Rapid Neurocognitive Improvement after Exosomal Stem Cell Therapy in a Traumatic Brain Injury Patient with Grade II DAI

Case Diagnosis: 18-year-old male with polytrauma and traumatic brain injury (TBI) consistent with grade 2 diffuse axonal injury (DAI) and intraparenchymal hematoma (IPH)

Case Description or Program Description: Patient fell three stories and was airlifted to a level-1 trauma center with GCS 7 requiring field intubation. MRI Brain demonstrated left-sided IPH and increased signal in the subcortical white matter/corpus callosum indicative of grade 2 DAI. Despite poor prognosis, patient was extubated after 12 hours and discharged on day 4. Patient had neurocognitive deficits across multiple domains along headaches. Exosomal stem cell therapy (ESCT) was initiated 3 days after discharge. On post-treatment day 3, patient subjectively reported completed resolution of previous symptoms.

Setting: Outpatient

Assessment/Results: Patient demonstrated functional decline in multiple neurocognitive domains including memory, concentration, reading comprehension, executive motor planning, abstraction, and reasoning. He endorsed headaches and occasional mood irregularities. ESCT started five days after initial injury. Patient endorsed rapid symptomatic resolution within 72 hours post-ESCT. Importantly, patient returned to school within six weeks without significant cognitive impairment.

Discussion (relevance): DAI is a type of TBI caused by rapid accelerative/decelerative forces leading to shearing of nerve axons. Patients with DAI generally have a worse prognosis and full recovery can be rare. Many patients experience lifelong cognitive impairments. Emerging research suggests mesenchymal stem cells may enhance neuroplasticity, reduce neuroinflammation, and promote neuronal repair. Our patient underwent ESCT with significant improvements in cognitive functioning. To our knowledge, there are no cases of ESCT in human subjects with DAI. Early ESCT may have improved our patient’s neuro-recovery timeline.

Conclusions: DAI can cause significant cognitive deficits, often requiring significant time for neuro-recovery. This case highlights early ESCT leading to improved cognitive functioning in a 19-year-old after severe TBI with grade II DAI. Complete symptomatic resolution was reported 72 hours post-treatment. Early ESCT may be an effective treatment for DAI and altering neuro-recovery trajectories.