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A seven-year-old girl fractured her tibia and called her parent for help only because she could not extricate her broken leg from under the chair which had fallen on it. Manipulation and application of a cast without anesthesia brought no complaint. A huge area of necrosis which laid bare the muscles and tendons of the leg was only detected because of the odor. This girl had a history of many severe injuries starting before the age of one year, all without her giving any evidence of pain or distress. There was no sign that she enjoyed the injuries nor the attention given her because of them. There was also no evidence of a disturbance in consciousness nor of joy or ecstasy.
Psychometric examinations revealed no mental deficiency; she was alert and active. She would cry only when her feelings were hurt but never as a result of physical stimuli. There were no gross manifestations indicating that she was in any way emotionally disturbed. Thorough neurological examination revealed no pathological findings.
Several cases of this kind have been described in the literature, some apparently due to a lesion of the left supramarginal gyrus. One theory suggests the possibility of a congenital structural defect with incomplete neural connections in the postcentral area. Another theory suggests that this condition may resemble the congenital aphasias and is dependent on a lack of established cerebral dominance.