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Von Economo neurons (VENs) are projection neurons located in layer V of the anterior cingulate and frontoinsular cortex that are increasingly attracting the interest of the scientific community as many studies point to their involvement in neuropsychiatric conditions. In this review we provide a critical appraisal of both historic and recent literature on VENs that highlights the importance of clinicopathological studies in areas of research where animal models are not available. Current data suggest that VENs represent a specialized neuronal type with a characteristic morphology that evolved only in a restricted number of species most likely from a population of pyramidal neurons present in ancestral mammals in the context of specific adaptive pressures. VENs, which evolved among primates only in the hominoid lineage, are particularly vulnerable in neuropsychiatric conditions characterized by deficits in social skills and emotional function. Moreover, recent evidence on the neurochemical profile, morphologic features, and laminar and regional distribution of VENs suggests that this intriguing neuronal population could be critically involved in autonomic regulation.

The anterior cingulate cortex, which is involved in cognitive and affective functioning, is important in investigating disorders in which individuals exhibit impairments in higher-order functions. In this study, we examined the anterior midcingulate cortex (aMCC) at the cellular level in patients with autism and in controls. We focused our analysis on layer V of the aMCC because it contains von Economo neurons, specialized cells thought to be involved in emotional expression and focused attention. Using a stereologic approach, we determined whether there were neuropathologic changes in von Economo neuron number, pyramidal neuron number, or pyramidal neuron size between diagnostic groups. When the groups were subdivided into young children and adolescents, pyramidal neuron and von Economo neuron numbers positively correlated with autism severity in young children, as measured by the Autism Diagnostic Interview—Revised. Young children with autism also had significantly smaller pyramidal neurons than their matched controls. Because the aMCC is involved in decision-making during uncertain situations, decreased pyramidal neuron size may reflect a potential reduction in the functional connectivity of the aMCC.