Brain Injury: Why Do Some Patients "Recover"?

• By Laurie Watanabe
• Feb 23, 2012

The seemingly miraculous recovery of function by Rep. Gabrielle Giffords was a reason for cheer following the assassination attempt that took the lives of six others last year.

The Arizona Congresswoman had sustained a terrible gunshot wound to her head. Yet today, she is walking and talking, and was greeted by enthusiastic applause from colleagues at President Obama's State of the Union address in January.

What causes such remarkable recoveries as Giffords'? Why do some patients with severe brain injuries recover amazingly well, while others do not?

Dr. Ricardo Komotar, of the University of Miami, specializes in neurosurgery. "It's mainly the initial insult," he says. "How severe is the initial insult and what part of the brain got injured?"

With some other injuries, getting early treatment, intensive rehabilitation and other interventions can change the final outcomes — but Komotar says that's not the case with brain injuries.

"Getting early treatment is not really what makes the difference," he explains. "How the patient is going to do is determined day one.

"You can never predict for sure, (but) when you see enough head injury, you have an idea of what the outcome is going to be. So depending on the severity of the head injury, depending on the time in which you're talking to the family, you can give them a general prognosis. Sometimes you know that an injury is fatal. Other times, you know the chance of functional recovery is slim, and so you make your best guess early on, but you always tell them there's a chance for recovery later on."

But do some patients' recoveries still surprise their doctors?

"Absolutely," Komotar says. "Every person's different. You can go by the numbers, but the numbers are only part of it, and every person's different, so it's very difficult to predict just based off of percentages."