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Long-term Effects of Bilateral Frontal Brain Lesion
60 Years After Injury With an Iron Bar
Maria Mataró, PhD;
M. Ángeles Jurado, PhD;
Carmen García-Sánchez, PhD;
Lluis Barraquer, MD;
Frederic R. Costa-Jussà, MD;
Carme Junqué, PhD
Arch Neurol. 2001;58:1139-1142.
Background Harlow's report of the case of Phineas P. Gage in 1848 was one of the
earliest description of the personality and behavioral changes following frontal
lobe damage. Since Harlow's articles, a few more case reports of frontal lobe
damage have been published. As standard neuropsychological and neurologic
evaluations may reveal subtle defects, case reports have been particularly
useful in characterizing the behavioral changes that follow frontal lobe damage.
Objective To describe the long-term outcome of an 81-year-old patient who sustained
a severe frontal brain lesion 60 years ago caused by the passage of an iron
spike through his head.
Results The patient has bilateral damage affecting the orbital and dorsolateral
frontal regions. He displays many of the typical frontal behavioral disturbances
described in the literature. His conduct is characterized by dependence on
others, cheerfulness, planning difficulties, problems establishing realistic
goals, lack of drive, and difficulties in initiating, continuing, and finishing
activities. Although gross cognitive functioning is intact, neuropsychological
deficits are present in the executive functioning, memory, and visuoconstructive
domains.
Conclusions In contrast with the antisocial conduct pattern usually associated with
frontal damage in the literature, this case suggests that large frontal lesions
can produce behavioral and personality changes that are compatible with stable
functioning in family, professional, and social settings. In addition to the
localization of the lesion, many other factors should be considered in the
long-term prognosis of frontal brain injured patients.
From the Departament de Psiquiatria i Psicobiologia Clínica,
Universitat de Barcelona (Drs Mataró, Jurado, and Junqué), Neurotraumatology
Research Unit, Vall d'Hebron University Hospital (Dr Matáro), Servei
de Neurologia, Hospital de la Santa Creu i Sant Pau (Drs García-Sánchez
and Barraquer), and Servei de Neurologia, Hospital de Barcelona (Dr Costa-Jussà),
Barcelona, Spain.
Corresponding author: Maria Mataró, PhD, Departament de Psiquiatria
i Psicobiologia Clínica, Universitat de Barcelona, Passeig de la Vall
d'Hebron 171, 08035 Barcelona, Spain (e-mail: mmataro{at}teleline.es).
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Arch Neurol. 2001;58(7):1172-1174.
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