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Table 1. Clinical Characteristics of the Three Principal Frontal Lobe SyndromesOrbitofrontal syndrome (disinhibited) Disinhibited, impulsive behavior (pseudopsychopathic) Inappropriate jocular affect, euphoria Emotional lability Poor judgment and insight Distractibility Frontal convexity syndrome (apathetic) Apathy (occasional brief angry or aggressive outbursts common) Indifference Psychomotor retardation Motor perseveration and impersistence Loss of self Stimulus-bound behavior Discrepant motor and verbal behavior Motor programming deficits Three-step hand sequence Alternating programs Reciprocal programs Rhythm tapping Multiple loops Poor word list generation Poor abstraction and categorization Segmented approach to visuospatial analysis Medial frontal syndrome (akinetic) Paucity of spontaneous movement and gesture Sparse verbal output (repetition may be preserved) Lower extremity weakness and loss of sensation Incontinence
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Frontal Lobe: Forehead * Loss of simple movement of various body parts (Paralysis). * Inability to plan a sequence of complex movements needed to complete multi-stepped tasks, such as making coffee (Sequencing). * Loss of spontaneity in interacting with others. * Loss of flexibility in thinking. * Persistence of a single thought (Perseveration). * Inability to focus on task (Attending). * Mood changes (Emotionally Labile). * Changes in social behavior. * Changes in personality. * Difficulty with problem solving. * Inability to express language (Broca's Aphasia).
Frontal Lobe Damage: Generally, damage to the frontal lobes causes loss of the ability to solve problems and to plan and initiate actions, such as crossing the street or answering a complex question.If the back part of the frontal lobe (which controls voluntary movements) is damaged, weakness or paralysis can result. Because each side of the brain predominantly controls movement of the opposite side of the body, damage to the left hemisphere causes weakness on the right side of the body, and vice versa.If the middle part of the frontal lobe is damaged, the ability to move the eyes, to perform complex movements in the correct sequence, or to say words may be impaired. Impairment of the ability to say words is called expressive aphasia (see Brain Dysfunction: Aphasia).If the front part of the frontal lobe is damaged, the result may be impaired concentration and reduced fluency of speech; apathy, inattentiveness, and delayed responses to questions; or a striking lack of inhibition, including socially inappropriate behavior. People who lose their inhibitions may be inappropriately euphoric or depressed, excessively argumentative or passive, and vulgar. They may show disregard for the consequences of their behavior. They may also repeat what they say.
The frontal lobes are considered our emotional control center and home to our personality. There is no other part of the brain where lesions can cause such a wide variety of symptoms (Kolb & Wishaw, 1990). The frontal lobes are involved in motor function, problem solving, spontaneity, memory, language, initiation, judgement, impulse control, and social and sexual behavior. The frontal lobes are extremely vulnerable to injury due to their location at the front of the cranium, proximity to the sphenoid wing and their large size. MRI studies have shown that the frontal area is the most common region of injury following mild to moderate traumatic brain injury (Levin et al., 1987).There are important asymmetrical differences in the frontal lobes. The left frontal lobe is involved in controlling language related movement, whereas the right frontal lobe plays a role in non-verbal abilities. Some researchers emphasize that this rule is not absolute and that with many people, both lobes are involved in nearly all behavior.Disturbance of motor function is typically characterized by loss of fine movements and strength of the arms, hands and fingers (Kuypers, 1981). Complex chains of motor movement also seem to be controlled by the frontal lobes (Leonard et al., 1988). Patients with frontal lobe damage exhibit little spontaneous facial expression, which points to the role of the frontal lobes in facial expression (Kolb & Milner, 1981). Broca's Aphasia, or difficulty in speaking, has been associated with frontal damage by Brown (1972).An interesting phenomenon of frontal lobe damage is the insignificant effect it can have on traditional IQ testing. Researchers believe that this may have to do with IQ tests typically assessing convergent rather than divergent thinking. Frontal lobe damage seems to have an impact on divergent thinking, or flexibility and problem solving ability. There is also evidence showing lingering interference with attention and memory even after good recovery from a TBI (Stuss et al., 1985).Another area often associated with frontal damage is that of "behavioral sponteneity." Kolb & Milner (1981) found that individual with frontal damage displayed fewer spontaneous facial movements, spoke fewer words (left frontal lesions) or excessively (right frontal lesions).One of the most common characteristics of frontal lobe damage is difficulty in interpreting feedback from the environment. Perseverating on a response (Milner, 1964), risk taking, and non-compliance with rules (Miller, 1985), and impaired associated learning (using external cues to help guide behavior) (Drewe, 1975) are a few examples of this type of deficit.The frontal lobes are also thought to play a part in our spatial orientation, including our body's orientation in space (Semmes et al., 1963).One of the most common effects of frontal damage can be a dramatic change in social behavior. A person's personality can undergo significant changes after an injury to the frontal lobes, especially when both lobes are involved. There are some differences in the left versus right frontal lobes in this area. Left frontal damage usually manifests as pseudodepression and right frontal damage as pseudopsychopathic (Blumer and Benson, 1975).Sexual behavior can also be effected by frontal lesions. Orbital frontal damage can introduce abnormal sexual behavior, while dorolateral lesions may reduce sexual interest (Walker and Blummer, 1975).Some common tests for frontal lobe function are: Wisconsin Card Sorting (response inhibition); Finger Tapping (motor skills); Token Test (language skills).
Frontal lobe lesionsThe frontal lobes represent a large volume of the brain but the presentation of frontal lobe lesions can be very subtle. Neurological examination and even psychometric testing may miss the diagnosis. It is largely the higher functions and personality that are affected.EpidemiologyIncidence Frontal lobe dementia is the 3rd commonest form of dementia, after Alzheimer’s disease and multi-infarct dementia but it is very much less common than Alzheimer's.Risk Factors Lesions can be vascular in origin (thrombotic, embolic or haemorrhagic), due to space occupying lesions (tumours or abscess) or traumatic. There may be other mechanisms like frontal dementia or multiple sclerosis. The effect will depend upon the exact location. In infants and young children brain damage results in adjacent areas taking over the function of the affected area but even a little later in life this ability fades and is lost. Most lesions occur in older people.PresentationSymptoms The patient often complains of remarkably little. It is those around who complain. Take the history from one who knows him well. Ask about developmental history, head injury, and social history including educational and personal attainments, work history, and substance abuse.Signs Motor symptoms are fairly subtle: * Loss of fine movement * Loss of speed and strength in hand and limb movement * Poor programming of movements * Poor voluntary eye gaze The higher functions are affected. * Short term memory is impaired with easy distraction. * Convergent thinking is when there is one correct answer and divergent when there are multiple correct answers. Frontal lobe damage impairs divergent thinking. * Loss of spontaneous behaviour, like speaking and verbal fluency1, impaired drawing and doodling, with general lethargy and initiation of daily routines. * Impaired strategy formation and planning, especially in unfamiliar situations, * There is inappropriate behaviour with difficulty using social cues and information to direct, control, or change personal behaviour. * Inhibition impaired. This leads to perseveration (continuing to attempt a task that is obviously failing). They may confabulate. * Behavioural changes include breaking rules and taking risks, not following task instructions and gambling. (Gambling involves assessing risk and outcome). * Social and sexual behaviour inappropriate2 or altered from previously. In social reasoning the left lobe is more important than the right3. * Pseudodepression with psychomotor retardation, while the indifference is like "la belle indifference" of hysteria. * Pseudopsychopathy (because of the lack of social inhibitions) * Humour seems to decline with age but is more marked in frontal lobe lesions4.
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Well, you open your forehead and take a look.
Quote from: Queen Victoria on September 24, 2011, 10:21:22 PMWell, you open your forehead and take a look. My forehead is rather huge, I might need specialized equipment!
Quote from: couldbecousin on September 24, 2011, 10:34:36 PMQuote from: Queen Victoria on September 24, 2011, 10:21:22 PMWell, you open your forehead and take a look. My forehead is rather huge, I might need specialized equipment! No dear, just look at your picture and follow the line around your head.
