What we know about the injuries Paul Pelosi sustained in attack

On Monday, Nancy Pelosi (D-Calif.) appeared to offer a more cautious assessment, saying her husband is “making steady progress on what will be a long recovery process.”

Head injuries are the most common. common causesAbout 1.7 million adults are affected by this condition each year. Treatment and recovery depend on a multitude of factors, including whether the injury was closed or the skull was fractured open, as well as on the victim’s age and general health, and whether they were unconscious and, if so, for how long.

Numerous complicating factors influence the decision about whether — and when — to operate. In less severe cases, supportive care can be offered to give the brain a “safe place to recover and rehab, which should start as early as possible,” said Thomas M. Scalea, the chief surgeon at the University of Maryland’s Shock Trauma Center in Baltimore.

Paul Pelosi’s recovery process and rehabilitation outcomes are “completely unknown at this point,” Scalea said, adding that it would be unwise to hypothesize about his recovery time, because no hard and fast rules apply to brain injuries. Although younger people may be more tolerant to such injuries than older ones, all outcomes will depend on the results of a neurological exam as well as imaging studies.

Court documents filed Tuesday by the San Francisco district attorney’s office and based in part on the San Francisco Police Department’s incident report and law enforcement interviews offer a few more details about the attack.

They suggest Pelosi had good recall of events leading up to the attack — a good sign, experts say — including being awakened by his alleged assailant, David DePape, and his attempts to defuse the situation in the half-hour before the police arrived.

The documents emphasize the force of the attack — a significant factor in the physical damage caused. DePape lunged at Pelosi, the documents say, “striking Mr. Pelosi in the head at full force with the hammer, which knocked Mr. Pelosi unconscious.” He was unresponsive for about three minutes, the documents say, “waking up in a pool of his own blood.” It is not clear whether that blood was from his head or from the injuries to his arm and hands.

Pelosi was brought to Zuckerberg San Francisco General Hospital. This is the only Level 1 trauma center within the city. He underwent surgery.

Capitol Police cameras caught break-in at Pelosi home, but no one was watching

The treatment of head injuries has made huge progress, much of this thanks to the excellent care provided by soldiers in Afghanistan and Iraq.

Mild injuries that cause a temporary loss of consciousness for less than 30 seconds are considered mild. However, complications can quickly escalate if the brain is damaged. Secondary complications can occur quickly or later. Patients are now closely monitored for dangerously high levels of intercranial pressure. This can be treated with medication or surgery. Subdural hemorhages, which are slow bleedings that occur after hitting their heads, can lead to confusion, paralysis, and even death.

The recovery process for people over 65 can be more difficult than it is for younger adults. Seniors have slower recovery rates and poorer cognitive outcomes.

“Everything is harder when you are in your 80s than in your 20s,” William Stiers, an associate professor of physical medicine rehabilitation at Johns Hopkins University School of Medicine, said the following: “You are starting out from a somewhat weaker position than in your 30s and 40s, with less cognitive reserve to fall back on.”

The healing of wounds is also slower for older people, though general fitness — including a heart, lungs, kidneys and a liver that are functioning well — makes a big difference to a person’s prognosis, Stiers said.

However, it is difficult to know if Pelosi will need long-term care. “We don’t know the severity of his injuries,” said Ali Salim, division chief of trauma, burn and critical care at Mass General Brigham in Boston.

Added Scalea, “Nothing I have heard makes me think he can’t have a very good outcome, and we certainly hope that he does.”