The full impact of brain injuries such as those suffered by

Michael Schumacher

on Sunday can take months to diagnose.

Gary Hartstein, a former Formula One trackside doctor, said: "The brain's plasticity makes prognosis impossible to pronounce definitively for quite some time. Weeks to months."

The nature of Schumacher's treatment "suggests that something very serious has happened", said Chris Chandler, consultant neurosurgeon at King's College Hospital in London.

"Certainly after blunt trauma, which is what you would term his injury, the brain does swell and that swelling contained within the rigid box of the skull can cause dangerous pressure on the vital structure to the brain," he told Sky News. "That brain swelling needs to be controlled. The fact that he was wearing a helmet simply means that it has minimised the severity of the injury, but still it is possible to sustain a serious injury even with the helmet."

‘Brain haemorrhage’

Chandler said the fact that Schumacher (44) was in a coma meant he could have suffered several different injuries.

“He could have suffered a diffuse injury to his brain, which can then result in brain swelling. He could have sustained some sort of brain haemorrhage and if there was a blood clot within his brain or on the surface of his brain underneath his skull, that might need to be removed.

“Sometimes there is nothing actually to remove but you put in an intracranial pressure monitor, which basically is an operation that requires drilling a hole in the skull and putting a fine probe inside. Or if there is diffuse swelling of the brain, sometimes surgeons remove a large piece of the skull . . . so there is space for the brain to swell to minimise the pressure on vital structure. It’s not clear from the reports that I’ve heard exactly what the nature of this emergency operation was. But the fact that they undertook something almost immediately . . . suggests that something very serious has happened.”

Hartstein said the fact that Schumacher was conscious and speaking immediately after the accident was common. “It’s quite well known that extradural haematomas, a kind of cerebral haemorrhage, can leave a lucid interval after injury. Then as the haematoma forms, the increase in pressure causes sudden and dramatic symptoms. Pressure must be relieved rapidly.

“Any severe head injury leads to a loss of co-ordination of tongue and throat muscles. This happens to some when they sleep – called snoring. But this is respiratory obstruction and causes carbon dioxide to rise and oxygen to fall.

“But the brain wants oxygen and hates CO2. So we put tubes in these patients’ tracheas and use respirators. This . . . gives excellent control of ventilation.

"But to intubate someone, he or she needs to be pretty deeply anaesthetised. So this is the usual 'artificial coma'. It is an induced coma, but in fact it's like a prolonged, protective, anaesthetic."
Guardian Service

Gary Hartstein tweets as @former_f1doc. His responses were edited from his tweets.