Orbitofrontal syndrome — MRCPsych Paper A MCQ

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EasyNeuroanatomyOrbitofrontal syndromeMRCPsych Paper A

Following a traumatic brain injury, a 48-year-old man becomes socially disinhibited. He makes tactless comments, acts impulsively despite adverse consequences and shows impaired social judgement. His motor and visual examinations are normal. Damage to which brain region best accounts for this presentation?

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Correct answer: B — Orbitofrontal cortex

The correct answer is **E, orbitofrontal cortex**. Orbitofrontal injury impairs the integration of reward, punishment and social-emotional information, producing impulsivity, tactlessness, socially inappropriate behaviour and poor judgement. This is the characteristic orbitofrontal disinhibition syndrome. Dorsolateral prefrontal damage more typically causes deficits in planning, working memory, cognitive flexibility and problem-solving. Anterior cingulate damage is more closely associated with reduced motivation, apathy or abulia. A primary motor cortex lesion would cause contralateral upper motor neurone weakness, while an occipital pole lesion would produce visual-field or cortical visual deficits. The normal motor and visual examinations further argue against those posterior and motor localisations.

Reference: Robin A, Bastin J. Role and Functions of the Human Orbitofrontal Cortex. Journal of Clinical Neurophysiology. 2025;42(7):609–615. https://pubmed.ncbi.nlm.nih.gov/41186438/