Surprising neurobehavioral functioning and brief major depression following penetrating brain injury in an adolescent

We present a case focusing on the surprising paucity of changes in behavior and executive functioning following accidental gunshot injury in an adolescent. Detailed image analysis revealed lesions in the right frontopolar, anterior orbitofrontal, temporal polar, anterior inferior temporal cortices and amygdala. It is possible that partial sparing of the orbitofrontal area and the fact that the lesion was unilateral, in addition to the subject's superior preinjury intellectual status, premorbid psychiatric health and healthy family functioning, are relevant factors in his excellent overall short-term outcome. Neuropsychiatric aspects of major depression in the subject are also reviewed. The subject's lesion is consistent with a depressive symptom complex, described previously following focal right frontal lesions in children and adolescents as well as in adult studies of penetrating brain injury. The case is unique in that extensive baseline data are available from 16, 13 and 4 months before the penetrating brain injury as well as follow-up data at 8 months following this injury.