MRI Results, Optic Nerve, Another Brain Surgery?

Graham Update Day 52 (7/30/14)

This morning just before Graham went to his first therapy session, Graham's neurologist here at Cook Children's (who has been amazing!) pulled me out of the room to discuss Graham's MRI results.  He let me know that he couldn't say a lot about the optic nerve until radiology compared it to his CT scan (which would come a little later in the morning) but that he could discuss the rest of Graham's injuries with me immediately...

The first thing that he did was confirm that Graham had a very small mid-brain injury consistent with what his ophthalmologist had observed clinically last night.  It didn't seem to concern his neurologist that much, and seemed to share the sentiment that the pupillary activity in Graham's left eye would get better with time.

His mood got a lot more somber as he discussed the rest of Graham's injuries.  The first thing showed and described was severe damage to both sides of Graham's frontal cortex.  Damage here typically affects personally and short term memory, that latter of which has been a problem with Graham thus far.  His biggest concern is that "if Graham doesn't have a short term memory, it will be impossible for him to learn."  He said that his injuries also explained Graham's minuscule attention span.

He also showed me that Graham's frontal lobe had severe damage as well.  He said this would also affect his personality, especially lowering his inhibitions and raising his impulsiveness.  We have observed this in Graham.  One Graham-ism from before the accident is that he is DEATHLY afraid of heights - to the point that I cannot even pick him up to give him a hug; I have to bend down to hug him so he can keep two feet on the ground. So far since the accident, Graham has been fearful of NOTHING.  I am free to pick him up and he actually enjoys the ride- a clear sign that his inhibitions have been affected.

These are all things that we have known, and have been praying would improve, but I would be lying if I said I wasn't shaken up by my conversation with the neurologist.  It's one thing to see changes in behavior, but it's another to see the damage on screen.  It was a very tough pill to swallow, and drove me immediately to prayer.

Graham would eventually have his CT scan, and as we have seen time and time again with our little fighter, the witness always comes after the trial of our faith.  His physical therapist came to tell me after their session that it was his best yet.  14 out of 15 times he was able to bend down and pick up an object with no balance assistance. He is walking so well now that we are no longer required to hold onto his gate-belt when he walks, we can just hold his hand.  And when Graham told me all about his physical therapy session, I grabbed him and picked him up to give him a hug - and he freaked out just a bit.  He was scared of heights again.  Inhibitions?  Coming back!

Immediately after my conversation with Graham's neurologist, I said a prayer and did the first thing that came to my mind - I decided I was going to work diligently on challenging Graham's short term memory.  I told him just before 9 am that I needed him to remember three words - ball, lion, carrot.  We went over them a few times, and then Graham said he would remember them.  And he did.  He came back from gym - ball, lion, carrot.  After the CT scan?  Ball, lion, carrot.  After a nap?  Ball, lion, carrot.  After art class?  Ball.  Lion.  Carrot.  And yes, one of his many nick-names has caught on here.  See his art below.

When his neurologist came back to review the CT scan and saw Graham's trick he was very pleasantly surprised.  He said "well he clearly has a short-term memory.  Now we just need to work on that attention span," and proceeded to review the CT scan.  The findings?  Graham's optic nerves are both in tact.  There is pressure on the optic nerve going into his right eye due to some damage to the surrounding tissue, and we cannot be sure at this point that he will be able to see again.  But we are sure that his optic nerve is not severed, an injury that WOULD rule out vision in his right eye.  It is a huge blessing and a miracle.

His doctor did see some things that gave him pause and moved him to contact neurosurgery.  Graham had extensive fractures INSIDE the base of his skull during his accident. There is one area that showed up today where his brain his basically pressing into Graham's right orbital and onto his optic nerve.  It is really close to the back of his eye.  I think that what they are seeing is an area that Dr. Braga repaired by sewing a tissue-flap onto the base of his skull, but neurosurgery came by briefly today and said they were reviewing all of Graham's records and would some sort of an action plan (or inaction plan) tomorrow.  But as of right now, there is a possibility of more brain surgery to relieve pressure on the optic nerve and/or to shore up the base of the skull above the right orbital.

Today was an emotional roller coaster.  It started with a sobering MRI report, but by the end of the day Graham was thumbing his nose at it.  So really nothing has changed, except yet again Graham is doing better than the day before.  Graham continues to defy the odds and overcome his "severe brain damage" to recover more and more every single day.  He amazes me.  And I'm amazed every day by everyone who prays for Graham, even after nearly two months.  Thank you because prayer is real, it is powerful, and in Graham's case - it is clearly working.