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diencephalic connections Laplane found that the lack of motivation of the patient with bifrontal lesions and bipallidal lesions to be the same, though one would expect the latter to be manifest more as a bradykinesia than as a bradyphrenia (slowness of thinking) Benson (and Kleist and others before him) related the syndrome of apathy and lack of initiative to lesions in the sagittal or medial frontal cortex, and a facetious, unguarded, and socially inappropriate state (see below) to orbital and dorsolateral frontal lesions This division has held up only broadly in our experience The opposite state, in a sense, is the hyperactivity syndrome, or organic drivenness, described by von Economo in children who had survived an attack of encephalitis lethargica In our patients, this syndrome has been produced by combined frontal and temporal lobe lesions, usually traumatic but also encephalitic, although exact clinicopathologic correlations could not be made Such patients may also exhibit brief but intense involvement with some meaningless activity, such as sorting papers in an attic or hoarding objects or food Combativeness and extreme insomnia or an otherwise disrupted sleep cycle are often part of the syndrome The hyperactivity of young boys and the mania or hypomania of manic-depressive disease, despite similar symptoms, also lack a known anatomic basis In addition to the disorders of initiative and spontaneity, frontal lobe lesions result in a number of other changes in personality and behavior These, too, are easier to observe in the patient s natural environment for example, by his family than to measure by psychologic tests It has been dif cult to nd a term for all these personality changes Some patients, particularly those with inferofrontal lesions, feel compelled to make silly jokes that are inappropriate to the situation so-called Witzelsucht or moria; they are socially uninhibited and lack awareness of their behavior The patient is no longer the sensitive, compassionate, effective human being that he once was, having lost his usual ways of reacting with affection and consideration to family and friends In more advanced instances, there is an almost complete disregard for social conventions and an interest only in immediate personal grati cation The patient seems to lose an inherent theory of mind, through which the normal individual recognizes the motivations and thought processes of other sapient persons; this results in the inability to incorporate these factors into the patient s responses These changes, observed characteristically in lobotomized patients, came to be recognized as too great a price to pay for the loss of neurotic traits, pain, depression, and tortured self-concern, for which reasons lobotomies were done; hence the procedure raised public outcry and became obsolete The effect of unilateral prefrontal lesions is a question that continues to vex clinicians If the lesions are small, their effects are undetectable; even a large lesion, such as a tumor, may long escape detection Rylander, by careful psychologic testing, has shown that patients with lesions of either frontal lobe manifest a slight elevation and instability of mood, with increased talkativeness and a tendency to joke, lack of tact, inability to adapt to a new situation, and loss of initiative changes that in our experience are more readily recognized if the lesion is on the right Large left frontal lesions have been more prone to cause abulia in our material In general, we agree that the greatest cognitive-intellectual de cits relate to lesions in the dorsolateral parts of the prefrontal lobes and that the greatest personality, mood, and behavioral changes stem from lesions of the medial-orbital parts, although the two types of disorder often merge with one another The diagnosis of lesions in the orbital regions is facilitated by the nding of uni-. syncfusion pdf viewer mvc NuGet Gallery | Syncfusion. AspNet . PdfViewer 17.1.0.48
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