Post-Traumatic Brain Injury Symptoms After a Motorcycle Accident

Post-traumatic brain injury (TBI) sequelae from a car accident?

Hello Doctor: My father was hospitalized due to a motorcycle accident at the end of April, which resulted in a brain injury.
He was in a coma with a Glasgow Coma Scale score of 3 and had an intracranial pressure monitor inserted.
He gradually regained consciousness and is no longer in a coma, but he still has a nasogastric tube in place because he often lacks awareness and cannot eat or drink.
Initially, he was diagnosed with hydrocephalus after the accident, but after two months, the hydrocephalus resolved, so no surgery was performed.
However, since regaining consciousness, my father's personality has changed dramatically—he is irritable and uncontrollable, has memory and cognitive issues, and does not recognize family members.
He also experiences hallucinations.
Additionally, my father, who originally only spoke Taiwanese, now speaks fluent Mandarin and hardly uses Taiwanese, leading people to mistakenly believe he is from mainland China.
Since surgery is not needed, the neurosurgeon suggested it would be best for him to return home and recuperate.
He is only taking Xintan, but it has not been effective, and his emotional state is worsening.
Even with six sedatives a day, he still cannot sleep and is becoming increasingly irritable.
My question is: Is it true, as his doctor stated, that we can only wait for him to improve on his own? Are there any other medications or treatments that can be considered? Our family has been severely affected by my father's unusual behavior, and even the doctors and nurses seem unable to help.
Please assist us with a response.
Thank you.

Xiao Ling, 30~39 year old female. Ask Date: 2011/07/21

Dr. Ding Xianwei reply Neurosurgery

Based on your description, I would like to offer my suggestions.
Your father may be experiencing changes in temperament due to frontal lobe damage, which is part of the sequelae of a head injury.
Frankly, it is quite remarkable that he has progressed from a Glasgow Coma Scale score of three to his current state.
However, in my experience, if I am not mistaken, he may not have truly regained consciousness yet, which could explain the symptoms he is exhibiting.
I recommend primarily protecting him from harm, and for the rest, it is best to let things unfold naturally.
After some time, there may be a chance for improvement.

Reply Date: 2011/07/21

More Info

Post-traumatic brain injury (TBI) can lead to a variety of symptoms and complications, especially following a severe incident like a motorcycle accident. Your father's case, where he experienced a coma and subsequent changes in personality, memory, and behavior, is indicative of the complex nature of brain injuries.
Firstly, it’s important to understand that brain injuries can manifest in numerous ways. The symptoms you describe—such as personality changes, memory issues, and even language shifts—are not uncommon in individuals who have suffered significant head trauma. The brain is a highly intricate organ, and damage to specific areas can lead to alterations in behavior and cognitive function.
The fact that your father was initially in a coma (with a Glasgow Coma Scale score of 3) indicates a severe injury. While he has since regained consciousness, the road to recovery can be long and fraught with challenges. The changes in his personality, including increased irritability and confusion, may be attributed to a condition known as post-traumatic personality change, which can occur after a TBI. This condition can lead to emotional dysregulation, impulsivity, and difficulties in social interactions.

The sudden ability to speak Mandarin fluently, while previously only speaking Taiwanese, is particularly intriguing and may suggest a phenomenon known as "foreign accent syndrome," which can occur after brain injury. This syndrome is rare and can result in individuals speaking in a different accent or even a different language, often without prior knowledge of it.
Regarding the management of your father's symptoms, it is crucial to have a comprehensive approach. While the neurosurgeons have indicated that surgery is not necessary at this time, ongoing rehabilitation is essential. This may include physical therapy, occupational therapy, and speech therapy, which can help address cognitive deficits and improve overall functioning.
In terms of medication, it is concerning that the current treatment with anxiolytics (like the sedatives you mentioned) is not yielding positive results. It may be beneficial to consult with a neurologist or a psychiatrist who specializes in brain injuries. They can evaluate whether adjustments to his medication regimen are necessary or if alternative treatments, such as mood stabilizers or antipsychotic medications, might be appropriate to help manage his symptoms more effectively.

Additionally, behavioral therapy could be beneficial for both your father and your family. This type of therapy can provide strategies to cope with the emotional and psychological challenges that arise from TBI. Family therapy may also be helpful, as it can assist family members in understanding the changes your father is experiencing and develop strategies to support him.

Lastly, patience and support from family members are crucial during this recovery process. It can be incredibly challenging to witness a loved one undergo such significant changes, but understanding that recovery from TBI can take time may help in coping with the situation. Regular follow-ups with healthcare providers are essential to monitor his progress and make necessary adjustments to his treatment plan.

In summary, while your father's condition may seem daunting, there are various avenues for treatment and support. Engaging with specialists in brain injury rehabilitation, exploring medication adjustments, and considering therapy options can all contribute to improving his quality of life and aiding in his recovery.

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