Dr. Anders Cohen - Chief Neurosurgeon at Brooklyn
Hospital Center

Sarah Burke - all the best for a speedy recovery.

Dr. Anders Cohen is Chief of Neurosurgery at Brooklyn Hospital Center in New York City with years of experience treating traumatic brain injuries. He spoke with us on the phone to give us more insight on Sarah Burke's condition based upon official statements.

Official statement - January 12, 2011 -

On Wednesday, Burke underwent a successful operation to repair a tear to her vertebral artery which resulted in an intracranial hemorrhage at the time of her fall. William T. Couldwell, M.D. Ph.D., professor and chair ofNeurosurgery at University of Utah performed the operation to repair the artery.

“With injuries of this type, we need to observe the course of her brain function before making definitive pronouncements about Sarah’s prognosis for recovery,” said Couldwell. “Our Neuro Critical Care team will be monitoring her condition and response continuously over the coming hours and days.”

BNQT: Dr. Cohen, based on your expertise what insight can you provide us based upon this initial status update on Sarah Burke's condition? (Ed's note - read most recent update here)

Dr. Cohen: I'd start off by saying that it's extremely serious. Just the nature of the injury and the location of the injury make it a very difficult situation.

BNQT: It said there was a tear in the vertebral artery, presumably from impact, can you shed any light on that?

Dr Cohen: There's a left and a right vertebral artery. They run on each side of the neckbone and spine and enter right where your neck ends and the base of your skull begins, those blood vessels are joined together and provide blood to the brain stem and the back of the brain and she probably landed with a severe kind of twisting or trauma to the head neck region, kind of the base of the skull /top of the neck and that would cause a stretching of that vessel or an injury to the bone around it that could cause an injury to that artery.

BNQT: So is this different than a traumatic brain injury?

Dr Cohen: It's really a cause and effect. What happens is that the vessel is torn, and there are two main issues about it: one is that the tearing of the blood vessel caused a clot at the base of a brain, so that creates trauma to the brain, so now you'll have sudden bleeding, a sudden clot that puts pressure on the brain. And then secondary, you have a situation where that blood vessel feeds a portion of the brain so we don't know how much of that blood flow is interrupted or was substandard to feeding that area of a brain. So it's a combination of the clot putting pressure and also a partial interruption of blood flow to delicate areas of the brain

BNQT: This is interesting because I didn't realize that it affected that area, the brain stem, which is where the most basic functions derive, correct?

Dr. Cohen: Exactly. It's all of the things you don't think about: your heart rate, your temperature, your breathing rate, coordination of things; how you think in your head, when you initiate a contact - think, talk, move - it all goes through your brain stem to go down to your body, so you can't have any quality of life without your brain stem functioning.

BNQT: Sarah is currently listed in critical but stable condition. With reports of a successful surgery complete, what sort of time arc are we looking for, both short term, medium term, and long term?

Dr. Cohen: Sure. The brain, like any other part of the body when it's an insult injury, it will swell. So they removed the offending agent, which was the blood clot, and repaired the blood vessel. Even with that being done super quick, super well, super successfully, the brain was severely irritated by the bleeding and the possible loss of blood flow for a period of time, so it will swell. So they're probably doing very aggressive critical care measures to counteract the swelling. I usually tell patients that the first critical care window is the first 72 hours because it will swell. The swelling after the insult is between 24-48 hours. It will rise, it will swell, and it will subside as soon as it is counteracted. So with the clot being removed and all of this being done this morning, she's still in a very nip and tuck time frame to counteract that swelling so that the swelling itself doesn't create additional injuries to what's already happened.

BNQT: Is it true that in a critical situation like this it's common to remove a part of the skull to allow the brain to swell unrestricted and maybe place that section in another part of the body to keep it oxygenated and keep blood flow to that so they can replace that later on? Is that potentially one example of something they might be doing?

Dr Cohen: That's one example from a very severe case, which this may very well be, because if you think any other part of your body, like if you hit your leg, or your arm, swelling can happen and the skin can stretch. The skull, which protects the brain in most circumstances becomes the enemy in these situations. So if the brain needs to swell, you need to let it run its course of swelling to go through with the medical treatments, so it's one of the tactics that we can use is to remove a piece of skull at the site of an injury, let the brain run its swelling course, and allow that swelling to happen without it turning into a pressure cooker. It's really the best example - that the skull will turn the brain into a pressure cooker. If pressure builds up on the inside and you don't allow it to escape, then it can swell on itself and create more injuries. So by removing that skull, you allow the brain to rise and swell and then calm back down again, and then you can put the skull on at a later time. Now a good example, they did that with the Congresswoman, Ms Giffords. When her brain swelled up, the bullet, they removed a part of her skull, allowed it to swell, and then put it back on later.

BNQT; And for the medium term, is it just a wait and see game to see how the patient responds?

Dr Cohen: If I'd seen her films I could give you a more of a outlook, but based on this type of injury and where it was, this range of recovery is very wide. I mean, if the clot wasn't that big and they got in, repaired it, and removed that clot,  and because there are two veterbral arteries  - that if the other (non-injured artery) was able to bring blood flow up adequately enough while this was going on - then she has the chance to have a significant recovery. If the clot was sizable and put a lot of pressure on the brain stem or the blood flow was significantly effected, then the prognosis of recovery could be very poor and very long, and that will ultimately be a wait and see. Regardless - at this point you don't want to counteract the swelling that is now inevitable. Now it's about keeping her stable and then start to assess what was her main attack, what was irritated and what needs time to recover, what was injured to the point where it may not recover? And that may be just be a function of time assuming they get her through this initial swelling window.

James: Okay, very insightful. Is there anything else you think is worth mentioning, or worth adding at this stage?

Dr Cohen: Well I think that you're really at the point where it's kind of a series of hurdles, and we'll know a lot more after the first 24-48 hours post surgery when given accurate information. If I knew what was going on with her reflexes right now, there are ways that she can be assessed right now without the medication, where she has people reacting, eye reflexes, gag reflexes, we could say okay this part is functioning, this part is not functioning, but right now it's really a wait and see, allowing her to get through the swelling and see what recovers. It's a very difficult injury, the injury that she sustained, to create a tear in the artery like that is pretty sizable in itself, so I would be very guarded with all optimism right now until we get through this window and see how she bounces back.

RELATED - SARAH BURKE CAREER HIGHLIGHTS [VIDEO]