Fast and Slow Recovery of Consciousness Following Traumatic Brain Injury

Sujith Swarna; Jordan R Saadon; Jermaine Robertson; Vaibhav Vagal; Nathaniel A Cleri; Kurt Butler; Xi Cheng; Yindong Hua; Seyed Morsal Mosallami Aghili; Chiemeka Uwakwe; Jason Zhang; Xuwen Zheng; Aniket Singh; Cassie Wang; Thomas Hagan; Chuan Huang; Petar M Djurić; Charles B Mikell; Sima Mofakham

doi:10.1007/s12028-025-02304-2

Fast and Slow Recovery of Consciousness Following Traumatic Brain Injury

Neurocrit Care. 2025 Jun 27. doi: 10.1007/s12028-025-02304-2. Online ahead of print.

Authors

Sujith Swarna¹, Jordan R Saadon^{1

2}, Jermaine Robertson¹, Vaibhav Vagal¹, Nathaniel A Cleri^{1

3}, Kurt Butler⁴, Xi Cheng^{1

4}, Yindong Hua^{1

4}, Seyed Morsal Mosallami Aghili¹, Chiemeka Uwakwe¹, Jason Zhang¹, Xuwen Zheng¹, Aniket Singh^{1

4}, Cassie Wang^{1

5}, Thomas Hagan⁶, Chuan Huang^{6

7

8}, Petar M Djurić⁴, Charles B Mikell¹, Sima Mofakham^{9

10}

Affiliations

¹ Department of Neurosurgery, Renaissance School of Medicine at Stony, Brook University, Stony Brook, NY, USA.
² Department of Neurosurgery, University of Maryland Medical Center, Baltimore, MD, USA.
³ Department of Surgery, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY, USA.
⁴ Department of Electrical and Computer Engineering, Stony Brook University, Stony Brook, NY, USA.
⁵ Department of Internal Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY, USA.
⁶ Department of Biomedical Engineering, Stony Brook University, Stony Brook, NY, USA.
⁷ Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA, USA.
⁸ Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, USA.
⁹ Department of Neurosurgery, Renaissance School of Medicine at Stony, Brook University, Stony Brook, NY, USA. Sima.Mofakham@stonybrookmedicine.edu.
¹⁰ Department of Electrical and Computer Engineering, Stony Brook University, Stony Brook, NY, USA. Sima.Mofakham@stonybrookmedicine.edu.

PMID: 40579677
DOI: 10.1007/s12028-025-02304-2

Abstract

Background: Consciousness recovery after severe traumatic brain injury (sTBI) can take minutes to years. Despite this variability, we hypothesized that we could identify subgroups with distinct temporal recovery trajectories and that these subgroups would have distinct clinical features.

Methods: We conducted a retrospective cohort study to analyze recovery trajectories for patients with sTBI (Glasgow Coma Scale [GCS] score ≤ 8) admitted to Stony Brook University Hospital from 2010 to 2019. Patients meeting our criteria for recovery (GCS score ≥ 13) were classified into cohorts using the slopes of their recovery trajectories. We then characterized these groups by their clinical features, neuroimaging, and electroencephalography (EEG).

Results: A total of 501 patients with sTBI (348 men, mean age 51 years) were included in this study. Of these, 299 recovered. After analyzing their recovery rates, two distinct groups emerged, (1) fast recovery (n = 215) and (2) slow recovery (n = 84), with a median recovery time of 6 (interquartile range [IQR] 2-12) vs. 33 (IQR 27-44.75) days. Slow recovery patients had higher Injury Severity Scores (median 30 [IQR 25-41.75] vs. 24 [IQR 16-30]; 95% confidence interval [CI] 4.4495-10.6105; P < 0.001), more thalamic injury on neuroimaging (normalized volume [voxels] - 0.664 vs. 1.74; R² = 0.781; P < 0.016), and impaired interhemispheric connectivity on EEG (phase-locking value 0.35 vs. 0.44; 95% CI 0.055-0.14; P < 0.001).

Conclusions: Recovery after sTBI falls into two broad categories, distinguishable by injury severity, thalamic injury, and disrupted interhemispheric connectivity. This model accounts for heterogeneity in TBI outcomes and represents progress toward identifying targets for future neuromodulatory therapeutic development.

Keywords: Coma; Consciousness disorders; Traumatic brain injury.

Abstract

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