SPARED AND IMPAIRED COGNITIVE-ABILITIES AFTER BILATERAL FRONTAL DAMAGE

We report on a patient (PG) with a severe behavioural disorder followi ng massive bilateral prefrontal damage due to herpetic encephalitis. T he lesion involves also the mesial and polar regions of the temporal l obes; the frontal dorso-lateral cortices were relatively spared. The p atient's inattentiveness and alternating impulsive and apathetic behav iour led to her social alienation. The only self-motivated activities we observed were those initiated to satisfy her enhanced urge to eat a nd 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 str iking feature of the syndrome was the patient's consistent ''utilizati on behaviour''. Her motor behaviour was marked by constant akathisia. She performed surprisingly well on intelligence, ''frontal'', and visu o-spa tial tests. This non-demented patient exhibited a clear dissocia tion between her relatively spared cognitive abilities and grossly imp aired behaviour. In the discussion we explore the extent to which a de fect of the supervisory control may be held responsible for the incons istencies in the patient's coping skill performances.