Prefrontal damage in childhood and changes in the development of personality: A case report

Bahia, Valéria Santoro; Takada, Leonel Tadao; Caixeta, Leonardo; Lucato, Leandro Tavares; Porto, Claudia Sellitto; Nitrini, Ricardo

doi:10.1590/S1980-57642013DN70100019

ABSTRACT

Frontal lobe lesions are associated with behavioral abnormalities and executive dysfunction. When these lesions occur early in life, the symptoms are even more severe as the anatomical and functional substrates underlying personality and behavior are damaged, distorting normal modulation by interaction with the psychosocial environment. We present a case of a 40-year-old man who suffered a frontal lobe lesion at the age of nine years and developed impulsivity, disinhibition and inappropriate behaviors while showing some preservation of insight. Brain MRI revealed lesions to bilateral orbitofrontal cortex, ventromedial prefrontal cortex, anterior cingulate gyri and genu of the corpus callosum , which were more extensive on the right side. The right prefrontal dorsolateral cortex was severely damaged, whereas the right ventrolateral prefrontal cortex was spared. We will discuss the correlation of the damaged pre frontal regions with the symptoms presented by the patient.

Key words:
traumatic brain injury; neuropsychology; frontal lobe; social behavior

RESUMO

Lesões no lobo frontal são associadas com sintomas de distúrbios do comportamento e disfunção executiva. Quando a lesão ocorre em fase precoce da vida, os sintomas são ainda mais intensos pois o substrato anatômico e funcional da formação da personalidade e comportamento está danificado, então, a sua modulação decorrente da interação com o meio psicossocial será distorcida. Apresentamos aqui o caso de um homem de 40 anos que sofreu uma lesão no lobo frontal aos nove anos de idade, com sintomas de impulsividade com manutenção parcial da autocrítica, desinibição e comportamento inapropriado. A ressonância de crânio evidenciava lesões bilaterais do córtex orbitofrontal da porção anterior do giro do cíngulo e do joelho do corpo caloso e do córtex ventromedial, mais extensa à direita. O córtex pré-frontal dorsolateral estava extensamente acometido à direita, enquanto o córtex pré-frontal ventrolateral parecia poupado. Discutiremos a correlação das áreas pré frontais lesadas com a sintomatologia do paciente.

Palavras-chave:
traumatismo craniocerebral; neuropsicologia; lobo frontal; comportamento social

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REFERENCES

Macmillan M. Phineas Gage's contribution to brain surgery. J Hist Neurosci 1996;5:56-77.
Tranel D, Eslinger PJ. Effects of early onset brain injury on the development of cognition and behavior: introduction to the special issue. Dev Neuropsychol 2000;18:273-280.
Lezak M. Neuropsychological Assessment. Third Edition. Oxford, editor. New York: Oxford University Press; 1995.
Spreen O, Strauss E. A Compendium of Neuropsychological Tests: Administration, Norms, and Commentary. Second Edition.; New York: Oxford University Press 1998.
Eslinger PJ, Robinson-Long M, Realmuto J, et al. Developmental frontal lobe imaging in moral judgment: Arthur Benton's enduring influence 60 years later. J Clin Exp Neuropsychol 2009;31:158-169.
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Anderson SW, Damasio H, Tranel D, Damasio AR. Long-term sequelae of prefrontal cortex damage acquired in early childhood. Dev Neuropsychol2000;18:281-296.
Eslinger PJ, Grattan LM, Damasio H, Damasio AR. Developmental consequences of childhood frontal lobe damage. Arch Neurol 1992;49: 764-769.
Price BH, Daffner KR, Stowe RM, Mesulam MM. The comportmental learning disabilities of early frontal lobe damage. Brain 1990;113:1383-1393.
Eslinger PJ, Flaherty-Craig C V, Benton AL. Developmental outcomes after early prefrontal cortex damage. BrainCognition 2004;55:84- 103.
Viskontas IV, Possin KL, Miller BL. Symptoms of frontotemporal dementia provide insights into orbitofrontal cortex function and social behavior. Ann N Y Acad Sci 2007;1121:528-545.
Wallis JD. Orbitofrontal cortex and its contribution to decision-making. 2007;30:31-56.
Shamay-Tsoory SG. The neural bases for empathy. Neuroscientist 2011;17:18-24.
Zald DH, Andreotti C. Neuropsychological assessment of the orbital and ventromedial prefrontal cortex. Neuropsychologia 2010;48:3377-3391.
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Fuster JM. Frontal lobe and cognitive development. J Neurocytol 2002 ; 31:373-385.
Eisenberg N. Emotion, regulation, and moral development. Ann Rev Psychol 2000;51:665-697.
Moll J, Zahn R, De Oliveira-Souza R, et al. Impairment of prosocial sentiments is associated with frontopolar and septal damage in frontotemporal dementia. NeuroImage 2011;54:1735-1742.
Grattan LM,. Eslinger PJ Long-term psychological consequences of childhood frontal lobe lesion in patient DT. BrainCog 1992;20:185-195.
Moll J, De Oliveira-Souza R, Eslinger PJ, et al. The Neural Correlates of Moral Sensitivity: A Functional Magnetic Resonance Imaging Investigation of Basic and Moral Emotions. J Neurosci 2002;22:2730-2736.
Moll J, De Oliveira-Souza R,. Eslinger PJ Morals and the human brain: a working model. Neuroreport 2003;14:299-305.
World Health Organization. ICD-10 Classifications of Mental and Behavioural Disorder: Clinical Descriptions and Diagnostic Guidelines. Geneva; 1992.
Ruocco AC.The neuropsychology of borderline personality disorder: a meta-analysis and review. Psychiatry Res 2005;137:191-202.

Publication Dates

Publication in this collection
Jan-Mar 2013

History

Received
10 Nov 2012
Accepted
15 Jan 2013

This is an open-access article distributed under the terms of the Creative Commons Attribution License

[1] Macmillan M. Phineas Gage's contribution to brain surgery. J Hist Neurosci 1996;5:56-77.

[2] Tranel D, Eslinger PJ. Effects of early onset brain injury on the development of cognition and behavior: introduction to the special issue. Dev Neuropsychol 2000;18:273-280.

[3] Lezak M. Neuropsychological Assessment. Third Edition. Oxford, editor. New York: Oxford University Press; 1995.

[4] Spreen O, Strauss E. A Compendium of Neuropsychological Tests: Administration, Norms, and Commentary. Second Edition.; New York: Oxford University Press 1998.

[5] Eslinger PJ, Robinson-Long M, Realmuto J, et al. Developmental frontal lobe imaging in moral judgment: Arthur Benton's enduring influence 60 years later. J Clin Exp Neuropsychol 2009;31:158-169.

[6] Anderson SW, Aksan N, Kochanska G, Damasio H, Wisnowski J, Afifi A. The earliest behavioral expression of focal damage to human prefrontal cortex. Cortex 2007;43:806-816.

[7] Anderson SW, Damasio H, Tranel D, Damasio AR. Long-term sequelae of prefrontal cortex damage acquired in early childhood. Dev Neuropsychol2000;18:281-296.

[8] Eslinger PJ, Grattan LM, Damasio H, Damasio AR. Developmental consequences of childhood frontal lobe damage. Arch Neurol 1992;49: 764-769.

[9] Price BH, Daffner KR, Stowe RM, Mesulam MM. The comportmental learning disabilities of early frontal lobe damage. Brain 1990;113:1383-1393.

[10] Eslinger PJ, Flaherty-Craig C V, Benton AL. Developmental outcomes after early prefrontal cortex damage. BrainCognition 2004;55:84- 103.

[11] Viskontas IV, Possin KL, Miller BL. Symptoms of frontotemporal dementia provide insights into orbitofrontal cortex function and social behavior. Ann N Y Acad Sci 2007;1121:528-545.

[12] Wallis JD. Orbitofrontal cortex and its contribution to decision-making. 2007;30:31-56.

[13] Shamay-Tsoory SG. The neural bases for empathy. Neuroscientist 2011;17:18-24.

[14] Zald DH, Andreotti C. Neuropsychological assessment of the orbital and ventromedial prefrontal cortex. Neuropsychologia 2010;48:3377-3391.

[15] Mitchell DGV. The nexus between decision making and emotion regulation: a review of convergent neurocognitive substrates. Behav BrainRes 2011;217:215-231.

[16] Rushworth MFS, Noonan MP, Boorman ED, Walton ME, Behrens TE. Frontal cortex and reward-guided learning and decision-making. Neuron 2011;70:1054-1069.

[17] Fuster JM. Frontal lobe and cognitive development. J Neurocytol 2002 ; 31:373-385.

[18] Eisenberg N. Emotion, regulation, and moral development. Ann Rev Psychol 2000;51:665-697.

[19] Moll J, Zahn R, De Oliveira-Souza R, et al. Impairment of prosocial sentiments is associated with frontopolar and septal damage in frontotemporal dementia. NeuroImage 2011;54:1735-1742.

[20] Grattan LM,. Eslinger PJ Long-term psychological consequences of childhood frontal lobe lesion in patient DT. BrainCog 1992;20:185-195.

[21] Moll J, De Oliveira-Souza R, Eslinger PJ, et al. The Neural Correlates of Moral Sensitivity: A Functional Magnetic Resonance Imaging Investigation of Basic and Moral Emotions. J Neurosci 2002;22:2730-2736.

[22] Moll J, De Oliveira-Souza R,. Eslinger PJ Morals and the human brain: a working model. Neuroreport 2003;14:299-305.

[23] World Health Organization. ICD-10 Classifications of Mental and Behavioural Disorder: Clinical Descriptions and Diagnostic Guidelines. Geneva; 1992.

[24] Ruocco AC.The neuropsychology of borderline personality disorder: a meta-analysis and review. Psychiatry Res 2005;137:191-202.

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