1551 - Not Alone: From Suicide Attempt to Full Neurological and Speech recovery; A Rehab Success Story

Friday, February 23, 2024

5:00 PM – 6:30 PM EDT

Presenting Author(s)

CT

Cesar Trivino, Jr., MD

Resident
Memorial Healthcare System ( Regional Hospital South)
Miramar, Florida, United States

Co-Author(s)

KJ

Kevin John, DO

Resident Physician
Memorial Regional Hospital South
Hollywood, Florida, United States
HL

Hannah Levine, BS

Medical Student
Charles E. Schmidt College of Medicine at Florida Atlantic University
Wellington, Florida, United States
IM

Ian Miller, DO

Physical Medicine and Rehabilitation, Attending
Memorial Healthcare System
Hollywood, Florida, United States

Case Diagnosis: Traumatic Brain Injury in the setting of self-inflicted gunshot wound

Case Description: 26 y.o. male with PMH of concussion (x3 LOC from competitive football, possible CTE) who presented to trauma-ICU after a self-inflicted gunshot wound to the head. Upon arrival, vitals were stable, GCS 15, but he was quadriparetic. Imaging revealed an open skull and frontal sinus fractures, subdural hematoma, extensive hemorrhagic contusions, bilateral frontal lobe injury, and subarachnoid hemorrhage. He arrived at acute rehabilitation as total assist with expressive aphasia. Appropriate medical management and intensive rehabilitation led to a full neurological and speech recovery.

Discussions: Self-inflicted craniocerebral gunshot wounds are highly fatal, with 91% mortality rate at scene of the trauma or in hospital, and an even greater mortality rate for bi-hemispheric injuries, seen in our patient. Our patient had a history of multiple concussions prior to his suicide attempt. While there is currently insufficient evidence linking chronic traumatic encephalopathy (CTE) and serious suicide attempts in athletes, there are previous reports of similar progressive neuropsychiatric symptoms and serious suicide attempt in several former professional athletes. This patient survived a highly fatal suicide attempt and potentially had prior undiagnosed CTE, yet he made a full recovery through comprehensive rehabilitation.

Conclusions: This case report underscores the importance of an aggressive and comprehensive approach to treatment and rehabilitation of self-inflicted craniocerebral gunshot wounds. It also invites the possibility of a link between CTE and serious suicide attempts in young athletes. This calls for further research in this area and for increased attention to this potential risk by practitioners working with athletes who might have CTE. Our multidisciplinary team approach within a tertiary care center provided this young man with the opportunity to enhance his functional and speaking abilities which would not have been possible in a different setting.