Abstract

Objective: Literature suggests processing speed (PS) and recent memory functions are particularly vulnerable and persistent following severe traumatic brain injury (TBI). Initial validation studies with the WAIS-IV and WMS-IV identify largest effect sizes for PS and perceptual reasoning (PR), and visual working memory (VWM) and auditory memory (AM) index scores respectively. The case of BR illustrates results contradictory to these findings. Method: BR is a 23-year-old employed right-handed male with 12 years of education and normal neurobehavioral history. Pre-injury academic TerraNova percentile scores ranged from 55 to 67. He was in a vehicular collision with severe TBI with GCS 3 at scene and 4 at hospital. Retrograde amnesia was 2 days at 9 months and dense post traumatic amnesia was estimated at 24 days. There were left temporal and occipital skull fractures. CT indicated multiple contusions in frontal (right worse than left with shift) and left temporal lobes. EEG indicated severe encephalopathy. MRI at 7 months was diffusely abnormal. He had gradual improvement in cognition. Results: Testing at 9 months was valid with impaired verbal comprehension index 74 (consistent with left temporal contusion) but intact and strong scores for PS (108), PR (105), VWM (106) and AM (98) yet persisting indications of impairment in other areas including executive dysfunction (e.g., Trails B 85" with 2 errors) and hyposmia on right. Conclusion(s): Intact and even strong scores on measures of PS and recent memory may be seen in persons following diffuse and multi-focal severe TBI who have evidence of persisting neuropsychological impairment in other areas.