Behavioral Effects of Congenital Ventromedial Prefrontal Cortex Malformation

Background: A detailed behavioral profile associated with focal congenital malformation of the ventromedial prefrontal cortex (vmPFC) has not been reported previously. Here we describe a 14 year-old boy, B.W., with neurological and psychiatric sequelae stemming from focal cortical malformation of the left vmPFC. Case Presentation: B.W.'s behavior has been characterized through extensive review Patience of clinical and personal records along with behavioral and neuropsychological testing. A central feature of the behavioral profile is severe antisocial behavior. He is aggressive, manipulative, and callous; features consistent with psychopathy. Other problems include: egocentricity, impulsivity, hyperactivity, lack of empathy, lack of respect for authority, impaired moral judgment, an inability to plan ahead, and poor frustration tolerance. Conclusions: The vmPFC has a profound contribution to the development of human prosocial behavior. B.W. demonstrates how a congenital lesion to this cortical region severely disrupts this process

Lesion mapping of cognitive abilities linked to intelligence

The Wechsler Adult Intelligence Scale (WAIS) assesses a wide range of cognitive abilities and impairments. Factor analyses have documented four underlying indices that jointly comprise intelligence as assessed with the WAIS: verbal comprehension (VCI), perceptual organization (POI), working memory (WMI), and processing speed (PSI). We used nonparametric voxel-based lesion-symptom mapping in 241 patients with focal brain damage to investigate their neural underpinnings. Statistically significant lesion-deficit relationships were found in left inferior frontal cortex for VCI, in left frontal and parietal cortex for WMI, and in right parietal cortex for POI. There was no reliable single localization for PSI. Statistical power maps and cross-validation analyses quantified specificity and sensitivity of the index scores in predicting lesion locations. Our findings provide comprehensive lesion maps of intelligence factors, and make specific recommendations for interpretation and application of the WAIS to the study of intelligence in health and disease