title: Abulia following penetrating brain injury during endoscopic sinus surgery with disruption of the anterior cingulate circuit: case report.
abstract: BACKGROUND
  It is common knowledge that the frontal lobes mediate complex human behavior and that damage to these regions can cause executive dysfunction, apathy, disinhibition and personality changes. However, it is less well known that subcortical structures such as the caudate and thalamus are part of functionally segregated fronto-subcortical circuits, that can also alter behavior after injury. CASE PRESENTATION We present a 57 year old woman who suffered penetrating brain injury during endoscopic sinus surgery causing right basal ganglia injury which resulted in an abulic syndrome.
  
  
  CONCLUSIONS
  Abulia does not result solely from cortical injury but can occur after disruption anywhere in the anterior cingulate circuit--in the case of our patient, most prominently at the right caudate.
authors.affiliation: Department of Neurology, University of Virginia Health Sciences Center, Charlottesville, Virginia 22908, USA. aag5w@virginia.edu
authors.forename: Alexander A
authors.initials: AA
authors.lastname: Grunsfeld
authors.forename: Ivan S
authors.initials: IS
authors.lastname: Login
mesh_terms: D000405:Akinetic Mutism / Q000209:etiology*; D001479:Basal Ganglia / Q000293:injuries* / Q000473:pathology; D004724:Endoscopy / Q000009:adverse effects*; D005260:Female; D007839:Functional Laterality; D006179:Gyrus Cinguli / Q000473:pathology*; D020197:Head Injuries, Penetrating / Q000150:complications*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D009434:Neural Pathways / Q000293:injuries / Q000473:pathology; D010256:Paranasal Sinuses; D012852:Sinusitis / Q000601:surgery