DISTURBANCE OF SOCIAL COGNITION AFTER TRAUMATIC ORBITOFRONTAL BRAIN INJURY

A patient with traumatic orbitomedial frontal lobe damage demonstrated good neurocognitive recovery but a lasting, profound disturbance of e motional regulation and social cognition. initial neuropsychological f indings included a complete anosmia, mildly reduced fluency and distur bed motor regulation. The impairments of fluency and motor regulation resolved, and formal measures of ''frontal lobe'' functioning were gen erally intact. However, she remained impaired on tasks requiring the i nterpretation of social situations, which mirrored her impairment in r eal life functioning. This disturbance in social cognition appeared re lated to difficulty appreciating and integrating the relatively subtle social and emotional cues required for the appropriate interpretation of events. The patient's presentation represents an intermediate posi tion between patients with profound neurobehavioral deficits and patie nts with impaired real-life social cognition despite intact neuropsych ological performance following orbitofrontal damage. Variations in the orbitofrontal behavioral syndrome may be related to extent of lesion, time post injury and the course of recovery in different patients. (C ) 1997 National Academy of Neuropsychology.