SPARED AND IMPAIRED COGNITIVE-ABILITIES AFTER BILATERAL FRONTAL DAMAGE

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 anemia 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-spa tial 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.