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Open Access Highly Accessed Case report

Behavioral effects of congenital ventromedial prefrontal cortex malformation

Aaron D Boes1*, Amanda Hornaday Grafft2, Charuta Joshi3, Nathaniel A Chuang4, Peg Nopoulos5 and Steven W Anderson6

Author Affiliations

1 Department of Pediatric Neurology, Massachusetts General Hospital, Harvard University. MC WACC 8-835, 55 Fruit Street. Boston, MA 02114. USA

2 Departments of Neurology and Psychology, University of Iowa. 200 Hawkins Drive, 2007 RCP, Iowa City, IA 52242. USA

3 Department of Pediatric Neurology, University of Iowa. 2506 John Colloton Pavilion, 200 Hawkins Drive, Iowa City, IA 52242. USA

4 Department of Neuroradiology, Rady Children's Hospital of San Diego. 3020 Children's Way. MC 5101, San Diego, CA 92123. USA

5 Department of Psychiatry, University of Iowa. 200 Hawkins Drive, W285 GH, Iowa City, Iowa 52242. USA

6 Department of Neurology, University of Iowa. 200 Hawkins Drive, 2007 RCP, Iowa City, IA 52242. USA

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BMC Neurology 2011, 11:151  doi:10.1186/1471-2377-11-151

Published: 2 December 2011

Abstract

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.