Cooper: death of a sportsman Cooper loses his fight for life with the silent killer

duty to inform you that Davie Cooper died this morning.''

He said the footballer never regained consciousness. ''He would not be

aware at any point of what was going on.''

A consultant neurosurgeon, Mr Cruickshank took charge of Davie

Cooper's case when he was admitted to the Institute for Neurological

Sciences at the Southern General Hospital in Glasgow on Wednesday.

The hospital had to set up a special phone line to handle the hundreds

of inquiries and calls from well-wishers anxious about the football

player's condition.

But even as the calls, and faxes, were pouring in it was already clear

that the popular sportsman's life was rapidly ebbing.

Within a few hours of admission Mr Cruickshank had to tell his family

and his fiancee, Elizabeth Thomson, that his chances of survival were

slim. Yesterday morning he had to prepare them for the formalities of

death.

At 9.45 he and a colleague, a consultant anaesthetist, carried out the

examination which confirmed that Davie Cooper was brain dead. At ten

o'clock they switched off his life support system, and a man who had to

all appearances been a fit and healthy athlete less than 24 hours

previously, breathed his last.

Mr Cruickshank said that after Cooper collapsed on Wednesday morning,

a CT scan performed at Monklands Hospital confirmed he had suffered a

subarachnoid haemorrhage: bleeding between the membranes lining the

brain.

The doctors' priorities when he was wheeled into the Institute were to

confirm this and establish if there was anything needing treatment that

they could offer, like signs of brain swelling or impaired circulation

to the brain. Further scans confirmed both.

They tried to deal with this initially by sedating him and controlling

the blood pressure to improve the supply of blood to his brain.

These efforts continued, but it became clear about 10pm that he was

losing all neurological activity. Sedation was stopped so that he was

clear of any drugs or other agents that were likely to interfere with

the doctors' assessment of his condition. His condition deteriorated

seriously overnight.

''Initially when he came in there were some signs of neurological

activity but progressively through the night these signs went. They

fitted very well with the CT scan picture which showed a very serious

bleed and very serious problems going on inside his head,'' Mr

Cruickshank explained.

The most likely cause of the bleed, he said, would be rupture of an

aneurysm, a swelling of one of the blood vessels inside the head. That

is the most common cause of a subarachnoid haemorrhage.

''In these sorts of patients about 30% die immediately and the rest

survive and get to a unit such as this where we can help them.

''In David's case he had such a massive haemorrhage associated with a

seizure -- he suffered one when he collapsed and another at Monklands

hospital which aggravated the swelling -- I think the pathological state

he had got into was a natural consequence of the bleed.

''This is a completely silent disease. You have no knowledge it is

going to occur and there is usually no warning that it is going to

occur.''

The incidence of this disorder is put at eight per 100,000 population.

In the Institute's catchment area, the number who make it there alive

is in the order of 200 people a year.

''Of these we are able to operate on about 160,'' said Mr Cruickshank.

''But from the start that was never an option for Davie Cooper.''

''He never regained consciousness after he collapsed. He would not be

aware at any point of what was going on.''

Subarachnoid haemorrhage happened equally to fit healthy sportsmen as

it did any other member of the population.

''They usually occur in the spaces between the bony part of the skull

and the brain where the blood vessels have to traverse the spaces: these

are the major branches of the carotid arteries.

''It is at these junctions where the branches occur that these

aneurysms develop -- imagine a hose pipe that gets a very thin area of

wall and balloons out. At some time or other the pressure causes the

wall to give and it will burst.

''The bleed you see in the scan is round the brain and in all the

fissures and spaces round the brain rather than in the brain substance

itself.''

There was no evidence that the impact of footballers' regular

head-contact with the ball made them more prone to haemorrhages, he

added.

The fact that someone like Davie Cooper could keel over and die so

abruptly is bound to make anyone wonder if they, too, have a cerebral

aneurysm lurking inside them.

Some people are luckier: they have a slower bleed which produces

symptoms, like blinding headaches, which will bring them to the notice

of specialists.

Or they may have other indications which merit specific investigation,

such as a family history of the same problem, or a known deficiency of

collagen, the body's principal structural protein.

In fact looking for aneurysms in such cases is the bread-and-butter of

the Institute's neuroradiology department, the consultant in charge, Dr

Donald Hadley, said yesterday.

''If you can get it clipped, you can return to a normal life,'' he

said. They saw several every day, ''but you can't screen the entire

population.''

Apart from the practical difficulties, one reason is that the

examination, an angiogram, is invasive -- a catheter 1mm wide is

inserted from the thigh through each in turn of the four great arteries

serving the brain, and a tracing medium squirted from the tip to make

its way through the rest of the brain's circulation.

This allows a series of rapid-fire X-rays from different angles to

build up a map of the circulation, allowing the radiologists to spot any

untoward bulges.

Within a few years, says Dr Hadley, the non-invasive, non-radioactive

MRI scanner may provide a safer way of getting the same information, but

that technique is not yet proven.

The established course when an aneurysm is spotted is for surgeons to

open the skull and clip the affected vessel to forestall any

haemorrhage; increasingly, and in particular where the problem is

inaccessible, catheters are being used to insert tiny platinum clips

around the aneurysm, building them up so that the weak spot is blocked

off.

''This technique is proven for areas the surgeons can't get at.

Whether it is better in all cases is now the subject of international

trials involving thousands of patients,'' said Dr Hadley. ''But unless

there is something to indicate the condition in the first place, it is

down to luck whether or not it bursts.''