Spared and impaired cognitive abilities after bilateral frontal damage.
We report on a patient (PG) with a severe behavioural disorder following massive bilateral prefrontal damage due to herpetic encephalitis. The lesion involves also the mesial and polar regions of the temporal lobes; the frontal dorso-lateral cortices were relatively spared. The patient's inattentiveness and alternating impulsive and apathetic behaviour led to her social alienation. The only self-motivated activities we observed were those initiated to satisfy her enhanced urge to eat and play games. She did not react to surprise stimuli that consistently elicit a reaction of surprise in healthy people. She also presented "adynamic aphasia" associated with anomia and episodic amnesia. A striking feature of the syndrome was the patient's consistent "utilization behaviour". Her motor behaviour was marked by constant akathisia. She performed surprisingly well on intelligence, "frontal", and visuo-spatial tests. This non-demented patient exhibited a clear dissociation between her relatively spared cognitive abilities and grossly impaired behaviour. In the discussion we explore the extent to which a defect of the supervisory control may be held responsible for the inconsistencies in the patient's coping skill performances.
Brazzelli
M
M
Neuropsychology Unit, Clinica del Lavoro Foundation, IRCCS, Medical Center of Rehabilitation, Veruno (NO), Italy.
Colombo
N
N
Della Sala
S
S
Spinnler
H
H
D000293:Adolescent; D000328:Adult; D001288:Attention / Q000502:physiology; D001925:Brain Damage, Chronic / Q000175:diagnosis / Q000503:physiopathology* / Q000523:psychology; D001931:Brain Mapping; D003072:Cognition Disorders / Q000175:diagnosis / Q000503:physiopathology* / Q000523:psychology; D004292:Dominance, Cerebral / Q000502:physiology*; D004644:Emotions / Q000502:physiology; D004660:Encephalitis / Q000175:diagnosis / Q000503:physiopathology* / Q000523:psychology; D005500:Follow-Up Studies; D005625:Frontal Lobe / Q000503:physiopathology*; D006561:Herpes Simplex / Q000175:diagnosis / Q000503:physiopathology* / Q000523:psychology; D006801:Humans; D007100:Imitative Behavior / Q000502:physiology; D008279:Magnetic Resonance Imaging; D011939:Mental Recall / Q000502:physiology; D009042:Motivation; D009483:Neuropsychological Tests; D012919:Social Behavior; D013239:Stereotyped Behavior / Q000502:physiology; D014705:Verbal Behavior