Jules Bianchi recovery - Japan 2014

[SectorOne]

Mod edit: This thread is for Bianchi's recovery, ie events after the race.

Discussion of the race and events on the circuit belong in the race thread. http://www.f1technical.net/forum/viewto ... ead#unread
Discussion of safe recovery of cars on track http://www.f1technical.net/forum/viewto ... ead#unread

____________________________________

Statement about Bianchi´s injury,

“Jules remains in the Intensive Care Unit of the Mie General Medical Center in Yokkaichi. He has suffered a diffuse axonal injury and is in a critical but stable condition. The medical professionals at the hospital are providing the very best treatment and care and we are grateful for everything they have done for Jules since his accident.
“We are also grateful for the presence of Professor Gerard Saillant, President of the FIA Medical Commission, and Professor Alessandro Frati, Neurosurgeon of the University of Rome La Sapienza, who has travelled to Japan at the request of Scuderia Ferrari. They arrived at the hospital today and met with the medical personnel responsible for Jules’ treatment, in order to be fully informed of his clinical status so that they are able to advise the family. Professors Saillant and Frati acknowledge the excellent care being provided by the Mie General Medical Center and would like to thank their Japanese colleagues.”

http://www.jamesallenonf1.com/2014/10/b ... condition/

[Moose]

Wow, that sounds very bad. A quick read up on diffuse axonal injuries says that 90% of patients never wake up, and those that do are almost always impaired afterwards. Sad news .

[turbof1]

From what I gather about DAI:
-it happens through shear forces running through the head. So Bianchi's head probably did not hit the bulldozer, but his injury came from rapid deacceleration.
-DAI ranges from being fully cured within a few months to being paralyzed forever. Let's hope he recovers.

[The_table]

The outcome is frequently coma, with over 90% of patients with severe DAI never regaining consciousness.[2] Those who do wake up often remain significantly impaired.

Other authors state that DAI can occur in every degree of severity from (very) mild or moderate to (very) severe.
Concussion may be a milder type of diffuse axonal injury.

(Thanks wikipedia)

[foxmulder_ms]

The FOM is making author claims like crazy on those youtube videos. Even though it's amateur footage meaning they have no leg to stand on, youtube's policy unfortunaly is to block videos automatically upon such a claim.

They actually do have a leg to stand on - if you read the small print on the back of any F1 ticket, you'll see that my using the ticket you sign over all copyright for all photos and videos taken at the track to the FIA.

No they don't. It is smt to record whole or a significant portion of the race and smt else to have a few minutes of it. Also laws of the country you are in have some say, too. If I had a 1-2 minute video on the track, they can do nothing to prevent me putting it anywhere I want.

[SectorOne]

Will be interesting to see which level he´s at.

Grading of diffuse axonal injury has been described histologically according to the anatomic distribution of injury, which correlated with outcome 1-3. The classification was first proposed by Adams in 1989 4 and divides diffuse axonal injury (DAI) into three grades:

grade I: involves grey-white matter interfaces
most commonly: parasagittal regions of frontal lobes, periventricular temporal lobes
less commonly: parietal and occipital lobes, internal and external capsules, and cerebellum
often inapparent on conventional imaging
may have changes on MRS 3

grade II: involves corpus callosum in addition to stage I locations
observed in approximately 20% of patients
most commonly: posterior body and splenium but does advance anteriorly with increasing severity of injury
most frequently unilateral
may be seen on SWI 3

grade III: involves brainstem in addition to stage I and II locations
most commonly: rostral midbrain, superior cerebellar peduncles, medial lemnisci and corticospinal tracts

http://radiopaedia.org/articles/grading ... nal-injury

Treatment and prognosis

Unfortunately little can be done for patients with diffuse axonal injury other than trying to minimise secondary damage caused by cerebral oedema, hypoxia etc.

Depending on the severity and distribution of injury (see grading of diffuse axonal injury) patients can vary from minimally affected to being in a persistent vegetative state 1-2. The amount of axonal injury in the brain stem is predictive of long term vegetative state, whereas supratentorial injury can result in focal neurological or neurophsychiatric deficits 1.

http://radiopaedia.org/articles/diffuse-axonal-injury

[Shakeman]

From the good doc, http://formerf1doc.wordpress.com/2014/1 ... al-injury/

Some good detail.

Somber prognosis.

[thedutchguy]

Gary Hartstein - Former F1 doc just blogged:
http://formerf1doc.wordpress.com/2014/1 ... al-injury/

Diffuse axonal injury

When we talk about “severe” head injury, as I mentioned Sunday, we’re talking about a classification that’s done CLINICALLY. That means the Glasgow score is assigned without taking into account exactly what the injuries are. Eyes, verbal, motor. That’s it.

We’ve spoken quite a bit about hematomas – collections of blood either outside of the membranes protecting the brain (“extradural” hematoma), within those membranes (“subdural”), under them (“subarachnoid”) or in the brain substance itself (“intracerebral”). Hematomas cause damage by compressing and displacing brain tissue, but also by increasing the intracranial pressure (see earlier posts about this).

When we take a patient to the CT scanner to see what the injuries are, we’re sometimes surprised to see that our (very) comatose patient has a shockingly “normal” looking scan. When the scan shows essentially generalised swelling with no significant focal neurosurgical lesions (i.e., bruises and hematomas), we talk about diffuse axonal injury, or DAI. We HATE when this happens. We have a scan that’s remarkably . . . pristine, with a patient who is seriously comatose.

Let’s look at the terms just a bit:

DIFFUSE: unlike hematomas, which by definition occur at a given location, using conventional imaging, DAI doesn’t show any SPECIFIC location for damage. This obviously isn’t particularly good news, because it precludes systematisation of the patient’s symptoms, makes rehabbing harder, etc.

AXONAL: the axons are the cable part of the nerve cell. They’re insulated cables, to conduct nerve impulses faster, so they’re covered in a fatty membrane, making them whitish. When you group lots of axons together you get white matter. The cell bodies of the nerve cells (neurons) are greyish . . . so when you put a bunch of nerve cell bodies together, yep, there it is, grey matter.

DAI seems to damage the white matter of the brain. The cabling. Once again, this isn’t really great, as the cabling is what allows higher-level information processing by hooking up the various brain areas (e.g., visual and auditory. I SEE you talking, HEAR your words, but actually it’s associative areas of my brain that fuse the information and integrates it into my experience of YOU TALKING. That kind of processing is easily interrupted with DAI.

This will often be associated with brain swelling, at least initially.

I’m totally gutted, sickened, by having to ask you to go back to December and January’s posts for more about ICP if you’re interested. I don’t have the heart to go through this again. Not for another of our guys. Jeez.

DAI is usually associated with a somber prognosis. Jules is young, strong, and is being cared for by a superb team. C’mon Jules. Go for it.

[lebesset]

From what I gather about DAI:
-it happens through shear forces running through the head. So Bianchi's head probably did not hit the bulldozer, but his injury came from rapid deacceleration.
-DAI ranges from being fully cured within a few months to being paralyzed forever. Let's hope he recovers.

certainly that's in accordance with my previous observations based on the slowmo .... as I said the roll bar hooking onto the tow hitch looked to cause the rapid deceleration as he slid past the digger

I wonder if a gravel trap instead of tarmac would have lessened the force of the impact , looking at the overhead it looks to me to be a strange place to put a tarmac access onto the track

[Shrieker]

Come on Jules, roll a twenty...

[Andres125sx]

Terrible news, this is so sad....

[Gaz.]

I really don't know what to say.

Forza Jules.

[erikhfp]

Richard Hammond also had a diffuse axonal injury (http://news.bbc.co.uk/2/hi/health/5392296.stm) and he recovered fairly well (I remember him saying he still has some issues) and with regards to Bianchi's career if he starts to recover, Sir Stirling Moss and Hammond had a similar brain injury and Sir Stirling went on to race after his accident although he said he did not act instinctively anymore and instead he had to think about what he was doing when he was racing. Now I know Jules might have damage to other parts the brain and I am basing all this information on assumptions that the damage might be similar (both Hammond and Moss had damage to the front of the brain and Jules hit the recovery vehicle fairly head on) and the hope that Jules might recover to the same degree or even better than Moss and Hammond.

[Miguel]

That's a tough pill . I guess the stats will only remember the 1st of May, 1994, but last Sunday was a very bad Sunday for F1. Let's just hope though that Jules beats the odds once more.

[rich1701]

having seen the speed and force involved with his accident, de acceleration of the entire car i suspect isn't the main concern. Ive seen others like Burti which were worse in this respect. it was the initial impact with the roll hoop and head rest area of the car and the JCB, the rollhoop, engine cover and left side pod appear to be completely destroyed. the impact of this blow was extremely severe. the car then continued for a short time afterwards. It isn't clear if Bianchi's helmet had a direct impact with the JCB, I suspect it did.

I fear for Jules and his family, the accident is brutal with its force, and sadly I cannot see how anyone can survive this impact