Bilateral Anterior Cingulate Gyrus Lesions

A 40 year old man had been ill for three days prior to his hospital admission. When examined, he was mute, akinetic, indifferent to painful stimuli, and incontinent of urine. His eyes were open; deep tendon reflexes were intact; bilateral Babinski signs were present; muscle tone was normal; he was unable to swallow foods and liquids fed to him; his pupils were of normal size and pupillary reactions to light, both direct and consensual, were normal. Thus by clinical standards, he was unresponsive to external stimuli, yet not in coma. A t necropsy bilateral lesions were found in the anterior cingulate gyri. This patient resembled in many ways the case recently reported by Nielsen and Jacobs’ in which there was found at necropsy a destructive lesion involving the anterior cingulate gyri and the underlying corpus callosum. In a subsequent paper Nielsen’ analyzed the symptomatology referable to bilateral lesions of the anterior cingulate gyri. He also drew attention to the clinical differences between cases in which lesions involved only the corpus callosum and of those in which both the corpus callosum and projection fibers from both cingulate gyri were involved. The present study emphasizes the similarities of these cases.