- Associated Press - Sunday, January 23, 2011

HOUSTON | The Houston hospital treating Rep. Gabrielle Giffords said Sunday that her condition is improving daily, but gave no update on the buildup of brain fluid that has kept the Arizona congresswoman in intensive care.

A hospital statement said Mrs. Giffords would continue to receive therapy in the intensive care unit “until her physicians determine she is ready for transfer” to a nearby center where she would begin a full rehabilitation program.

They said the next medical updates would be provided when that happens.

Mrs. Giffords was flown to Memorial Hermann Texas Medical Center Hospital on Friday from Tucson, where she was shot in the forehead on Jan. 8 while meeting with constituents.

At a news conference shortly after her arrival in Houston, doctors said she had been given a tube to drain excess cerebrospinal fluid. Everyone makes such fluid, but an injury can prevent the fluid from being cleared away as rapidly as normal. A backup can cause pressure and swelling within the brain.

“It’s a common problem,” occurring in 15 percent to 20 percent of people with a brain injury or brain surgery, said Dr. Reid C. Thompson, chairman of neurological surgery at Vanderbilt University Medical Center in Nashville, Tenn., who is not involved in Mrs. Giffords‘ care.

Another possible reason for a drainage tube: “After a gunshot wound to the head and brain where there is a lot of soft tissue injury, it is common to develop a leak of spinal fluid. This raises the risk of a meningitis and slows down wound healing,” he said.

The tube is a short-term solution that doctors usually don’t use for longer than a week or two because of the risk of infection, said Dr. Steve Williams, rehab chief at Boston Medical Center and Boston University School of Medicine.

If the problem persists, this temporary catheter can be converted to a permanent one called a shunt. That involves an hourlong surgery to tunnel a thin tube from inside the brain down the neck and under the skin to the abdomen, where the fluid can drain and be dispersed in the belly, Dr. Williams said.

That is less than ideal — those can clog over time, requiring medical attention.

Meanwhile, the legal case against suspect Jared Lee Loughner will take its next step forward, with his arraigned set for Monday afternoon in Phoenix.

Investigators have been poring over surveillance video, interviewing witnesses and analyzing items seized from Mr. Loughner’s home as they build a case in the rampage that wounded 12 people besides Mrs. Giffords and killed six others, including a federal judge and a 9-year-old girl born on Sept. 11, 2001.

It’s a case that likely will take years to play out as it goes through the many phases of the criminal justice system: prosecutions by both federal and state authorities, proceedings over whether to move the case to a different venue, a possible insanity defense by Mr. Loughner and prosecutors’ likely push for the death penalty.

Investigators have said Mr. Loughner was mentally disturbed and acting increasingly erratic in the weeks leading up to the shooting. If he pleads not guilty by reason of insanity and is successful, he could avoid the death penalty and be sent to a mental health facility instead of prison.

“I don’t see a lot of other viable defenses,” agreed Michael Piccarreta, a Tucson lawyer who has practiced criminal defense in federal court for 30 years. “It appears the actual guilt or innocence of the shooting will not be difficult to prove, and his pre-shooting behavior seems to be a history of erratic behavior — issues of pre-existing mental illness.”