Abstract Objective Individuals exposed to lead often have persistent medical issues, changes in personality, and cognitive decline, with worsening symptoms following chronic exposure. Lead poisoning in children can have lasting effects as they age. This case study examines the correlation between cognitive ability and brain damage, with demyelination, following lead exposure in an academically well performing eight-year-old. Lead poisoning was verified by medical records and neuroimaging showing demyelination is included. Method The individual was an eight-year-old male who was exposed to lead multiple times in a home environment over the course of one year starting as a two-year-old. Cognitive ability, academic achievement, and emotional development were assessed with clinical interview of the child and his mother and comprehensive test battery including cognitive and emotional measures. Testing also included appropriate imbedded and free-standing validity measures. Results Cognitive testing showed relative weakness in certain measures of verbal and visuospatial processing speed as well as indications of deficit in sustained attention. These deficits did not reach objective impairment but suggest weakness in these areas in the context of superior overall cognitive ability and academic achievement. Observation showed hyperactivity and anxious behaviors, the individual’s mother reported elevated anxiety and unusually high somatic complaints. Conclusion This pattern of scores corresponded to what is typically seen in patients with lead poisoning, suggesting an impact of lead poisoning on the individual’s neural development, potentially causing both cognitive and psychiatric deficits. This case is unique because, despite his lead poisoning, the patient performs well academically, suggesting that the brain can compensate for this impairment given the correct environment.