Frontal lobe syndrome in a patient with bilateral globus pallidus lesions

This article describes a patient who experienced the rapid onset of an irreversible behavioral change while vacationing in La Paz, Bolivia (altitude, 4070 m). The only lesions demonstrated on a magnetic resonance imaging scan were bilateral hemorrhages in the globus pallidus. The behavior change was characterized by apathy and lack of motivation, features commonly associated with bilateral frontal lobe disease. This case is a further demonstration of how subcortical lesions can produce behavioral syndromes that are clinically indistinguishable from classic cortical syndromes. It is cases such as this that show how a strict localizationist concept of behavioral function is too restrictive and how it is necessary to consider a wide network of neuronal interconnections when explaining the mechanism of a dissolution of complex higher functions.