naa a22 4500 510799590 CHVBK 20180411083349.0 cr unu---uuuuu 180411e20131201xx s 000 0 eng 10.1007/s12028-013-9870-x doi (NATIONALLICENCE)springer-10.1007/s12028-013-9870-x Unexpected Recovery of Function After Severe Traumatic Brain Injury: The Limits of Early Neuroimaging-Based Outcome Prediction [Elektronische Daten] [Brian Edlow, Joseph Giacino, Ronald Hirschberg, Jason Gerrard, Ona Wu, Leigh Hochberg] Background: Prognostication in the early stage of traumatic coma is a common challenge in the neuro-intensive care unit. We report the unexpected recovery of functional milestones (i.e., consciousness, communication, and community reintegration) in a 19-year-old man who sustained a severe traumatic brain injury. The early magnetic resonance imaging (MRI) findings, at the time, suggested a poor prognosis. Methods: During the first year of the patient's recovery, MRI with diffusion tensor imaging and T2*-weighted imaging was performed on day 8 (coma), day 44 (minimally conscious state), day 198 (post-traumatic confusional state), and day 366 (community reintegration). Mean apparent diffusion coefficient (ADC) and fractional anisotropy values in the corpus callosum, cerebral hemispheric white matter, and thalamus were compared with clinical assessments using the Disability Rating Scale (DRS). Results: Extensive diffusion restriction in the corpus callosum and bihemispheric white matter was observed on day 8, with ADC values in a range typically associated with neurotoxic injury (230-400×10−6mm2/s). T2*-weighted MRI revealed widespread hemorrhagic axonal injury in the cerebral hemispheres, corpus callosum, and brainstem. Despite the presence of severe axonal injury on early MRI, the patient regained the ability to communicate and perform activities of daily living independently at 1year post-injury (DRS=8). Conclusions: MRI data should be interpreted with caution when prognosticating for patients in traumatic coma. Recovery of consciousness and community reintegration are possible even when extensive traumatic axonal injury is demonstrated by early MRI. Springer Science+Business Media New York, 2013 Traumatic brain injury nationallicence Coma nationallicence Magnetic resonance imaging nationallicence Traumatic axonal injury nationallicence Diffusion-weighted imaging nationallicence Apparent diffusion coefficient nationallicence Diffusion tensor imaging nationallicence Edlow Brian Department of Neurology, Massachusetts General Hospital, Harvard Medical School, 175 Cambridge Street, Suite 300, 02114, Boston, MA, USA aut Giacino Joseph Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, USA aut Hirschberg Ronald Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, USA aut Gerrard Jason Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA aut Wu Ona Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, USA aut Hochberg Leigh Department of Neurology, Massachusetts General Hospital, Harvard Medical School, 175 Cambridge Street, Suite 300, 02114, Boston, MA, USA aut Neurocritical Care Springer US; http://www.springer-ny.com 19/3(2013-12-01), 364-375 1541-6933 19:3<364 2013 19 12028 https://doi.org/10.1007/s12028-013-9870-x text/html Onlinezugriff via DOI 1 research-article jats NATIONALLICENCE 856 40 https://doi.org/10.1007/s12028-013-9870-x text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Edlow Brian Department of Neurology, Massachusetts General Hospital, Harvard Medical School, 175 Cambridge Street, Suite 300, 02114, Boston, MA, USA aut NATIONALLICENCE 700 1- Giacino Joseph Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, USA aut NATIONALLICENCE 700 1- Hirschberg Ronald Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, USA aut NATIONALLICENCE 700 1- Gerrard Jason Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA aut NATIONALLICENCE 700 1- Wu Ona Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, USA aut NATIONALLICENCE 700 1- Hochberg Leigh Department of Neurology, Massachusetts General Hospital, Harvard Medical School, 175 Cambridge Street, Suite 300, 02114, Boston, MA, USA aut NATIONALLICENCE 773 0- Neurocritical Care Springer US; http://www.springer-ny.com 19/3(2013-12-01), 364-375 1541-6933 19:3<364 2013 19 12028 Metadata rights reserved Springer special CC-BY-NC licence nationallicence BK010053 XK010053 XK010000 NATIONALLICENCE NATIONALLICENCE NL-springer