The Consultant Neuroradiologist reported that there had been global shrinkage of Archie’s brain since the last MRI scan of 15th April 2022.
There had been development of fluid overlying the brain inside the skull. The abnormal appearance of great and white matter continued and had become worse since the earlier MRI.
There was severe damage to the deep centre of the brain including to the thalamus. The severe coning seen on 15th April 2022 had not changed. The cerebellar tonsils which had been squashed together with the lower part of the brain stem and had herniated through the bottom of the skull remained but there were signs now of necrosis (death or decay). There were signs of necrosis of the medulla and it was now shrunken. Dr P explained that this is the lower part of the brain stem which controls breathing and heartbeat.
There was still the absence of blood circulation through the larger arteries that supplied blood to the front and back of the brain.
In terms of the spine there was no evidence of primary injury to the spine, something Archie’s parents had been very concerned about but the clinician observed that there was evidence of necrosis of the front part of the thoracic spinal cord. He thought that looked related to a loss of blood supply. He observed further necrosis lower down the spine in the lumbar region and also found “necrotic debris” caused when necrotic tissue has shed higher up in the spinal cord.
In summary Dr P’s evidence to the Court on 6th June 2022 was that Archie’s loss of brain volume was caused by an atrophy of the brain and this was consistent with it not getting oxygen. The development of fluid in the skull was as a consequence of the deprivation of blood supply and oxygen. He said that the brain tissue was beginning to issue fluid and it was gathering in a compartment where it would not normally be expected to be present. There had been a number of changes since 15th April 2022 and certainly no improvements in the appearance of the brain structures.
Dr P was asked particularly about the thalamus as that was a hugely important area involved in vision, speech and in consciousness. It is also involved in movement of limbs and sensation. He said the areas of damage were much more marked and there had been a progression of damage.
He was asked about the brain stem. He said it remained in an abnormal position at the top of the spinal canal. The structures had changed between the two scans. There was necrosis of the brain stem. He said somewhere between 10 and 20% of the brain stem had undergone necrosis but that damage to the brain stem was over 50%. The necrosis was caused by the squashing of the brain stem and the coning into the top of the spinal cord.
Dr P was asked if the necrosis would continue and he said that there was probably not much more that could occur. In his experience, from the scans, Archie had reached the point of no return. The sort of images he was seeing were ones he usually saw at perimortem or postmortem.