I want to sum up some of the questions that I believe should be asked based on the topics I have discussed here, here, here and here.

1. With regard to the extent of the brain damage:

a. Two parts of the brain appear to be important here, the cortex and the thalamus.

b. The cortex appears to be relatively well-preserved in the frontal and temporal lobes. What does that mean?

c. The frontal lobe is where IQ and personality reside.

d. The neuropathologist indicates that the thalamus appears relatively preserved, but on
microscopic examination has some damage that is not quantified by the pathologist.

e. The role of the thalamus is now considered more important to consciousness than
thought previously because of the findings made upon examination of Karen Anne Quinlan’s
brain.

f. The neuropathologist compares the weights of Terri’s and Karen’s brains—but notably
does not mention how the brain damage compares though Terri has some intact cortex (as
did Quinlan) and some damage to the thalamus.

g. The greatest damage to Terri’s brain was in the back—essentially the part that controls
motor skills and physical ability.

h. Terri was dehydrated to death, Karen was not.

Thus:

1. Given the significance of the thalamus to consciousness and the fact that Quinlan’s main problem was damage to that part of the brain—why did the neuropathologist not see fit to make a comparison of the two thalumuses? Could it be because Terri’s thalamus was not as damaged and had viable tissue?
2. If Terri had viable cortex and viable thalamus—is it not medically possible that she was conscious of everything that was being done to her?
3. Is the brain weight comparison between Terri and Karen really apt in light of the fact that Terri was dehydrated for weeks? Emcee has good information on that point.
4. What is more important, brain weight or brain architecture? If Karen Quinlan had no viable thalamus tissue and Terri did—isn’t that more significant?
5. If Terri’s and Karen’s thalamus damage was similar in degree, wouldn’t the neuropathologist have mentioned that as well as brain weight?

With regard to the argument by the neuropathologist supporting the judge’s decision not to allow an MRI or PET scan.

1. Did he check with the manufacturer to determine whether Terri’s implants contraindicated an MRI?
2. Why did he not disclose in the report that his authoritative source on this point says that it is only “some” implants that contraindicate MRI’s?
3. Who asked him to address that issue. If it no one did, why did he address it?

Finally, on the brain:

1. If Terri’s implants were not of the type that contraindicated an MRI or PET scan (or adequate precautions could be taken to prevent complications), and given that Terri had viable cortex and viable thalamus and given that PVS cannot be diagnosed by autopsy—shouldn’t those tests have been administered? Wouldn’t they have more accurately revealed her true cognitive state than an autopsy performed after she was dead?

Update: I want to add something based on Captain Ed’s post at Captain’s Quarter’s wherein he paraphrases the Medical Examiner saying: With her vision center destroyed, she had cortical blindness. In the opinion of the coroner after examining the brain, Terri’s condition would never have improved.

The brain autopsy says this about the vision centers on page 4 of Nelson’s report: The lateral geniculate nucleus (visual) demonstrated transneuronal degeneration with gliosis, while the medial geniculate nucleas (auditory) was relatively preserved.

First, this does not say that she is totally blind—it says she has degeneration with gliosis—it does not quantify exactly how much—or at least the amount is not clear from the narrative in the report. (Update: Dr. Rangel at RangelMD belives that the report indicates that it was destroyed—see his comments in the comments section) Second, gliosis is: an excess of astroglia in damaged areas of the central nervous system; see also astrocytosis. Third, dehydration can cause an increase of astrocytosis according to a study done on mice. Read the article. Even after rehydration the increase continued. Recall that Terri underwent dehydration twice.

Further, even though you cannot replace neurons—you can retrain the ones left. Is it not possible that when the neuropathologist says she couldn’t have improved—he is talking only about brain architecture? Rehabilitation does not change brain architecture—it merely retrains what one has left. This report does not prove that Terri could not have regained some functions—especially given the relatively good state of her frontal lobes.(Update: It has been made clear to me by reading Dr. Rangel , that the frontal lobes were severely damaged—though not has much as other areas—Thus, to rephrase: Does this report truly and completely rule out any possibility of improvement in function?) And, I would ask whether or not removing the thalamus implants might have improved the communication between the frontal lobes and the back of the brain where motor skills and physical ability are found—thus enabling more physical function. Someone should ask that question.

More questions for inquiring minds later.