0
September 1989, Vol 46, No. 9 >
Article | September 1989

Frontal Lobe Syndrome in a Patient With Bilateral Globus Pallidus Lesions

Richard L. Strub, MD
[+] Author Affiliations

Accepted for publication October 27, 1988.

Reprint requests to Ochsner Clinic and Alton Ochsner Medical Foundation, 1514 Jefferson Highway, New Orleans, LA 70121 (Dr Strub).


Arch Neurol. 1989;46(9):1024-1027. doi:10.1001/archneur.1989.00520450096027
Text Size: A A A
Published online
Article
References
Comments

• This article describes a patient who experienced the rapid onset of an irreversible behavioral change while vacationing in La Paz, Bolivia (altitude, 4070 m). The only lesions demonstrated on a magnetic resonance imaging scan were bilateral hemorrhages in the globus pallidus. The behavior change was characterized by apathy and lack of motivation, features commonly associated with bilateral frontal lobe disease. This case is a further demonstration of how subcortical lesions can produce behavioral syndromes that are clinically indistinguishable from classic cortical syndromes. It is cases such as this that show how a strict localizationist concept of behavioral function is too restrictive and how it is necessary to consider a wide network of neuronal interconnections when explaining the mechanism of a dissolution of complex higher functions.

REFERENCES

1 +
Stuss DT, Benson DF. The Frontal Lobes . New York, NY: Raven Press; 1986;.
2 +
Strub RL, Black FW. Mental Status Examination in Neurology . Philadelphia, Pa: FA Davis Co Publishers; 1985;.
3 +
Milner B.  Effects of different brain lesions on card sorting . Arch Neurol . 1963;;9:90-100.
4 +
Freeman W, Watts JW. Psychosurgery . Springfield, Ill. Charles C Thomas Publisher; 1950;.
5 +
Ballantine HT, Cassidy WL, Flanagan N, Marino R.  Stereotaxic anterior cingulotomy for neuropsychiatric illness and intractable pain . J Neurosurg . 1967;;26:488-495.
6 +
Sweet WH.  Treatment of medically intractable mental disease by limited frontal leucotomy: justifiable? N Engl J Med . 1973;;289:1117-1125, 1141-1142.
7 +
Okawa M, Maeda S, Nujui H, Kawafuchi J.  Psychiatric symptoms in ruptured anterior communicating aneurysms: social prognosis . Acta Psychiatr Scand . 1980;;61:306-312.
8 +
Storey PB.  Brain damage and personality change after subarachnoid hemorrhage . Br J Psychiatry . 1970;;117:129-142.
9 +
Nauta WJH, Walle JH:  The problem of the frontal lobe: a reinterpretation . J Psychiatr Res . 1971;;8:167-187.
10 +
Richfield EK, Twyman R, Berent S.  Neurological syndrome following bilateral damage to the head of the caudate nuclei . Ann Neurol . 1987;;22:768-771.
11 +
Bogousslavsky J, Ferrazzini M, Regli F, Assal G, Tanabe H, Delaloye-Bischof A.  Manic delirium and frontal-like syndrome with paramedian infarction of the right thalamus . J Neurol Neurosurg Psychiatry . 1988;;51:116-119.
12 +
Katz DI, Alexander MP, Mandell AM.  Dementia following strokes in the mesencephalon and diencephalon . Arch Neurol . 1987;;44:1127-1133.
13 +
Crosby EC, Humphrey T, Lauer EW. Correlative Anatomy of the Nervous System . New York, NY: Macmillan Publishing Co Inc; 1962;:300-304.
14 +
Mesulam M-M.  Patterns in behavioral neuroanatomy: association areas, the limb system, and hemispheric specialization . In: Principles of Behavioral Neurology . Philadelphia, Pa: FA Davis Co Publishers; 1985;:1-70.
15 +
Cummings JL, Benson DF.  Subcortical dementia: review of an emerging concept . Arch Neurol . 1984;;41:874-879.
16 +
Alexander MP, Naeser MA, Palumbo CL.  Correlations of subcortical CT lesion sites and aphasia profiles . Brain . 1987;;110:961-991.
17 +
Ferro JM, Kertesz A, Black SE.  Subcortical neglect: quantitation, anatomy, and recovery . Neurology . 1987;;37:1487-1492.
18 +
Rayman RB, McNaughton BB.  Hypoxia: USAF experience 1970-1980 . Aviat Space Environ Med . 1983;;54:357-359.
19 +
Brooks CJ. Loss of cabin pressure in Canadian forces ejection seat aircraft, 1962-1982. Aviat Space Environ Med. 1984;55:1154-1163.
20 +
Singh I, Khanna PK, Srivastava M, Lal M, Roy SB, Subramanyam CSV.  Acute mountain sickness . N Engl J Med . 1969;;280:175-184.
21 +
Dickinson J, Heath D, Gosney J, Williams D.  Altitude-related deaths in seven trekkers in the Himalayas . Thorax . 1983;;38:646-656.
22 +
Houston CS.  Altitude illness: the dangers of the heights and how to avoid them . Postgrad Med . 1983;;74:231-248.
23 +
Haymaker W, Davison C.  Fatalities resulting from exposure to simulated high altitudes in decompression chambers . J Neuropathol Exp Neurol . 1950;;9:29-59.
24 +
Wilson R.  Acute high-altitude illness in mountaineers and problems of rescue . Ann Intern Med . 1973;;78:421-428.
25 +
Behnke AR.  Decompression sickness: advances and interpretations . Aerospace Med . 1971;;42:255-267.

First Page Preview

First page PDF preview

Figures

Tables

Interactive Graphics

Video

Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

1 +
Stuss DT, Benson DF. The Frontal Lobes . New York, NY: Raven Press; 1986;.
2 +
Strub RL, Black FW. Mental Status Examination in Neurology . Philadelphia, Pa: FA Davis Co Publishers; 1985;.
3 +
Milner B.  Effects of different brain lesions on card sorting . Arch Neurol . 1963;;9:90-100.
4 +
Freeman W, Watts JW. Psychosurgery . Springfield, Ill. Charles C Thomas Publisher; 1950;.
5 +
Ballantine HT, Cassidy WL, Flanagan N, Marino R.  Stereotaxic anterior cingulotomy for neuropsychiatric illness and intractable pain . J Neurosurg . 1967;;26:488-495.
6 +
Sweet WH.  Treatment of medically intractable mental disease by limited frontal leucotomy: justifiable? N Engl J Med . 1973;;289:1117-1125, 1141-1142.
7 +
Okawa M, Maeda S, Nujui H, Kawafuchi J.  Psychiatric symptoms in ruptured anterior communicating aneurysms: social prognosis . Acta Psychiatr Scand . 1980;;61:306-312.
8 +
Storey PB.  Brain damage and personality change after subarachnoid hemorrhage . Br J Psychiatry . 1970;;117:129-142.
9 +
Nauta WJH, Walle JH:  The problem of the frontal lobe: a reinterpretation . J Psychiatr Res . 1971;;8:167-187.
10 +
Richfield EK, Twyman R, Berent S.  Neurological syndrome following bilateral damage to the head of the caudate nuclei . Ann Neurol . 1987;;22:768-771.
11 +
Bogousslavsky J, Ferrazzini M, Regli F, Assal G, Tanabe H, Delaloye-Bischof A.  Manic delirium and frontal-like syndrome with paramedian infarction of the right thalamus . J Neurol Neurosurg Psychiatry . 1988;;51:116-119.
12 +
Katz DI, Alexander MP, Mandell AM.  Dementia following strokes in the mesencephalon and diencephalon . Arch Neurol . 1987;;44:1127-1133.
13 +
Crosby EC, Humphrey T, Lauer EW. Correlative Anatomy of the Nervous System . New York, NY: Macmillan Publishing Co Inc; 1962;:300-304.
14 +
Mesulam M-M.  Patterns in behavioral neuroanatomy: association areas, the limb system, and hemispheric specialization . In: Principles of Behavioral Neurology . Philadelphia, Pa: FA Davis Co Publishers; 1985;:1-70.
15 +
Cummings JL, Benson DF.  Subcortical dementia: review of an emerging concept . Arch Neurol . 1984;;41:874-879.
16 +
Alexander MP, Naeser MA, Palumbo CL.  Correlations of subcortical CT lesion sites and aphasia profiles . Brain . 1987;;110:961-991.
17 +
Ferro JM, Kertesz A, Black SE.  Subcortical neglect: quantitation, anatomy, and recovery . Neurology . 1987;;37:1487-1492.
18 +
Rayman RB, McNaughton BB.  Hypoxia: USAF experience 1970-1980 . Aviat Space Environ Med . 1983;;54:357-359.
19 +
Brooks CJ. Loss of cabin pressure in Canadian forces ejection seat aircraft, 1962-1982. Aviat Space Environ Med. 1984;55:1154-1163.
20 +
Singh I, Khanna PK, Srivastava M, Lal M, Roy SB, Subramanyam CSV.  Acute mountain sickness . N Engl J Med . 1969;;280:175-184.
21 +
Dickinson J, Heath D, Gosney J, Williams D.  Altitude-related deaths in seven trekkers in the Himalayas . Thorax . 1983;;38:646-656.
22 +
Houston CS.  Altitude illness: the dangers of the heights and how to avoid them . Postgrad Med . 1983;;74:231-248.
23 +
Haymaker W, Davison C.  Fatalities resulting from exposure to simulated high altitudes in decompression chambers . J Neuropathol Exp Neurol . 1950;;9:29-59.
24 +
Wilson R.  Acute high-altitude illness in mountaineers and problems of rescue . Ann Intern Med . 1973;;78:421-428.
25 +
Behnke AR.  Decompression sickness: advances and interpretations . Aerospace Med . 1971;;42:255-267.

Correspondence

Submit a Letter
CME Course for:


You need to register in order to view this quiz.


To understand the clinical management of acute heart failure syndromes.
Accreditation Information The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.
The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Note: You must get at least of the answers correct to pass this quiz.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
To view and print your certificate and access a summary of your CME courses go to My CME.
NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s “Cited By” API will populate this tab (http://www.crossref.org/citedby.html).
Compression-Only CPR: Pushing the Science Forward
Cone
AAM 2010;304:1493-1495.
All you need to read in the other general journals
BMJ 2010;341:c5893-c1494.
Submit a Comment

Some tools below are only available to our subscribers or users with an online account.

Related Content

Customize your page view by dragging & repositioning the boxes below.

© 2012 American Medical Association. All Rights Reserved.
Powered bySilverchair Information Systems