Bilateral paramedian thalamic infarction with persisting signs of frontal lobe dysfunction.

Cognition and behavior of a 46-year-old woman with a bilateral paramedian thalamic infarction is discussed with regard to dysfunctions of executive behaviors associated with frontal lobe function. The patient displayed marked disturbances in traditional neuropsychological tests measuring frontal lobe functions, as well as in attentional and mnemonic tasks depending on strategic behavior or on response flexibility, response shifting, or response inhibition. Behaviorally, the patient showed considerable apathy, confusion and perseverative tendencies in the acute state, and a diminished psychic self-activation in the chronic state. In spite of long-lasting rehabilitation efforts, the patients' neurobehavioral deficits remained and became obvious in situations with high cognitive demands.