Polite Dissent

Get your copies of Naoki Urasawa’s Monster out because this is the first of a series of medical annotations of the manga. This first post addresses chapter one of volume one — well, chapter one actually has a great deal of medicine in it, so I’m splitting it into two posts. The second part will be posted later tonight.

I’ll start with a brief synopsis of the plot, and then provide the medical footnotes. As always, questions are welcome

Chapter Synopsis:
Dr. Kenzo Tenma is the star neurosurgeon at the Eisler Memorial Hospital in Germany. He is a brilliant young doctor, who emigrated to Germany from Japan to benefit from working in a larger hospital with better equipment and staff.

As the chapter opens, Tenma is congratulated by his team upon a successful surgery. As he walks into the hospital corridor, he sees the wife and children of a Turkish man who was brought in at the same time as his patient. Unfortunately, the Turkish patient was operated on by the less skilled Dr. Becker and died.

Tenma is catching up on sleep at his apartment when his girlfriend — the daughter of the hospital’s director — stops by. While there, they watch a press conference by the director explaining the surgery that Tenma just performed on a famous singer¹. Of course, the director takes full credit for the operation and doesn’t even mention Tenma. Later on, it comes out that the director is even publishing Tenma’s papers under his own name.

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Footnotes:
^1. A cerebral aneurysm occurs when there is a weak spot in one of the arteries that supplies the brain with blood. Arterial pressure causes this weak spot to bulge out like a balloon, forming an aneurysm. Some aneurysms are so small that nobody knows that they even exist. Sometimes they can become large enough that they press against a nerve or a vital part of the brain and cause symptoms such as pain, numbness, or weakness. Aneurysms can also leak or burst, sending blood into the area surrounding the brain (the subarachnoid space, hence this is known as a subarachnoid hemorrhage).

This is precisely what has happened in the case presented: the patient’s aneurysm burst causing a subarachnoid hemorrhage.

This is where a neurosurgeon like Dr. Tenma comes in. He and his team remove part of the skull and retract the tissue layers surrounding the brain. The hematoma is drained and a small metal clip is placed on the base of the aneurysm to stop it from bleeding.

Even with quick surgical treatment, complications can follow a subarachnoid hemorrhage. Vasospasm (“cerebrovascular spasm”) is a common complication. In this situation, one or more of the large arteries at the base of the brain narrow and reduce the blood flow to the brain. This restricts the supply of oxygen (“cerebral ischemia”) to the brain and — despite maximum therapy — leads to stroke or death in about 15-20% of patients. The exact cause of the vasospasm is unknown. It generally starts 3 days out, peaks around day 10, and resolves in 2-4 weeks.

The ventricles of the brain produce and recycle the cerebrospinal fluid. When the ventricles become blocked (or otherwise stop working), they swell leading to a condition known as hydrocephalus. When this follows an injury (such as a subarachnoid hemorrhage) it is known as secondary hydrocephalus.

Compare the sizes of the ventricles

Tags: comics medicine aneurysm subarachnoid hemorrhage hydrocephalus naoki urasawa monster