Middle aged female with no previous medical problems presented as a trauma patient after a motor vehicle accident. The patient had decreased level of consciousness. CT head revealed subdural hematoma as well as frontal lobe contusion. She was taken to the operating room for craniotomy and subdural hematoma evacuation.

Several days after the admission her condition improved and the patient was able to follow simple commands. She was taken off mechanical ventilation. Follow-up CT head revealed evolving contusions in the frontal lobes. (Click on the image above to see a larger version).

Later in her hospital state, she was able to communicate, yet her family noted a striking difference in her behavior. Previously energetic and an enthusiastic person, she was apathetic, inattentive and even inappropriate at times. She was being described by nurses as “not a very nice person”.

Several months after discharge her condition somewhat improved, yet she continued to struggle with a lack of drive, mood swings and distractibility. Neurocognitive evaluating and rehabilitation were warranted.

Frontal lobe, due to its anatomical location is often subjected to injury and trauma. In general, patients with frontal lobe damage suffer from attention disorder and impaired executive function. The patients exhibit difficulties with planning and completing a complex task. Many patients are unable to continue fruitful employment.

Depending on the affected portion of the frontal lobes (orbitofrontal syndrome) the patient could become disinhibited and impulsive. Patients suffer from inappropriate euphoria and poor judgment. Some patients exhibit a peculiar sexual behavior.

If frontal convexity is primarily affected (apathetic syndrome) the patients suffer from apathy, psychomotor retardation and indifference. The patients are generally less talkative and less social. Creativity and problem solving skills are impaired as well.

If the motor strip, located towards the back of the frontal lobes, is damaged the patient might suffer from weakness on the opposite side of the body.

Recognizing the long term emotional and behavioral consequences of the frontal lobe injury is very important for a successful rehabilitation of these patients. Even though they could be subtle, these changes might have a dramatic effect on the quality of life of the injured person.