Long-term effects of bilateral frontal brain lesion - 60 years after injury with an iron bar

Background: Harlow's report of the case of Phineas P. Gage in 1848 was one of the earliest description of the personality and behavioral changes follo wing frontal lobe damage. Since Harlow's articles, a few more case reports of frontal lobe damage have been published. As standard neuropsychological and neurologic evaluations may reveal subtle defects, case reports have bee n particularly useful in characterizing the behavioral changes that follow frontal lobe damage. Objective: To describe the long-term outcome of an 81-year-old patient who sustained a severe frontal brain lesion 60 years ago caused by the passage of an iron spike through his head. Results: The patient has bilateral damage affecting the orbital and dorsola teral frontal regions. He displays many of the typical frontal behavioral d isturbances described in the literature. His conduct is characterized by de pendence on others, cheerfulness, planning difficulties, problems establish ing realistic goals, lack of drive, and difficulties in initiating, continu ing, and finishing activities. Although gross cognitive functioning is inta ct, neuropsychological deficits are present in the executive functioning, m emory, and visuoconstructive domains. Conclusions: In contrast with the antisocial conduct pattern usually associ ated with frontal damage in the literature, this case suggests that large f rontal lesions can produce behavioral and personality changes that are comp atible with stable functioning in family, professional, and social settings . In addition to the localization of the lesion, many other factors should be considered in the long-term prognosis of frontal brain injured patients.