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Monitoring emergence from coma following severe brain injury in an octogenarian (abstract)
Crossley, M., Shiel, A., WILSON, B.A., Gelling, L. Fryer., Coleman, M., & Pickard, J
Journal of the International Neuropsychological Society, 8, 171-172
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This case study describes the emergence from coma of an 80-year old female who suffered severe traumatic brain injury as a result of a car-pedestrian accident. She was seen as a participant in a multidisciplinary research project designed to investigate the relationships between behavioural and neurofunctional measures following severe brain injury. Emergence from coma was monitored behaviorally using the Wessex Head Injury Matrix (WHIM) which measures spontaneous behaviors, and responses to naturally occurring and to standardized stimuli. Neurofunctional measures (PET, transcranial magnetic stimulation, somatosensory evoked potential, and EEG) were taken during the fourth week following injury as the patient was beginning to emerge from coma, and again, 6 months following brain injury when she was judged to have achieved her maximum level of recovery. 18-Flurodeoxy-glucose PET studies indicated that the patient's global metabolic rate was suppressed by approximately 40% compared to age matched controls. There was no evidence of focal lesions and electrophysiological measures indicated that brain stem function was preserved. The patient suffered post traumatic amnesia for 14 weeks. Subsequently, she responded well to rehabilitation and was discharged home at 5 months under the care of her family. Neuropsychological testing at 6 months indicated that the patient had impaired memory and executive functions, but well preserved language and verbal perceptual skills. She was able to work with the aid of a frame, and reported an acceptable quality of life. In addition to demonstrating the links between behavioral and neurofunctional measures in the early assessment of recovery from coma, this case exemplifies the rehabilitation potential of premorbidly healthy older adults following severe brain injury.