Monitoring emergence from coma following severe brain injury in an octogenarian using behavioural indicators, electrophysiological measures and metabolic studies: A demonstration of the potential for good recovery in older adults

Abstract

This case study describes a multi-disciplinary investigation of the emergence from coma of an 80-year old female (KE) following severe traumatic brain injury. The relationship between cognitive/behavioural ability and the integrity of cerebral function was assessed using neuropsychological measures, positron emission tomography, electroencephalography, somatosensory evoked potentials and trans-cranial magnetic stimulation. These investigations were performed as KE was beginning to emerge from coma (4 weeks) and, again, approximately 1 year following brain injury, when she was judged to have achieved her maximum level of recovery. Neuropsychological measures revealed improvement during the first year post-injury in KE's speed of information processing, memory and executive abilities. Electrophysiological and metabolic studies indicated a restoration of functional integrity that was consistent with the gradual recovery in higher brain function documented using behavioural procedures. This case study demonstrates the rehabilitation potential of pre-morbidly healthy older adults following severe traumatic brain injury.

Noninvasive Brain Stimulation in Traumatic Brain Injury

“…128 TMS assessment at 12 months revealed a remarkable increase in MEP amplitudes from those recorded at 4 weeks. 18-FDG PET suggested a general increase in the metabolic rate and showed a regression in the global reduction over the year.…”

Geriatric Traumatic Brain Injury: Epidemiology, Outcomes, Knowledge Gaps, and Future Directions

“…86,87 In an illustrative case report, Crossley and colleagues elegantly described an 80-year-old woman with normal pre-injury function-defined as complete independence in selfcare, financial and household management, and an active and healthy lifestyle-who made an excellent recovery after a severe TBI. 88 Very few studies of outcomes after geriatric TBI, however, have systematically measured pre-TBI functional status 21,64,[89][90][91] and even fewer have assessed the prognostic role of pre-TBI functional status on outcomes. 92,93 Initial Clinical Assessment and Diagnostic Studies…”

Multimodal imaging of recovery of functional networks associated with reversal of paradoxical herniation after cranioplasty

“…Such physiological assessments of recovery during post-operative management after craniectomies are likely to be particularly important for patients with severe brain injuries or the elderly who may recover slowly from their injuries (36). …”