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, 83 (5), 1002-18

Insights Into Human Behavior From Lesions to the Prefrontal Cortex

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Insights Into Human Behavior From Lesions to the Prefrontal Cortex

Sara M Szczepanski et al. Neuron.

Abstract

The prefrontal cortex (PFC), a cortical region that was once thought to be functionally insignificant, is now known to play an essential role in the organization and control of goal-directed thought and behavior. Neuroimaging, neurophysiological, and modeling techniques have led to tremendous advances in our understanding of PFC functions over the last few decades. It should be noted, however, that neurological, neuropathological, and neuropsychological studies have contributed some of the most essential, historical, and often prescient conclusions regarding the functions of this region. Importantly, examination of patients with brain damage allows one to draw conclusions about whether a brain area is necessary for a particular function. Here, we provide a broad overview of PFC functions based on behavioral and neural changes resulting from damage to PFC in both human patients and nonhuman primates.

Figures

Figure 1
Figure 1. Effects of Psychosurgery
(A) A computed tomography (CT) axial image of a patient who received a bilateral frontal leucotomy for a psychiatric disorder in the 1950s. The CT was obtained 30 years later. (B) A post-mortem specimen of a patient who received a bilateral frontal leucotomy for a psychiatric disorder in the 1950s. Note the massive subcortical white matter damage from the leucotomy disconnecting multiple PFC regions from the rest of the brain. The coronal slice from the neuropathological specimen is shown in relation to the axial CT scan in (A) (red dashed line). Neuropathological specimen compliments of Professor John Woodard, UC Irvine (Woodard, 2002).
Figure 2
Figure 2. Subdivisions of Prefrontal Cortex
Subdivisions of the prefrontal cortex are color-coded and labeled based upon their approximate anatomical locations in the human brain.
Figure 3
Figure 3. Lesions to Lateral Prefrontal Cortex
(A) An axial T2 magnetic resonance imaging (MRI) image showing an acute stroke in the left lateral prefrontal cortex. (B)A coronal neuropathological specimen of an infarct in the left lateral PFC (note the hemorrhagic conversion in the cortical mantle). The red dashed line on the MRI in (A) shows the approximate site of the post-mortem coronal slice. (C) An axial T1 MRI image showing infiltrating glioblastoma in the right lateral frontal cortex. (D)A post-mortem axial slice of an infiltrating glioblastoma in the right lateral frontal lobe. Neuropathological specimen in (B) compliments of Professor Dimitri Agamanolis, Akron Children’s Hospital (http://neuropathology-web.org/).
Figure 4
Figure 4. Lesions to Orbitofrontal Cortex
(A) A T2 axial MRI image of an acute right OFC contusion resulting from trauma (accidental fall down stairs). (B) A ventral view of a postmortem specimen showing chronic residual loss of tissue in right OFC. Note also the damage to the olfactory bulb. (C)A T1 axial MRI image showing extensive bilateral damage to the OFC (red arrows). (D) Acoronal post-mortem slice of a patient with fatal traumatic brain injury due to extensive OFC contusions. If this patient had survived, his/her MRI image would resemble (C). The red dashed line on the MRI in (C) shows the approximate site of this post-mortem coronal slice. (E) A ventral view of a post-mortem specimen showing chronic bilateral loss of tissue in the OFC due to trauma. (F) A post-mortem specimen (ventral view) of an unsuspected right meningioma in a patient with behavioral changes. Neuropathological specimens in (B) and (D) are compliments of Professor Edward C. Klatt, University of Utah (http://library.med.utah.edu/WebPath/CNSHTML/CNSIDX.html). Neuropathological specimen in (E) is compliments of Professor Walter Finkbeiner, UC San Francisco.
Figure 5
Figure 5. Lesions to Medial Prefrontal Cortex
(A) An axial T1 MRI image of a patient with a chronic left medial frontal lobe lesion due to the resection of a low-grade glioma. (B)A coronal neuropathological specimen of an infarct in the left medial PFC (note the hemorrhagic conversion in the cortical mantle). The dashed red line on the MRI in (A) shows the approximate site of the post-mortem coronal slice. Image in (A) is compliments of Professor Marianne Løvstad, University of Oslo. Neuropathology specimen in (B) is compliments of Professor Dimitri Agamanolis, Akron Children’s Hospital (http://neuropathology-web.org/).

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