PM&R Case Study: Neuropsychological Effects Following Traumatic Brain Injury

Abstract Background: According to the Center for Disease Control (CDC) close to 2.8 million people a year suffer from traumatic brain injuries (TBI) in the United States. Of that number, close to 96% will survive. The CDC estimates that medical costs as well as indirect costs, such as loss of productivity, nears almost 60 billion a year. With these staggering numbers, it is important to better understand the short term and long lasting effects of TBIs. TBIs can impair physical movement, vision, hearing, memory, thinking, and sensation. As well as cause depression and personality changes. Yet, some effects are less common such as verbal inhibition and emotional lability. Researching these unique cases can lead to better understanding of neuropsychology as well as better treatments to help those impacted. Case Information: A chart review was conducted with the assistance of medical records, including clinical summaries, surgery notes, and long term rehabilitation records. A 53-year-old man suffered a motorcycle accident in March of 2011. During this accident, his helmet suffered major damage, he lost consciousness, and had a Glasgow Coma Score of 4. At the scene, he required resuscitation several times and was intubated. Once at the hospital he was diagnosed with multiple rib fractures, an open left calcaneus and fifth metatarsal base fracture, as well as a severe traumatic brain injury with intracranial hemorrhage. He was in a coma for 13 days and underwent several surgeries within the hospital. Once he was released he began to notice chronic daily headaches, greatly impaired sleep duration/quality, and chronic pain in the left foot/ankle. In addition, he began to suffer from an impaired memory, increased impulsivity, increased distractibility, emotional lability, anxiety, and an inability to censor his verbal speech. While his physical ailments have decreased his quality of life they have not been as severe as his neuropsychological changes. Before the accident he was able to work a high paying job. Yet, after the accident his inability to curb his speech, remember important items, and his greatly increased anxiety have caused him to no longer be able to work. In addition, he has difficulty going to the gym or the supermarket because he is unable to stop conversations with strangers. While he used to spend 45 minutes at the gym he will now spend close to 5 hours due to his ongoing conversations. Conclusions: TBI is a major medical problem in the United States and while there can be great commonality among symptoms the ongoing sequela can be extremely varied. Yet, per the literature, there are very few cases on the loss of higher level filters on speech secondary to a TBI. Therefore, the specific mechanisms of this neurological injury as well as the ongoing rehabilitation and treatment are not well known. This case could provide an additional piece of the puzzle to potentially help advance the understanding of these rare long lasting effects as well as help provide a clearer picture of TBIs in general.