Squalor Syndrome After Focal Orbitofrontal Damage

OBJECTIVE: To investigate a responsible lesion for squalor syndrome. BACKGROUND: Squalor syndrome is a behavioral disorder characterized by extreme self-neglect and domestic squalor. Although frontal lobe dysfunction has been postulated to account for squalor syndrome, the relevant part of the frontal lobe has not been elucidated. METHODS: A 49-year-old housewife who suffered rupture of an anterior communicating artery aneurysm at the age of 40 years was examined using a wide range of neuropsychologic tasks. Computed tomography of the head and brain single photon emission tomography with IMP was also carried out. RESULTS: Her performance on neuropsychologic testing was within the normal range, except for the gambling task. Computed tomography of the head showed low-density areas in the bilateral orbitofrontal cortices, basal forebrain, and right ventromedial caudate. Brain single photon emission tomography with IMP showed decreased regional cerebral blood flow in the bilateral orbitofrontal cortices and the basal forebrain. CONCLUSIONS: Our findings suggest that an orbitofrontal lesion may be responsible for squalor syndrome by leading to inappropriate decision-making and abnormal impulsivity.