Special Reports

Decline came quickly after initial optimism

Crystal Brame defied the odds for one week, somehow clinging to life despite expectations she wouldn't survive even one night.

But something happened late Friday night that reversed a week's worth of progress, and over the course of three or four hours she suffered a rapid decline. At 8 a.m. Saturday a test showed she had no brain activity. By 4:40 p.m. she was declared dead.

Exactly what happened isn't known yet. Joe Lombino, the attorney for her family, said there are several possible explanations, including rapid encephalitis, a seizure or some other metabolic cause.

The primary-care physician who treated Brame will speak with reporters on Monday to offer more details, he said.

What is clear even now, however, is that Brame, 35, suffered a devastating brain injury from the shot her husband fired. A bullet entered the left side of her head and traveled down toward the base of her skull, Lombino said.

Along the way, it inflicted severe damage to the frontal and temporal lobes of her brain.

In an injury of that type, the biggest concern most likely would be a swelling of the brain, said Virginia Delyanis, director of neuroscience for MultiCare Health Systems.

Delyanis, a nurse, did not treat Crystal Brame and couldn't speak to her case specifically. She spoke in general terms Saturday about severe brain injuries.

The first 48 to 72 hours following a severe brain injury are considered the most dangerous, she said. That's when the swelling is likely to be most severe, possibly pushing the brain stem into the bottom of the skull and cutting off circulation to the brain.

Doctors use mechanical ventilation to keep carbon dioxide levels down and drugs to remove excess fluid from the brain, Delyanis said.

But even after the first 72 hours, a patient remains vulnerable to a variety of dangers, including seizure or infections that could use up the brain's supply of oxygen.

Jason Hagey: 253-941-9634