Psychosocial and neuropsychological outcomes in two high-functioning males 20 years after traumatic brain injury

Abstract

Abstract Researchers have emphasized a need for ongoing rehabilitation and support for individuals with traumatic brain injury FBI), yet there are few detailed descriptions of long-term outcome, and many people with long-standing TBI do not or cannot access support services. HB and NL, two men who sustained severe TBI, presented for neuropsychological consultation for the first time more than 20 years post-injury. Referral was prompted by significant mood and relationship disturbances, and ongoing mnemonic and cognitive symptoms. Structural imaging showed a very large lesion involving the orbitofrontal and dorsolateral regions of NL's left frontal lobe, while HB had a smaller lesion involving cortical and subcortical matter in the dorsolateral region of the left frontal lobe. Results from a range of neuropsychological tests indicated residual weakness in memory and variable impairments on two experimental tests of prefrontal working memory: Delayed Alternation and Object Alternation. The Minnesota Multiphasic Personality Inventory-2 highlighted a pattern of severe psychological disturbance in HB which improved in response to antidepressant medication. Measures of emotional empathy and adaptive functioning suggested significant changes attributable to disruption of prefrontal aspects of the limbic system.