Neurobehavioral Sequelae of Penetrating Right Frontal Lobe Trauma: A Case of Akinetic Mutism and Executive Dysfunction Following Self-Inflicted Gunshot Injury
Location
LSUHSC-NO
Publication Date
April 2026
Start Date
9-4-2026 10:00 AM
End Date
9-4-2026 2:00 PM
Description
Penetrating traumatic brain injuries involving the frontal lobes are associated with profound and evolving neuropsychiatric sequelae due to disruption of prefrontal cortical regions and their extensive subcortical networks. We present the case of a 61-year-old male with significant medical and psychiatric comorbidities who sustained a self-inflicted gunshot wound to the hard palate with ballistic trajectory through the right frontal lobe. Imaging revealed extensive frontal parenchymal injury with intraparenchymal, subarachnoid, and intraventricular hemorrhage, retained ballistic fragments, and multiple craniofacial fractures. Acute management required multidisciplinary care, including neurosurgical intervention for cerebrospinal fluid leak repair, external ventricular drain placement, and treatment of cerebral vasospasm. During recovery, the patient developed marked neurobehavioral changes characterized by initial mutism, reduced initiation, apathy, and later tangential and disorganized speech. These findings are consistent with dysfunction of medial and dorsolateral prefrontal circuits and overlap with syndromes of abulia and akinetic mutism. The case is discussed within contemporary models of frontal - subcortical network disruption and in historical context, highlighting parallels with classic descriptions of frontal lobe injury. This report underscores the complexity of distinguishing neurologic apathy from premorbid psychiatric illness following TBI and emphasizes that frontal lobe injuries represent dynamic, chronic conditions rather than static lesions. Comprehensive, longitudinal neurorehabilitation addressing executive function, motivation, speech, and emotional regulation is essential to optimize outcomes after penetrating frontal lobe trauma.
Recommended Citation
Stansberry, Katherine; Mipro, Olivia; and Conrad, Erich, "Neurobehavioral Sequelae of Penetrating Right Frontal Lobe Trauma: A Case of Akinetic Mutism and Executive Dysfunction Following Self-Inflicted Gunshot Injury" (2026). Dept. of Psychiatry Research Symposium. 2.
https://digitalscholar.lsuhsc.edu/psych_rd/2026/posters/2
Neurobehavioral Sequelae of Penetrating Right Frontal Lobe Trauma: A Case of Akinetic Mutism and Executive Dysfunction Following Self-Inflicted Gunshot Injury
LSUHSC-NO
Penetrating traumatic brain injuries involving the frontal lobes are associated with profound and evolving neuropsychiatric sequelae due to disruption of prefrontal cortical regions and their extensive subcortical networks. We present the case of a 61-year-old male with significant medical and psychiatric comorbidities who sustained a self-inflicted gunshot wound to the hard palate with ballistic trajectory through the right frontal lobe. Imaging revealed extensive frontal parenchymal injury with intraparenchymal, subarachnoid, and intraventricular hemorrhage, retained ballistic fragments, and multiple craniofacial fractures. Acute management required multidisciplinary care, including neurosurgical intervention for cerebrospinal fluid leak repair, external ventricular drain placement, and treatment of cerebral vasospasm. During recovery, the patient developed marked neurobehavioral changes characterized by initial mutism, reduced initiation, apathy, and later tangential and disorganized speech. These findings are consistent with dysfunction of medial and dorsolateral prefrontal circuits and overlap with syndromes of abulia and akinetic mutism. The case is discussed within contemporary models of frontal - subcortical network disruption and in historical context, highlighting parallels with classic descriptions of frontal lobe injury. This report underscores the complexity of distinguishing neurologic apathy from premorbid psychiatric illness following TBI and emphasizes that frontal lobe injuries represent dynamic, chronic conditions rather than static lesions. Comprehensive, longitudinal neurorehabilitation addressing executive function, motivation, speech, and emotional regulation is essential to optimize outcomes after penetrating frontal lobe trauma.