 3 months before replacing the bone, and that storage of the bone in a freezer can also increase the risk of infection.

Hydrocephalus - "water on the brain", refers to accumulations of CSF in neural cavities. This is unfortunately a common occurrence beyond a month after the injury, and will need specialised procedures (shunt treatment) to deal with it if it occurs.

Syndrome of the Trephined - another unfortunate common occurrence after decompressive craniectomies, of which common symptoms include dizziness, headaches, concentration difficulties, mood disturbances, irritability, and memory problems. Because Gator's particular situation involved the destruction of his frontal lobes, he will unfortunately suffer much worse symptoms than these. However, in general terms when the motor functions are affected, this then becomes known as motor trephine syndrome.

Bone resorption - when one undergoes a decompressive craniectomy, you're likely to have stray bone fragments swimming around and there's around a 50% chance that bone resorption will occur, which is when bone cells (known as osteoclasts) break down the bone and release minerals like calcium directly into the blood.

Persistent vegetative state - clearly the saddest effect of all extreme brain injuries. While decompressive craniectomies are effective at ameliorating intra-cranial pressure and reducing the risk of death, they offer no guarantee of restoring brain function once the patient suffers a TBI. The risks of surviving into a vegetative or minimally conscious state after undergoing craniectomy range upwards of 15-20%.

It may be that Steve Gator's clinicians need to be vigilant and ensure that his treatment is as risk-free as possible. And of course, wishing him all the best to recover well.
Stiver, S. (2009). Complications of decompressive craniectomy for traumatic brain injury Neurosurgical FOCUS, 26 (6) DOI: 10.3171/2009.4.FOCUS0965


  1. The midbrain is a relatively small structure at the top of the brain stem. Horrific as this attack is, I doubt it would have damaged that part of the brain.

  2. FYI, language function is not isolated nor primarily found in the frontal lobes but in the temporal lobe.

  3. This discussion has been Redditted in TWO places:

    Reddit (CogSci)

    Reddit (WTF)

    Follow the comments and some discussion there.

  4. Hi Daniel. Yes, I was referring to Broca's Area. While language is not isolated to the frontal lobe, Broca's Area is a key element of language function in the frontal lobe and the loss of it will clearly have an effect on Gator's comprehension or production of language.