Co-occurrence of brain lesions and cognitive deficit exaggeration

Findings are presented from a patient with a premorbid history of feigning or exaggerating physical and emotional symptoms, who subsequently developed cerebral infarcts and cerebral vascular anomalies. Analyses of the patient's responses to subsequent neuropsychological tests, as well as concurrent findings from several measures designed to directly assess malingering, suggested a pattern of exaggeration of cognitive symptoms. Results demonstrate that malingering may occur within the context of actual brain lesions, and the findings are discussed in regard to the need to routinely evaluate patient motivation, as well as the capabilities and limitations of available techniques for detecting motivationally based deficits.