Posttraumatic Anosmia and Orbital Frontal Damage: Neuropsychological and Neuropsychiatric Correlates

Twenty head-injury patients with marked posttraumatic anosmia, presumably indicating damage to the orbital frontal cortex, were administered a standard neuropsychological battery, a series of tests purported to be particularly sensitive to frontal lobe pathology, and a collateral interview designed to assess the presence of psychosocial symptoms characteristically attributed to damage to the frontal lobes. The patients' performances on routine testing were normal, as were their performances on the frontal lobe tests (except the Tinker Toy Test). However, all of the collaterals (first-degree relatives) reported that these same patients displayed many serious maladaptive behaviors and other psychosocial symptoms previously reported to be associated with frontal damage. Findings underscore the importance of obtaining information about head-injury patients' performance in activities of daily living (e.g., via collateral reports) in addition to standard neuropsychological testing. Finally, these data support previous research indicating that both posttraumatic anosmia and failure on the Tinker Toy Test have important prognostic significance in closed head trauma.