Spared and impaired cognitive abilities after bilateral frontal damage

Cortex. 1994 Mar;30(1):27-51. doi: 10.1016/s0010-9452(13)80323-1.

Abstract

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.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Attention / physiology
  • Brain Damage, Chronic / diagnosis
  • Brain Damage, Chronic / physiopathology*
  • Brain Damage, Chronic / psychology
  • Brain Mapping
  • Cognition Disorders / diagnosis
  • Cognition Disorders / physiopathology*
  • Cognition Disorders / psychology
  • Dominance, Cerebral / physiology*
  • Emotions / physiology
  • Encephalitis / diagnosis
  • Encephalitis / physiopathology*
  • Encephalitis / psychology
  • Follow-Up Studies
  • Frontal Lobe / physiopathology*
  • Herpes Simplex / diagnosis
  • Herpes Simplex / physiopathology*
  • Herpes Simplex / psychology
  • Humans
  • Imitative Behavior / physiology
  • Magnetic Resonance Imaging
  • Mental Recall / physiology
  • Motivation
  • Neuropsychological Tests
  • Social Behavior
  • Stereotyped Behavior / physiology
  • Verbal Behavior