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1620 - Functional and Psychological Recovery Following Severe Traumatic Brain Injury and Associated Profound Hearing Loss: A Case Report

Thursday, February 27, 2025

5:00 PM - 6:30 PM MST

Presenting Author(s)

CA

Caitlin R. Aguirre, BA

Medical Student
University of Texas Medical Branch School of Medicine
Webster, Texas, United States

Co-Author(s)

KB

Korosh Bahrami, BS

Fourth Year Medical Student
UTMB John Sealy School of Medicine
Dallas, Texas, United States
AD

Ana Durand-Sanchez, MD

Medical Director
Moody Neurorehabilitation Institute
Webster, Texas, United States

Case Diagnosis: A 41-year-old man three months following traumatic brain injury (TBI) with profound bilateral hearing loss, vestibular-ocular dysfunction, and psychological sequelae.

Case Description: The patient was a healthy 41-year-old man who sustained a traumatic brain injury while at work after a high-pressure pipe exploded. Upon hospital arrival, physical examination revealed a Glasgow Coma Scale of 6, and head CT showed a left temporal subdural hemorrhage, left parietal epidural hemorrhage with 6 mm midline shift, and bilateral temporal and left parietal skull fractures. The patient underwent an emergent left craniotomy. A subsequent MRI showed grade 3 diffuse axonal injury (DAI). After 14 days, the patient was medically stable and discharged to an inpatient rehabilitation program. Outpatient audiological testing revealed profound bilateral hearing loss.

Discussions: After one month of inpatient neurorehabilitation, the patient significantly improved: Activities-Specific Balance Confidence score increased from 53.75% to 80.9%, Functional Gait Assessment from 13/30 to 20/30, and Dizziness Handicap Inventory decreased from 80/100 to 26/100. His independence with daily activities progressed from maximal to supervised assistance. The patient also developed psychological sequelae—adjustment disorder with depressed mood, suicidal ideation, paranoia, and intermittent aggressive behavior—addressed through counseling tailored for his hearing loss. The patient's communication improved with a digital speech-to-text transcriber.

Conclusions: Severe TBIs with grade 3 DAI are associated with a higher likelihood of poor functional outcomes and increased rates of depression. Severe hearing loss can worsen this further, requiring the use of adapted coping strategies and assistive devices to aid in recovery. Despite our patient’s poor prognosis, he achieved fast improvements in functional independence and reintegrated within his community likely due to early, aggressive, high-level, transdisciplinary rehabilitation care. Tailored psychological support and assistive technologies are critical in improving functional and psychological outcomes for patients with severe TBI and associated hearing loss.