Responsibility of neurosurgeons in cooperation with clinical neuropsychologists to accomplish full social re-entry and good HRQoL for patients following acute brain damage

Abstract

Objectives: Physical neurologic and neuropsychological rehabilitation has an old tradition in Europe. Clinical recovery of physical neurological impairments following acute brain damaged do not guarantee successful social re-entry when overlooking long-lasting mental – cognitive, behavioural deficits after clinical demission. Problems in emotional adjustment are long-lasting and hinder social re-entry.
Patients and methods: Transdisciplinary early neurorehabilitation is based on careful physical and mental - cognitive diagnostics for an individualized therapeutic intervention, when neuropsychology is essential in patients with brain lesions. The role of individually planned early neuro-psychotherapy is underestimated when dealing with patients catastrophic reactions as first described by Kurt Goldstein. This was exemplarily demonstrated in a patient with severe higher cortical functioning disturbances after acute intracerebral haemorrhage and coma, followed by secondary hydrocephalus and major emotional adjustment behavioural disturbances.
Results: The 65 years old business man, who suffered from persisting complex mental-cognitive, behavioural, mood and emotional disturbances recovered full social competence due to professional neuropsychological neuropsychiatric treatment. 
Discussion: Early catastrophic reactions and fear of loss of self-identity are important key issues in the emotional adjustment after brain damaged. Further research is needed to explaining the links between loss of self-esteem, self-identity and the development of depression. Attention needs to be focused on a recovery beyond functional outcome. Conclusion: Neurosurgical-neuropsychological rehabilitation is a method to reconstruct lives within a social context.