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- Title
The Long-Term Spontaneous Course of a Severe Traumatic Brain Injury Incurred at Age 16 by a 47-Year-Old Physician: Investigation into Planning a Long-Term Prognosis Study of Childhood Traumatic Brain Injury.
- Authors
Tachibana, Tomoko; Tachibana, Hideaki
- Abstract
Objective: To clinically and comprehensively investigate and discuss a 47-year-old physician who entered medical school 3 years after incurring a severe traumatic brain injury (TBI) at age 16; to consider the concept of long-term prognosis studies in childhood TBI patients. Design: Observational, longitudinal, retrospective, and prospective case study. Materials and Methods: Follow-up observations and clinical findings from the time of injury to 3 years after injury were obtained from the patient's medical records. Our direct observations commenced around the time that the patient began her study of medicine, 3 years after her injury. Objective findings from December 2008, 31 years after the injury, were evaluated using the results of the patient's voluntary visit to the psychoneurotic department of Keio University Hospital. We ascertained comprehensive information on the natural course of the patient's TBI in an interview conducted in June 2009. Results: A 47-year-old female physician with a past history of severe TBI was diagnosed at age 16 with a brain contusion, basilar skull fracture, optic canal fracture, and injuries to both lower limbs, as well as other more minor injuries. The major neurological symptoms were loss of consciousness for 1 month, loss of vision in the right eye, and a facial palsy at the left side. She did not receive cognitive rehabilitation intervention. Although she was suffering from impairments, pain, and a remarkable reduction of memory and brain functions such as concentration, she entered medical school 3 years after the injury. She graduated from medical school and has practiced medicine continuously. In 2008, 31 years after her injury, her full-scale intelligence quotient (IQ) was found to be "superior. " Although a relative reduction of performance IQ score was present and localized brain atrophy of the left occipital lobe was observed. It was verified 20 years after the injury and later that her focal symptoms, as well as her neurological deficits and high brain functions, had improved. We have observed that her initiative was supported by her pride and confidence, and her symptoms were improved by her relatively young age at injury, her frontal lobe function, intelligence, desire for self-realization, acceptance of her own value in society, and a receptive environment. We also found that her initiative may have been reduced by the lack of understanding of people close to her, leading to depression, emotional disorders, and behavior disorders. Conclusions: 1) Her dysfunction symptoms have been improved by self-initiated compensatory devices; her studies to prepare for medical school entrance examinations, her learning during medical school, and her continuous medical practice. These events stood proxy for rehabilitation. 2) The following were considered strong contributing factors to the patient's prognosis: disease severity age, at injury, character prior to the injury, cognitive factors, psychosocial factors, social superiority, availability of social resources, adaptations by her family and severity of sequelae. 3) To provide survivors of severe childhood TBI with appropriate and reasonable interventions for the improvement of long-term prognosis, scientific evidence of the efficacy and validity of interventions will be essential.
- Subjects
BRAIN injury diagnosis; BRAIN injuries; INTERVIEWING; LONGITUDINAL method; MAGNETIC resonance imaging; SCIENTIFIC observation; WECHSLER Memory Scale; RETROSPECTIVE studies; PATIENTS' attitudes; DESCRIPTIVE statistics; GLASGOW Coma Scale; SYMPTOMS; ADOLESCENCE; PROGNOSIS
- Publication
International Medical Journal, 2012, Vol 19, Issue 4, p321
- ISSN
1341-2051
- Publication type
Article