Neuropsychiatric Sequelae in Moderate-to-Severe Traumatic Brain Injury: A Case Series from a Tertiary Neurorehabilitation Centre in India

Abstract Traumatic brain injury (TBI) remains a leading cause of disability in India, often resulting in long-term neuropsychiatric sequelae despite motor recovery. While physical rehabilitation is routinely addressed, behavioural and cognitive complications receive comparatively less attention, particularly in low-resource settings. We describe three adult male patients with moderate-to-severe TBI following road traffic accidents, admitted for neurorehabilitation between December 2022 and August 2023 at a tertiary centre in Kerala, India. Inclusion criteria were age ≥16 years, moderate-to-severe TBI (Glasgow Coma Scale ≤12) and neuropsychiatric symptoms during recovery. All cases had detailed acute care records, rehabilitation data and at least 6 months follow-up. All regained independent ambulation and improved basic activities of daily living, yet exhibited persistent symptoms such as agitation, disinhibition, irritability, verbal aggression, depressive features and impaired insight. The Rancho Los Amigos Scale and Agitated Behaviour Scale were used to monitor behavioural recovery. Management included tailored pharmacologic regimens, environmental modification, caregiver training and psychiatric consultation. Despite structured inpatient rehabilitation, caregiver burden remained high, and psychiatric follow-up was often suboptimal due to stigma and logistical barriers. TBI rehabilitation must integrate psychiatric assessment and long-term behavioural monitoring alongside physical recovery. This case series underscores the need for structured follow-up, culturally sensitive caregiver education and resource-appropriate models of neuropsychiatric care in low- and middle-income countries.