Adapt and Overcome: Remarkable Reintegration After Severe TBI

Case Diagnosis: Severe Traumatic Brain Injury (TBI) and resulting hemispheric cortical tissue loss in a young adult who made remarkable functional and cognitive gains and demonstrated meaningful reintegration.

Case Description or Program Description: A 21 year old male suffered a gun shot wound causing severe TBI with initial GCS of 3-4. His catalog of head injuries during initial survey included: penetrating brain injury with external tissue herniation, diffuse axonal injury, and subdural hematoma requiring decompressive hemicraniectomy. The patient was hospitalized for 94 total days, with multiple transitions in levels of care, until he was medically stable enough to begin inpatient rehabilitation.

Setting: Neurocognitive/TBI clinic at an academic institute

Assessment/Results: In a patient with a severe TBI, with resulting generalized cortical tissue loss in the right hemisphere, remarkable gains in reintegration have been accomplished. Neuropsychological testing demonstrates difficulty with tasks that required a timed-component, visual-spatial skills, and complex/sustained attention but was within average parameters for metrics like memory and reading. A multidisciplinary approach created the accommodations necessary to support reintegration into meaningful activities.

Discussion (relevance): In patients with any degree of brain injury, but particularly in severe cases, early identification of the extent of the injury and a multidisciplinary approach to the recovery process is paramount for ultimate successful reintegration in society. With guidance from extensive testing, accommodations have been outlined and fulfilled, and this patient has successfully returned to continue college-level education, hobbies including hunting/ sport shooting, and skiing. Understanding the role the rehabilitation team can play in patient recovery, like this case of severe TBI, is important in advocating for this level of care for severely injured patients.

Conclusions: Even in cases of severe brain injury, with remarkable cortical tissue loss, significant gains in social, cognitive, and functional realms are possible with adequate rehabilitation efforts, long-term clinical followup, and psychosocial support.