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Acute Frontal Lobe Syndrome and Dyscontrol Associated with Bilateral Caudate Nucleus Infarctions

Published online by Cambridge University Press:  02 January 2018

Richard G. Petty*
The Maudsley Hospital, Denmark Hill, London SE5 8AZ
Deirdre Bonner
The Maudsley Hospital, Denmark Hill, London SE5 8AZ
Vassilis Mouratoglou
The Maudsley Hospital, Denmark Hill, London SE5 8AZ
Marisa Silverman
The Maudsley Hospital, Denmark Hill, London SE5 8AZ
R. G. Petty, University of Pennsylvania, Department of Psychiatry, Brain Behavior Laboratory, 10th Floor, Gates Building, 3500 Spruce Street, Philadelphia, Pennsylvania 19104-4283, USA. Fax: 215 662 7903



A 67-year-old man presented with acute onset of spatial and temporal disorientation, memory loss and associated episodic dyscontrol. Investigations showed infarctions of both caudate nuclei. This patient presented a unique opportunity to study the relationship between the lesions, his behaviour, and neuropsychological testing.


Single case report Investigations included interviews to determine cognitive impairment i.e. WAIS-R, MMSE, and neurological examination.


Extensive neuropsychological testing revealed severe impairment on tasks requiring planning, memory or abstract thought. These findings are very similar to those seen in Huntington's disease.


A neurobiological hypothesis is proposed to account for his symptoms, and recent discoveries in the basic sciences used to inform his management.

Copyright © 1996 The Royal College of Psychiatrists 

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Buchsbaum, M. S. (1990) The frontal lobes, basal ganglia and temporal lobes as sites for schizophrenia. Schizophrenia Bulletin, 16, 377387.CrossRefGoogle ScholarPubMed
Caplan, L. R., Schmahmann, J. D., Kase, C. S., et al (1990) Caudate infarcts. Archives of Neurology, 47, 133143.CrossRefGoogle ScholarPubMed
Cummings, J. L. (1993) Frontal-subcortical circuits and human behavior. Archives of Neurology, 50, 873880.CrossRefGoogle ScholarPubMed
Jacobs, D. H. & Huber, S. J. (1992) The role of the caudate in nonmotor behaviors in Huntington's disease. Behavioural Neurology, 5, 205214.CrossRefGoogle ScholarPubMed
Krishnan, K. R. R., McDonald, W. M., Escalona, P. R., et al (1992) Magnetic resonance imaging of the caudate nuclei in depression. Archives of General Psychiatry, 49, 553557.CrossRefGoogle ScholarPubMed
Lewin, J. & Sumners, D. (1992) Successful treatment of episodic dyscontrol with carbamazepine. British Journal of Psychiatry, 161, 261–162.CrossRefGoogle ScholarPubMed
Mendez, M. F., Adams, N. L. & Lewandowski, K. S. (1989) Neurobehavioral changes associated with caudate lesions. Neurology, 39, 349354.CrossRefGoogle ScholarPubMed
Nikulina, E. M. & Kapravola, N. S. (1992) Role of dopamine receptors in the regulation of aggression in mice: relationship to genotype. Neuroscience and Behavioural Physiology, 22, 364369.CrossRefGoogle ScholarPubMed
Parent, A. (1990) Extrinsic connections of the basal ganglia. Trends in Neuroscience, 13, 254258.CrossRefGoogle ScholarPubMed
Pozzilli, C., Passafiume, D., Bastianello, S., et al (1987) Remote effects of caudate hemorrhage: a clinical and functional study. Cortex, 23, 341349.CrossRefGoogle ScholarPubMed
Richfield, E. K., Twyman, R. & Berent, S. (1987) Neurological syndrome following bilateral damage to the head of the caudate nuclei. Annals of Neurology, 22, 768771.CrossRefGoogle Scholar
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