Isolated frontopolar cortex lesion: a case study.

BACKGROUND

The frontopolar cortex has been proposed to mediate prospective memory functioning, multitasking, relational integration, processing of internal states, and self-referential evaluation. These theories are based primarily on functional activation studies. The few lesion models reported have not been restricted to the frontopolar cortex.

AIM: We used neuropsychological tests and neuroimaging to study an otherwise healthy woman with an isolated hemorrhagic infarct in the frontopolar cortex.

METHODS

In addition to a standard stroke work-up, the patient had cognitive psychometric tests reflecting the theoretical frontal functions of initiation, monitoring, inhibition, and working memory, as well as a test for emotional intelligence.

RESULTS

The midline frontopolar intracerebral hemorrhage was isolated, free of other pathology, and almost solely within Brodmann area 10. The only psychometric abnormalities concerned awareness of, understanding, and expressing emotions.

CONCLUSIONS

This report may be the first of an isolated bilateral lesion of the frontopolar cortex, Brodmann area 10, with uniformly normal frontal lobe tests except for 2 abnormal findings of emotional intelligence. This lesion study supports the proposal that the medial frontopolar cortex is necessary for emotional processing of internal states.