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We describe two patients with isolated brainstem lesions who exhibited behavioural and cognitive changes that are commonly associated with frontal lobe pathology, as leading clinical features. These cases illustrate the role of distributed neural networks in cognitive and behavioural processes. The brainstem, frontal-subcortical and limbic systems are extensively and reciprocally linked via neurotransmitter projection pathways. We argue that cognitive and behavioural features in patients with brainstem lesions reflect remote effects of brainstem structures on frontal lobe and limbic regions, as a consequence of disruption to ascending neurotransmitter pathways.
Acknowledgments
We wish to thank Dr. Jennian Geddes for performing the neuropathological examination.
This work was undertaken at UCLH/UCL who received a proportion of funding from the Department of Health's NIHR Biomedical Research Centres funding scheme. The work was supported by the UK Alzheimer Research Trust and Medical Research Council. JDW is supported by a Wellcome Trust Intermediate Clinical Fellowship. The Dementia Research Centre is an Alzheimer's Research Trust Co-ordinating Centre.