A 66-year-old hypertensive man suffers an infarct in the territory of the anterior cerebral artery. He lies still, does not speak spontaneously, answers questions only after long delay with brief whispered words, and appears indifferent to his hemiparesis. He is awake, follows simple commands eventually, and can be coaxed into limited activity. Which anatomical region best explains this syndrome?

• A Orbitofrontal cortex and ventromedial prefrontal region
• B Anterior cingulate gyrus and medial frontal cortex ✓
• C Dorsolateral prefrontal convexity
• D Dominant superior temporal gyrus

Explanation

Abulia, the severe form of apathy with reduced spontaneous speech, movement, and emotional reactivity in an awake patient who responds sluggishly to prompting, localises to the anterior cingulate gyrus and supplementary motor area in the medial frontal lobe, supplied by the anterior cerebral artery. The orbitofrontal region produces disinhibition rather than poverty of action, and dorsolateral lesions produce primarily dysexecutive deficits such as impaired planning and working memory.

Reference: Kaplan and Sadock's Synopsis of Psychiatry, 11th ed.

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Written and medically reviewed by the StethoPrep medical team.