Neuropsychological and Linguistic Outcomes after Gunshot Injury to Cerebellum: A Case Report

Abstract

Craniocerebral gunshot injuries (CGIs) are highly fatal and mostly seen in the military settings. CGIs to the posterior cortical regions and cerebellum in civilian population are uncommon. Cerebellum once thought to be mediating the motor and vestibular functions is increasingly seen as an important structure for human cognition and affect. We present a case of a 53-year-old police inspector who sustained a gunshot injury in the suboccipital region with resulting damage to predominantly left cerebellum and right occipital lobe. Patient presented with complaints of neck pain, reduced clarity of speech, and mild forgetfulness for day-to-day affairs after 7 months of injury. A comprehensive neuropsychological assessment revealed impairments in motor speed, processing speed, sustained attention, executive functions (verbal fluency, working memory), and encoding component of memory functions. The speech–language assessment revealed mild dysarthria and mild word finding difficulties. His profile with mild to moderate deficits in neuropsychological and speech language functioning was partly congruent with the cerebellar cognitive affective syndrome or Schmahmann’s syndrome. The spontaneous recovery and extent of damage to cerebellum may explain the milder form of the syndrome. The case highlights the need to routinely screen for cognitive-affective disturbances in patients with traumatic lesions to cerebellum.