Abraham Lincoln’s Ventriculostomy

lincoln

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Ventriculostomy

ventriculostomy

During ventriculostomy, the catheter is inserted through the brain and dura into the ventricular system via through a hole drilled into the skull.

Ventriculostomy, or external ventricular drainage, is surgical procedure to alleviate raised intracranial pressure by inserting a tube through the skull into the ventricles to remove cerebrospinal fluid.

Ventriculostomy was first used by Claude-Nicolas Le Cat for treatment of a newborn boy with hydrocephalus in 1744.

ventriculostomy-hydrocephalus

Hydrocephalus before (A) and after (B) CSF drainage via ventriculostomy, showing significant reduction in ventricular size.

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Ventriculostomy for head trauma

Ventriculostomy is also used to measure (monitor) and treat raised intracranial pressure by draining CSF and blood to relieve increased pressure inside the skull from cerebral edema (brain swelling) after head trauma.

EVD trauma

Top row: CT scans after head trauma, showing bleeding and edema in the brain after head trauma, causing raised intracranial pressure.
Bottom row: Ventriculostomy (external ventricular drainage) used to monitor and treat raised intracranial pressure.

Untreated, raised intracranial pressure can result in “herniation” (downward compression of the brain stem), leading to dysfunction of vital centers that regulate breathing and heart function, and ultimately brain stem death.

herniation

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The Lincoln Assassination

Abraham-Lincoln-Shooting

Lincoln was shot in the head by Johns Wilkes Booth at Ford’s Theatre in Washington DC on April 14, 1865.

The mortally wounded Lincoln was carried out of the theatre, across the street to the Petersen House , where he was attended by three doctors from the theater’s audience including army surgeon Charles Leale, later joined by other doctors including Joseph Barnes (Surgeon General Of the US Army).

Lincoln was declared dead at 7.22am on April 15, 1865.

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The Abraham Lincoln Head Shot

peace lincoln shot

Illustrations depicting Abraham Lincoln’s head wound by David A. Peace MS from University of Florida’s Department of Neurosurgery. The track of the bullet passes through the lateral horn of the lateral ventricle.

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The Doctor’s Notes

Dr Leale, feeling around by hand, discovered the bullet hole in the back of Lincoln’s  head right next to his left ear.  Leale attempted to remove the bullet, but the bullet was too deep in his head,and instead Leale dislodged a clot of blood in the wound. Consequently, Lincoln’s breathing improved.  Leale learned that if he continued to release more blood clots at a specific time, Lincoln would still breathe.

Here are some exerts from Leale’s actual account of the event:

I quickly passed the separated fingers of both hands through his 
blood matted hair to examine his head, and I discovered his mortal 
wound. The President had been shot in the back part of the head, 
behind the left ear. I easily removed the obstructing clot of blood 
from the wound, and this relieved the pressure on the brain.

As the symptoms indicated renewed brain compression, I again 
cleared the opening of clotted blood and pushed forward the button of 
bone, which acted as a valve, permitted an oozing of blood and re- 
lieved pressure on the brain. I again saw good results from this action.

The Hospital Steward arrived with the Nelaton probe and an ex- 
amination was made by the Surgeon General and myself, who introduced 
the probe to a distance of about two and a half inches, where it came 
in contact with a foreign substance, which lay across the track of the 
ball ; this was easily passed and the probe was introduced several inches 
further where it again touched a hard substance at first supposed to 
be the ball, but as the white porcelain bulb of the probe on its with- 
drawal did not indicate the mark of lead it was generally thought to 
be another piece of loose bone. The probe was introduced the second 
time and the ball was supposed to be distinctly felt. After this second 
exploration nothing further was done with the wound except to keep 
the opening free from coagula, which, if allowed to form and remain 
for a short time, produced signs of increased compression, the breathing 
becoming profoundly stertorous and intermittent, the pulse more feeble 
and irregular. After I had resigned my charge all that was profes- 
sionally done for the President was to repeat occasionally my original 
expedient of relieving the brain pressure by freeing the opening to the 
wound and to count the pulse and respirations. The President's posi- 
tion on the bed remained exactly as I had first placed him with the 
assistance of Dr. Taft and Dr. King.

lincoln death bed

It is clear that the bullet track left an opening into the lateral ventricle, a ventriculostomy.

When this ventriculostomy track occluded with blood clot and tissue, the dying President developed raised intracranial pressure, with compression of the breathing center in the brain stem and more labored breathing.

When the clot was removed, and the ventriculostomy opened, the President would transiently improve.

Lincoln’s ventriculostomy.

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