His wife brings a 39-year-old right-handed man to the office because she is concerned about his conduct. When the patient protested, he was robbed and struck in the head and legs with a baseball bat two months ago. He had trouble walking at first, but his injuries have now healed. His wife and other family members claim that his disposition has shifted dramatically following the attack. Prior to the assault, the patient was courteous, respectful, and nice. However, he has been extremely irritated and disrespectful since the incident, and he was recently dismissed from his job for insulting customers and making socially inappropriate comments to coworkers. Which anatomical area of the brain is the most likely cause of this patient's symptoms?

Question

Quizplus · Accepted Answer

Eductional Objective: This patient's personality shift, disinhibition, and irritability are most likely the result of orbitofrontal brain injury (OFC). The OFC is located in the frontal lobe and has strong modulatory links to the limbic system (the brain's major emotional system); it regulates behavior and emotions.
Pathological behavioral and emotional abnormalities are more likely when the OFC is injured bilaterally rather than unilaterally. Increased irritation in the setting of disinhibition may lead to blunt, violent conduct. The diagnostic workup includes gathering information regarding personality changes from family and friends, as well as neuropsychological tests and structural brain imaging.

His Wife Brings a 39-Year-Old Right-Handed Man to the Office