14 Recovery of pre-morbid levels of functioning after grade ii diffuse axonal injury following severe tbi

Abstract

<h3>Objective</h3> To present a case of complete functional recovery, achieving pre-morbid levels of functioning, after sustaining a severe v TBI (GCS: 8; PTA: 9 days) with neuro-radiological evidence of grade II diffuse axonal injury. <h3>Method</h3> A 32 year old, right handed manager of a shipping company was referred to our unit for neuro-rehabilitation following a severe TBI in a road traffic accident (RTA), 13 days previously. Within 24 hours post-TBI a brain CT Scan and a brain MRI T1, T2, FLAIR and DWI sequences) at 2 weeks were performed. The patient underwent full neuropsychological assessment, 14 weeks post-TBI, to evaluate his premorbid IQ using the Test of Word Accentuation (Spanish) and the Vocabulary subtest of the Wechsler Adult Intelligence Scale III version (WAIS III). His current IQ was assessed using the WAIS III full scale. The Barcelona Test – revised version assessed his language ability. Executive function was evaluated using the Stoop Test, Trail B and the Wisconsin Card Sorting Test (WCST). He was discharged with out-patient follow-up 3 weeks after the RTA. Out-patient neuropsychiatric review took place at 6, 20 weeks post-TBI and by telephone at 6 months. <h3>Results</h3> The patient made an excellent physical recovery with no neurological focal signs detected on discharge. The initial brain CT Scan was reported within normal range. Brain MRI (T2, FLAIR, DWI) revealed bilateral frontal hyperintensities in subcortical white matter, anterior splenium, posterior corpus callosum (CC), left internal capsule extending to the cerebral peduncle and left dorsolateral mescenphalon, compatible with non-haemorrhagic diffuse axonal damage (grade II).Pre- morbid IQ was estimated in the “above average” range. He scored in the “high or superior” range in all the rest of the tests of current cognitive performance (percentile range 77–96). Neuropsychiatric assessment found no evidence of neuropsychiatric or behavioural problems, only referring mild fatigue at 20 weeks follow-up. He gradually returned to work and was working full time at 6 months follow-up, referring improvement in his fatigue. <h3>Conclusions</h3> Complete recovery after grade II diffuse axonal damage is achievable.