A-249 Evidence for Frontal Lobe Involvement in the Visual Processing Streams
Abstract Objective Extant literature supports the “Two-Stream Hypothesis” of visual processing including a ventral stream (connecting the occipital lobe to the temporal lobe) and a dorsal stream (connecting the occipital lobe to the parietal lobe), but is not traditionally believed to involve the frontal lobe. Method “Eddie”, a healthy 14-year-old male, sustained a penetrating brain injury by accidentally lodging a pool cue through his right orbital bones and piercing his right frontal lobe through to the skull. He was ambulatory, awake, and alert on arrival to the ED, with a laceration, swelling, and bleeding of the eyelid. A cranial CT revealed a complex orbital roof fracture, injury to the orbit, and right frontal contusions. Eddie underwent a right supraorbital craniotomy with repair of the orbital roof fracture and debridement of bony fragments. Post-operative MRI revealed right frontal parenchymal edema and patchy areas of contusion. Results Neuropsychological evaluation revealed a robust cognitive reserve including verbal skills, working memory, processing speed, and word reading skills in the high average. Eddie demonstrated significant discrepancies in visually mediated skills including relatively weaker visual–spatial skills (24 standard score (SS) points lower than verbal skills), fluid reasoning with visual problem-solving (30 SS points lower than verbal skills), low average judgment of line orientation, and a discrepancy between verbal and visual memory. He also demonstrated mild difficulties consistent with his right orbito-frontal injury including weaknesses regarding impulsivity, self-monitoring, planning, and task approach. Conclusions The current case demonstrates possible involvement of the frontal lobe in the visual processing pathways.