ABSTRACT
OBJECTIVES: To establish the link between frontal lobe dysfunction and violent and criminal behaviour, based on a review of relevant literature. METHODS: Articles relating evidence of frontal lobe dysfunction with violence or crime were collected through a MEDLINE search using the keyword "frontal lobe" combined with the terms "aggression," "violence," "crime," "antisocial personality disorder," "psychopathy," "impulse control disorders", and "episodic dyscontrol." Reference lists were then searched for additional articles. RESULTS: High rates of neuropsychiatric abnormalities reported in persons with violent and criminal behaviour suggest an association between aggressive dyscontrol and brain injury, especially involving the frontal lobes. The studies reviewed support an association between frontal lobe dysfunction and increased aggressive and antisocial behaviour. Focal orbitofrontal injury is specifically associated with increased aggression. Deficits in frontal executive function may increase the likelihood of future aggression, but no study has reliably demonstrated a characteristic pattern of frontal network dysfunction predictive of violent crime. CONCLUSIONS: Clinically significant focal frontal lobe dysfunction is associated with aggressive dyscontrol, but the increased risk of violence seems less than is widely presumed. Evidence is strongest for an association between focal prefrontal damage and an impulsive subtype of aggressive behaviour.
Subject(s)
Aggression/psychology , Antisocial Personality Disorder/etiology , Brain Diseases/complications , Brain Diseases/psychology , Craniocerebral Trauma/complications , Craniocerebral Trauma/psychology , Criminal Psychology , Frontal Lobe , Neurocognitive Disorders/etiology , Violence/psychology , Antisocial Personality Disorder/diagnosis , Antisocial Personality Disorder/epidemiology , Biological Psychiatry , Craniocerebral Trauma/diagnosis , Criminology , Humans , Magnetic Resonance Imaging , Neurocognitive Disorders/diagnosis , Neurocognitive Disorders/epidemiology , Neuropsychological Tests , Predictive Value of Tests , Research Design/standards , Risk Factors , Tomography, Emission-Computed , Tomography, Emission-Computed, Single-PhotonABSTRACT
BACKGROUND: We present the signs, symptoms, and radiographic features of 36 children with ischemic infarctions of the basal ganglia, internal capsule, or thalamus. PATIENTS AND METHODS: The series includes 14 males and 22 females ranging in age from newborn to 13 years. Twenty-seven patients were evaluated with computed tomography, 34 with magnetic resonance imaging, 16 with magnetic resonance angiography, and 10 with conventional cerebral angiography. Thirty patients had unilateral lesions (16 left, 14 right) and 6 had bilateral infarctions. RESULTS: The most common presenting symptom was hemiplegia (30 of 36). Other children presented with aphasia (5 of 36), seizures (5 of 36), altered consciousness (5 of 36), and hemisensory changes (5 of 36). Four of 6 patients with bilateral lesions presented with altered mental status, but the location of a unilateral infarction within the thalamus or basal ganglia did not predict the clinical presentation. CONCLUSIONS: The risk factors for basal ganglia infarction in children are diverse, but systemic hypertension does not play a major role in children. The vascular occlusion often occurred in the large arteries, with secondary occlusion of the smaller penetrating arteries. Most children with a single unilateral infarction have a good prognosis.
