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6 - Case studies of focal prefrontal lesions in man

Published online by Cambridge University Press:  11 September 2009

Jarl Risberg
Lunds Universitet, Sweden
Jordan Grafman
National Institute of Health, Bethesda, MD, USA
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Against the nineteenth century backdrop of the tension between Franz Joseph Gall and Johann Spurzheim's phrenology versus Marie-Jean-Pierre Flourens' equipotentiality, Paul Broca and subsequently Carl Wernicke demonstrated cortical localization of expressive and receptive language functions and their descriptions were soon embraced by the larger medical and scientific community. As additional evidence of hemispheric specialization, John Hughlings Jackson described difficulty with “memory for persons, objects, and places” associated with posterior right hemisphere lesions which led him to introduce the term “imperception” (Finger, 1994). Interest in the frontal lobe was largely restricted to language characteristics associated with lesions of Broca's area as contrasted against those associated with more posterior lesions involving Wernicke's area.

Despite the advances of understanding brain function in the second half of the nineteenth century, the tension between the localizationist versus antilocalizationist camps continued to be present. Current interest in the frontal lobe extends far beyond expressive speech, and involves its role in executive functioning, perseveration, judgment, attention, emotional behavior, and motor programming and regulation, with regional specialization within the frontal system increasingly appreciated for unique contributions to complex human behavior. Thus, localization and antilocalization approaches are able to coexist within a functional system framework. In the present chapter, we will present important cases demonstrating the behavioral impairments associated with prefrontal lobe lesions that have greatly contributed to our understanding of neuropsychological functions of these regions.

The Frontal Lobes
Development, Function and Pathology
, pp. 163 - 177
Publisher: Cambridge University Press
Print publication year: 2006

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Barker, F. G., 2nd. (1995). Phineas among the phrenologists: the American crowbar case and nineteenth-century theories of cerebral localization. Journal of Neurosurgery, 82, 672–82.CrossRefGoogle ScholarPubMed
Benton, A. L. (1991). The prefrontal region: its early history. In Frontal Lobe Function and Dysfunction, eds. Levin, H. S., Eisenberg, H. M. and Benton, A. L.. New York: Oxford University Press, pp. 3–32Google Scholar
Bigelow, H. J. (1850). Dr. Harlow's case of recovery from the passage of an iron bar through the head. American Journal of Medical Science, 20, 1–22.Google Scholar
Boake, C. (2002). From the Binet-Simon to the Wechsler-Bellevue: tracing the history of intelligence testing. Journal of Clinical and Experimental Neuropsychology, 24, 383–405.CrossRefGoogle ScholarPubMed
Damasio, H., Grabowski, T., Frank, R., Galaburda, A. M. & Damasio, A. R. (1994). The return of Phineas Gage: clues about the brain from the skull of a famous patient. Science, 264, 1102–5.CrossRefGoogle ScholarPubMed
Eslinger, P. J. & Damasio, A. R. (1985). Severe disturbance of higher cognition after bilateral frontal lobe ablation: patient EVR. Neurology, 35, 1731–41.CrossRefGoogle ScholarPubMed
Finger, S. (1994). Origins of Neuroscience: A History of Explorations into Brain Function. New York: Oxford University Press.Google Scholar
Fleischman, J. (2002). Phineas Gage: A Gruesome but True Story about Brain Science. New York: Houghton Mifflin.Google Scholar
Haas, L. F. (2001). Phineas Gage and the science of brain localisation. Journal of Neurology, Neurosurgery, and Psychiatry, 71, 761.CrossRefGoogle ScholarPubMed
Harlow, J. M. (1848). Passage of an iron rod through the head. Boston Medical and Surgical Journal, 39, 389–93.Google Scholar
Harlow, J. M. (1999). Passage of an iron rod through the head. Journal of Neuropsychiatry and Clinical Neuroscience, 11, 281–3.CrossRefGoogle ScholarPubMed
Hebb, D. O. (1945). Man's frontal lobes: a critical review. Archives of Neurology and Psychiatry, 54, 10–24.CrossRefGoogle Scholar
Hebb, D. O. & Penfield, W. (1940). Human behavior after extensive bilateral removal from the frontal lobes. Archives of Neurology and Psychiatry, 43, 421–38.CrossRefGoogle Scholar
Lezak, M. D., Howieson, D. B. & Loring, D. W. (2004). Neuropsychological Assessment, 4th ed. New York: Oxford University Press.Google Scholar
Lhermitte, F. (1986). Human autonomy and the frontal lobes. Part II: Patient behavior in complex and social situations: the “environmental dependency syndrome”. Annals of Neurology, 19, 335–43.CrossRefGoogle ScholarPubMed
Lhermitte, F., Pillon, B. & Serdaru, M. (1986). Human autonomy and the frontal lobes. Part I: Imitation and utilization behavior: a neuropsychological study of 75 patients. Annals of Neurology, 19, 326–34.CrossRefGoogle ScholarPubMed
Macmillan, M. (2000a). An Odd Kind of Fame: Stories of Phineas Gage. Cambridge, MA: MIT Press.Google Scholar
Macmillan, M. (2000b). Restoring Phineas Gage: a 150th retrospective. Journal of the History of the Neurosciences, 9, 46–66.CrossRefGoogle Scholar
Mataro, M., Jurado, M. A., Garcia-Sanchez, C., et al. (2001). Long-term effects of bilateral frontal brain lesion: 60 years after injury with an iron bar. Archives of Neurology, 58, 1139–42.CrossRefGoogle ScholarPubMed
Neylan, T. C. (1999). Frontal lobe function: Mr. Phineas Gage's famous injury. Journal of Neuropsychiatry and Clinical Neuroscience, 11, 280–1.CrossRefGoogle ScholarPubMed
Ratiu, P. & Talos, I.-F. (2004). The tale of Phineas Gage, digitally remastered. The New England Journal of Medicine, 351, e21.CrossRefGoogle ScholarPubMed
Rolando, L. (1831). Della struttura degli emisferi cerebrali. Memorie della Reale Academia di Scienze di Torino, 35, 103–46.Google Scholar
Sattler, J. M. (1974). Assessment of Children's Intelligence. Philadelphia: W. B. Saunders.Google Scholar
Stuss, D. T. & Levine, B. (2002). Adult clinical neuropsychology: lessons from studies of the frontal lobes. Annual Review of Psychology, 53, 401–33.CrossRefGoogle ScholarPubMed
Wagar, B. M. & Thagard, P. (2004). Spiking Phineas Gage: a neurocomputational theory of cognitive-affective integration in decision making. Psychological Reviews, 111, 67–79.CrossRefGoogle ScholarPubMed
Wheeler, H. B. (1997). The 1996 Bigelow Award of the Boston Surgical Society: Henry Jacob Bigelow and David C. Sabiston, Jr. Annals of Surgery, 226, 146–52.CrossRefGoogle Scholar

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