After traumatic brain injury, a young mans astounding recovery

By Rebecca Hubert Williams September 15

On Nov. 8, 2012, my son Dylan two months into his junior year at Tufts University was struck by a car in a crosswalk. His head punched a hole through the cars windshield, and he suffered a traumatic brain injury so severe that doctors initially warned he might be permanently disabled. He might never be able to feed himself again.

When I got the call from the ambulance, I was sitting in a cozy chair reading The Black Swan: The Impact of the Highly Improbable, in which Nasim Nicholas Taleb argues that we should recognize the disproportionate effects of unexpected events on our lives. Dylans accident certainly made that case. An injury suffered in one second overwhelmed our family for months. Instead of studying abroad in Germany as he had planned, Dylan spent the rest of that academic year with doctors and therapists.

Every year, millions of Americans suffer traumatic brain injury, or TBI. When the TBI is as severe as Dylans, most victims struggle for years to recover, with varying degrees of success. Dylan has made an extraordinary comeback, one that has surprised and inspired not only his family and friends but also the doctors and nurses who treated him. The neurologist who enrolled my son in a neuroimaging research study said that after examining his initial brain scan, he would have put the odds against Dylan achieving his current capabilities at 10,000 to 1 I mean, something astronomical.

This is how it happened.

A devastating diagnosis

Dylan was unlucky to have been hit by an inattentive driver, but his luck changed in time to save his life. Because the accident occurred at 8:30 p.m. rather than in the middle of Bostons rush hour, he was brought to a hospital within a half hour and not just any hospital. It was Massachusetts General, a top-rated trauma center with a dedicated neurosciences intensive care unit. The immediate insertion into his skull of a drain tube relieved intercranial pressure, meaning Dylan didnt have to have part of his skull removed. He was quickly admitted to the ICU and equipped with a ventilator and feeding tube. Within 24 hours of the accident, he was getting an MRI scan.

The speed of triage was impressive, but the results of that scan were devastating. Dylans brain injury was rotational, meaning his head had been slammed around inside his skull. There was extensive damage at the cellular level. The diagnosis was grade III diffuse axonal injury, meaning that throughout his brain, axons nerve fibers that transmit electrical impulses had been sheared and torn, disrupting the brains internal communications system. In addition, the MRI showed several dark patches near the brain stem, indicating injury to the areas governing arousal and alertness. Doctors warned us that if Dylan could wake up, he might need assistance with every aspect of life possibly forever.

Fortunately, Dylans neocortex, the brains seat of higher-level processing, was mostly uninjured. And he had one other thing going for him, doctors said: his youth.

Studies have shown that youth is a prominent factor in neuroplasticity, the brains ability to form new connections to compensate for ones that get blocked or severed, to partially repair injured pathways and even to repurpose parts of the brain. It is clear, doctors say, that young people have greater potential for co-opting undamaged parts of the brain to take on new functions than older people do. And in general, the systemic health of young patients, such as more blood flow and oxygen, electrolyte balance and overall positive metabolic state, are helpful in healing.

Originally posted here:
After traumatic brain injury, a young mans astounding recovery