Return to Work within Four Months of Grade 3 Diffuse Axonal Injury

Abstract

Neuroprognostication following diffuse axonal injury (DAI) has historically relied on neuroimaging techniques with lower spatial resolution and contrast than techniques currently available in clinical practice. Since the initial studies of DAI classification and prognosis in the 1980s and 1990s, advances in neuroimaging have improved detection of brainstem microbleeds, a hallmark feature of Grade 3 DAI that has traditionally been associated with poor neurologic outcome. Here, we report clinical and radiologic data from two patients with severe traumatic brain injury and grade 3 DAI who recovered functional independence and returned to work within 4 months of injury. Importantly, both patients were scanned using 3 Tesla MRI protocols that included susceptibility-weighted imaging (SWI), a technique that provides enhanced sensitivity for detecting brainstem microbleeds. These observations highlight the importance of developing approaches to DAI classification and prognosis that better align with contemporary neuroimaging capabilities.

Note:

Funding: This work was supported by the NIH BRAIN Initiative (F32MH123001), the NIH National Institute of Neurological Disorders and Stroke (R21NS109627, RF1NS115268), NIH Director’s Office (DP2HD101400), Henry and Allison McCance Center for Brain Health / Mass General Neuroscience SPARC Award, James S. McDonnell Foundation, and Tiny Blue Dot Foundation.



Declaration of Interest: None to declare.



Ethical Approval: Approval was received by the local IRB.

Patient Consent: Both patients provided informed consent.

Keywords: traumatic brain injury, prognosis, consciousness, diffuse axonal injury, microbleed, neuroethics