Earlyonset frontal damage

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We have also studied patients with lesions similar to those described in the adult-onset group but acquired early in life, in fact as early as the first day of life and as late as age seven. In the 13 cases we have studied so far, we have investigated

Fig. 2. Three-dimensional reconstruction, from high resolution MR scans, of two right-handed adults with damage to the dorso-lateral sector of the right prefrontal cortex region. In A, a 54 year old man, the damage resulting from head trauma involves only dorso-lateral prefrontal regions; in B, a 22 year old woman, the damage involves the lower aspect of the right dorsolateral region and extends into the lateral ventral section, the result of a surgical ablation for the treatment of seizures.

Fig. 2. Three-dimensional reconstruction, from high resolution MR scans, of two right-handed adults with damage to the dorso-lateral sector of the right prefrontal cortex region. In A, a 54 year old man, the damage resulting from head trauma involves only dorso-lateral prefrontal regions; in B, a 22 year old woman, the damage involves the lower aspect of the right dorsolateral region and extends into the lateral ventral section, the result of a surgical ablation for the treatment of seizures.

Prefrontal Cortex And Trauma

Fig. 3. Examples of two patients with VMPFC damage in A due to meningeoma resection, in B due to a ruptured anterior communicating aneurysm. Note that the lesion in A does not reach the posterior part of the ventro-medial sector whereas in B the lesion does involve the most posterior part of this territory.

Fig. 3. Examples of two patients with VMPFC damage in A due to meningeoma resection, in B due to a ruptured anterior communicating aneurysm. Note that the lesion in A does not reach the posterior part of the ventro-medial sector whereas in B the lesion does involve the most posterior part of this territory.

Prefrontal Cortex Scan Bpd
Fig. 4. Three-dimensional reconstruction, from a high resolution MR scan, of the brain of a 27 year old man, right-handed, showing extensive damage to the right prefrontal region, both ventral and medial, and dorsolateral as well. The damage was due to perinatal trauma.

most of these patients as young adults, long after the onset of their lesions. As in the adult-onset group, the cause is quite varied and the damage can be bilateral or unilateral (Fig. 4). And as with the adult-onset group, these patients are of normal intelligence and their sensory and motor skills, conventional memory, speech and language are normal too. As young children, they exhibit dysfunctional social interactions, both at school and at home. They show difficult behavior control and are insensitive to punishment. In spite of their normal intelligence, they usually need special schooling because of poor working habits. They do not make friends.

After high school graduation, once they lose a relatively structured environment, their social and behavior problems worsen remarkably. They never make plans for the future, do not seek employment, and cannot maintain the jobs that may be procured for them. Stealing is a common problem from early on and they often get into legal problems (Anderson et al. 1999).

The neuropsychological profile of these patients is normal, similar to what happens in the adult-onset group, but they too show hypo-emotionality and a remarkable absence of social emotions, and their IGT is abnormal. The remarkable difference, relative to the adult-onset group, appears in the results of tasks measuring social interactions. Here the early-onset VMPFC patients perform abnormally on all the tasks in which the adult-onset patients do so well (the Optional Thinking test, the Awareness of Consequences test, the Means-Ends ProblemSolving procedure and the Standard Moral Interview). Of note, in the Kohlberg paradigm, they do not advance beyond the first level, which is the level most normal children reach by age nine (see Anderson et al. 1999).

In brief, adult-onset VMPFC patients have abnormal social conduct but appear to know the rules they violate, whereas early-onset VMPFC patients not only show abnormal social conduct but also seem not to have learned the social rules that govern that social conduct.

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