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a Hôpital Saint Vincent de Paul, Service de
Neuropédiatrie, Université René Descartes, Paris, France, b Clinique Spécialisée
de l'Autisme, Hôpital Rivière des Prairies et Département de
Psychiatrie de l'Université de Montréal, Canada, c Hôpital Fréderic Joliot, Département de Recherche
Médicale du Centre à l'Energie Atomique et Inserm U 29, Orsay,
France
Correspondence to: Dr Isabelle Jambaqué, Hôpital Saint Vincent de Paul, Service de Neuropédiatrie, 82 Avenue Denfert Rochereau, 75 674 Paris, Cedex 14, France. Telephone 0033 1 40 48 80 48; fax 0033 01 40 48 83 40.
Received 23 June 1997 and in revised form 6
March 1998;
Accepted 6 March 1998
OBJECTIVES
Autistic disorder is a developmental
handicap with an unknown neurological basis. Current neuropsychological
models for autism suggest an abnormal construction of visual perceptual
representation or a deficit in executive functions. These models
predict cerebral lesions in the temporo-occipital or frontal regions of
autistic patients. The present study aimed at studying the presence of symptoms of autism and visual agnosia in a 13 year old girl who had a
right temporo-occipital cortical dysplasia that was surgically removed
at the age of 7.
METHODSNeuropsychological evaluation included
Wechsler and Kaufman intelligence scales, a test of word fluency, digit
span, Corsi block, California verbal learning, Trail making, Benton
facial recognition, Snoodgrass object recognition tests, Rivermead face learning subtest, and developmental test of visual perception. The
ADI-R was used to show current and retrospective diagnosis of autistic
disorder. Neuroimagery included brain MRI, single photon emission
computed tomography (SPECT), and PET.
RESULTSBrain MRI showed a right occipital defect
and an abnormal hyperintensity of the right temporal cortex. PET and
SPECT disclosed a left frontal hypometabolism together with the right
occipital defect. Neuropsychological testing showed a visual
apperceptive agnosia and executive function deficits. Psychiatric study
confirmed the diagnosis of autistic disorder.
CONCLUSIONSAlthough the possibilty that autism
and visual agnosia were dissociable factors in this patient cannot be
excluded, the finding of both deficits supports the possibility that
occipito-temporal lesions can predispose to the development of autism.
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