title: Prefrontal cognitive dysfunction following brainstem lesion.
abstract: Prefrontal cortex (PFC) dysfunction can lead to impairment in planning and behavioral inhibition, as well as personality changes. As ascending monoaminergic brainstem systems modulate PFC functioning, it is possible that lesions in the brainstem lead to symptoms similar to prefrontal dysfunction. A 29-year-old man developed several cognitive and behavioral symptoms after neurosurgery for resection of a pilocytic astrocytoma in the pontine-mesencephalic area. A careful analysis of symptoms indicated PFC dysfunction that could be attributed to lesions in the ascending monoaminergic brainstem systems. Interestingly, the cognitive symptoms improved after treatment with methylphenidate, which is a drug that modules catecholaminergic neurotransmission, thereby supporting this hypothesis. This is a unique case of PFC dysfunction that may be related to post-operative lesion of the catecholaminergic nuclei in the brainstem.
authors.affiliation: Department of Neuroscience, Fumec University, Brazil.
authors.forename: João Vinícius
authors.initials: JV
authors.lastname: Salgado
authors.forename: Melissa
authors.initials: M
authors.lastname: Costa-Silva
authors.forename: Leandro Fernandes
authors.initials: LF
authors.lastname: Malloy-Diniz
authors.forename: José Maurício
authors.initials: JM
authors.lastname: Siqueira
authors.forename: Antônio Lúcio
authors.initials: AL
authors.lastname: Teixeira
mesh_terms: D000293:Adolescent; D000328:Adult; D001254:Astrocytoma / Q000175:diagnosis / Q000601:surgery*; D001288:Attention / Q000187:drug effects / Q000502:physiology; D020295:Brain Stem Neoplasms / Q000175:diagnosis / Q000601:surgery*; D000697:Central Nervous System Stimulants / Q000627:therapeutic use; D003072:Cognition Disorders / Q000175:diagnosis / Q000188:drug therapy / Q000503:physiopathology*; D004522:Educational Status; D005500:Follow-Up Studies; D006801:Humans; D007175:Impulsive Behavior / Q000175:diagnosis / Q000188:drug therapy / Q000503:physiopathology; D007266:Inhibition, Psychological; D007398:Interpersonal Relations; D007859:Learning Disabilities / Q000175:diagnosis / Q000188:drug therapy / Q000503:physiopathology; D008297:Male; D008774:Methylphenidate / Q000627:therapeutic use; D009483:Neuropsychological Tests; D011183:Postoperative Complications / Q000175:diagnosis / Q000188:drug therapy / Q000503:physiopathology*; D017397:Prefrontal Cortex / Q000503:physiopathology*; D011340:Problem Solving / Q000187:drug effects / Q000502:physiology
chemical_list: D000697:Central Nervous System Stimulants; D008774:Methylphenidate