Autism and visual agnosia in a child with right occipital lobectomy
- aHôpital Saint Vincent de Paul, Service de Neuropédiatrie, Université René Descartes, Paris, France, bClinique Spécialisée de l’Autisme, Hôpital Rivière des Prairies et Département de Psychiatrie de l’Université de Montréal, Canada, cHôpital Fréderic Joliot, Département de Recherche Médicale du Centre à l’Energie Atomique et Inserm U 29, Orsay, France
- 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
- Revised 6 March 1998
- Accepted 6 March 1998
Abstract
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.
METHODS Neuropsychological 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.
RESULTS Brain 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.
CONCLUSIONS Although 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.
