The Japanese journal of neuropsychology

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ArticleTitle	Frontal lobe symptoms visually presented
Language	J
AuthorList	Michitaka Funayama¹⁾, Masaru Mimura²⁾
Affiliation	¹⁾Department of Neuropsychiatry, Ashikaga Red Cross Hospital ²⁾Department of Neuropsychiatry, Showa University School of Medicine
Publication	Japanese Journal of Neuropsychology: 25 (2), 148-161, 2009
Received
Accepted
Abstract	We report here four individuals with focal frontal damage who presented with unique clinical pictures. The case 1 suffered from occlusion of the circle of Willis and resulted in almost complete damage in the bilateral prefrontal lobes. The case showed no voluntary behaviors, but presented with grasping, gazing, groping, forced stuffing, and compulsive manipulation of tools triggered only by external stimuli. The clinical features thus suggest severe impairment of human autonomy and remarkable dependence on the external environment following frontal damages. The case 1 and case 2 were characterized by a pathological behavior of 'forced gazing'. Whenever people came into their sight, both patients were forced to gaze at faces, specifically eyes, and kept on gazing until the people disappear from their sight. The mechanism of such abnormal behaviors was accounted by diminished frontal inhibitory control over the parietal lobes so that the patients became extremely dependent on external stimuli. The cognitive process which is common to grasp phenomenon, compulsive manipulation of tools, utilization behavior, imitation behavior and environmental dependency syndrome was argued. The case 3 and case 4 presented with particular behavioral abnormality caused by domain specific disinhibition, i.e., forced collectionism and forced shopping, respectively. Such domain specific disinhibitory symptoms were different from overall and general disinhibition. Both case 3 and 4 were compromised with the right orbitofrontal cortex lesion. Domain specific disinhibitory symptoms were discussed in terms of impulsive control and compulsive tendency.
Keywords	forced gazing, autonomy, forced collectionism, orbitofrontal cortex, compulsion