Left dorsomedial thalamic infarction and “sociopathy”

─in view of non-verbal communication

Abstract

   Previously I and my colleagues reported that a right-handed 48-year-old man developed severe personality changes and a frontal-like syndrome, i.e. “acquired sociopathy”, after recovery from acute-onset impairment of consciousness at age 43. Other neurological and neuropsychological disturbances, especially verbal and visual amnesia, were unremarkable. MRI showed a very small infarct in the left paramedian area of the thalamus, mainly involving the dorsomedial nucleus(DM). This case shows dissociation between memory(Papez)and emotional circuits(Yakovlev). Recent functional neuroanatomy study results suggest three primary frontal circuits: dorsolateral, orbitofrontal, and anterior cingulate; all connected to the DM, which plays an important role also in schizophrenia , i.e. “developmental sociopathy”. Personality is a matter of society, and personality disorders in schizophrenia and personality changes in stroke, which are evaluated by non-verbal communication and behavior observations, seem to have common basis in the pathomechanism.