1523 - Communication is Key: Reemergence of Language in Severe Traumatic Brain Injury

Thursday, February 22, 2024

5:00 PM – 6:30 PM EDT

Presenting Author(s)

PV

Peter D. Vu, MD

Resident Physician
University of Texas Heath Science Center at Houston, TIRR Memorial Hermann
Houston, Texas, United States

Co-Author(s)

MC

Morgan R. Cowan, DO

Resident Physician
University of Texas Health Science Center at Houston
Houston, Texas, United States
MQ

Melanie Quoilin, MD

Resident Physician
UT health
Houston, Texas, United States
CB

Colton A. Besett, MD

Physical Medicine and Rehabilitation Resident Physician
UTHealth Houston
Houston, Texas, United States

Corresponding Author(s)

MN

Michael Nguyen, MD

Attending / Assistant Professor
McGovern Medical School / UTHealth
Houston, Texas, United States

Case Diagnosis: Impaired functional communication secondary to TBI

Case Description: A previously healthy 18-year-old male presented to the inpatient disorder-of-consciousness unit after a six-story fall. He sustained a traumatic subarachnoid hemorrhage, right subdural hematoma with left to right midline shift, extensive anterior and basilar skull fracture, and traumatic left ICA dissection with left MCA and PCA infarct. This necessitated a left decompressive hemicraniectomy and hemi-cranioplasty. CT head showed extensive atrophy and lack of frontal, parietal, or temporal parenchyma.

Despite extensive insults and drastic brain mass loss, including language areas, his rehabilitation highlights his communication. Initially, he communicated with blinks (1 for yes, 2 for no). Over time, his blinks became more accurate as his cognitive function improved. Eventually, he established a yes/no system via head movements with 100% accuracy and was able to identify colors, objects, and words. By discharge, he demonstrated answering short paragraphs.

Discussions: Linguistic networks consist of left frontal and temporal regions, with specific topological regions having functional hierarchies pertaining to communication processing (1). Specific white matter fiber tracts connecting these gray matter regions have shown particular importance for higher-order language functions (2). TBI alters normal brain signaling pathways (3), with superior temporal gyrus activity corresponding to the reemergence of language capabilities (4). Furthermore, in bilingual speakers, cortical-subcortical recruitment has resolved cross-language interference that can occur between different languages (5). In this case, the level of injury and corresponding imaging suggests the patient may never communicate. However, the improvement in comprehension and participation different from his pre-injury communication suggests an awakening of function and pathways pertinent to language comprehension and communication, similar to learning a new language.

Conclusions: In TBI, relearning language and communication is influenced by left frontal and temporal tissue reactivation, fiber tract signaling neuroplasticity and cortical-subcortical recruitment. This case highlights more studies are needed to fully elicit language and communication.