Table 2.

Summary of case studies and small series of emotional empathy

Brain region	Reference	Cases with lesion site n	Time post-injury	Type of injury	Conclusions
Prefrontal and orbitofrontal hypoperfusion	Kemp et al., 2013	1	3–4 years	Caudate haemorrhage	Prefrontal and orbitofrontal hypoperfusion → impaired affective perspective-taking and impaired recognition of negative emotions
Right medial prefronal and orbitofrontal	Fisher et al., 2011	1	1 and 8 years	Trauma	Right medial prefrontal lesion → acute deficits in a variety of social and executive functions; but full recovery and normal affective perspective taking by 8 years post-injury
Left medial frontal and orbitofrontal with bilateral frontal hypoperfusion by SPECT	Grattan and Eslinger, 1992	1	26 years	Intracerebral haemorrhage	Left medial and orbitofrontal subarachnoid haemorrhage at age 7 with bilateral hypoperfusion → impaired empathy and cognitive flexibility at age 33
Medial prefrontal	Bird et al., 2004	1	87 and 101 days	Anterior cerebral artery stroke	Subacute bilateral medial prefrontal stroke → no clear deficits in empathy, but relative weakness in affective perspective-taking
Right dorsomedial prefrontal	Herbet et al., 2013	5	Immediately post-op, 3 months	Slow-growing tumour, surgical	Lesions caused empathy deficits immediately postoperatively, but patients recovered 3 months later
Right prefrontal	Leigh et al., 2013	3	Within 48 h	Stroke	Acute right prefrontal lesions → impaired affective perspective-taking
Right dorsolateral prefrontal	Eslinger et al., 1997	1	5–15 years	Trauma	Right prefrontal lesion → impaired emotional empathy but intact cognitive flexibility 5–15 years after lesion age 3
Right inferior frontal gyrus and STG	Samson et al., 2005	1	8 months	Stroke	Right inferior frontal gyrus (and superior tempoiral gyrus lesion) → impaired inhibition of self-perspective
Right inferior frontal gyrus, temporal pole, and insula	Herbet et al., 2013	5	Immediately post-op, 3 months	Slow-growing tumour, surgical	Lesions caused perspective-taking deficits immediately post-op, but recovered 3 months later
Right temporal pole, medial orbitofrontal	Narvid et al., 2009	1	5+ years	FTD	Right and medial orbitofrontal, temporal atrophy → impaired emotional recognition and emotional empathy
Right temporal pole	Perry et al., 2001	2		FTD	Both with right temporal pole atrophy → impaired empathy (IRI) and impaired recognition of emotion through prosody and facial expression
Amygdala	Stone et al., 2003	2	12 years (1)	1 surgical	Bilateral amygdala → impaired theory of mind, affective perspective-taking
				1 herpes
Right amygdala	Leigh et al., 2013	27 total, 4 amygdala lesions	Within 48 h	Stroke	All with right amygdala lesions → impaired affective perspective-taking
Bilateral amygdala	Hurlemann et al., 2010	2		Urbach-Wiethe disease	Bilateral amygdala lesions → deficits in emotional but not cognitive empathy
Anterior insula, anterior cingulate	Gu et al., 2012	3 anterior insula, 3 anterior cingulate cortex, 6 other	3–32 months	Glioma	Anterior insula lesion → impaired implicit and explicit perception of another person’s pain (emotional contagion)
Anterior cingulate cortex	Baird et al., 2006	3	Not stated	Glioma, surgery, haematoma	Right anterior cingulate cortex → impaired emotional recognitionBilateral anterior cingulate cortex → impaired theory of mind
Right anterior insula, or its connections	Couto et al., 2013	2	18 months	Stroke	Right insular damage → no impairment; Sub-insular damage → empathy impairment
Cerebellum	Roldan Gersch-covich et al., 2011	1	3 months	Stroke	Bilateral cerebellar lesions → impaired empathy on a variety of tests

STG = superior temporal gyrus.