Description of brain injury in the amnesic patient N.A. Based on magnetic resonance imaging

doi:10.1016/0014-4886(89)90168-4

Experimental Neurology

Volume 105, Issue 1, July 1989, Pages 23-35

https://doi.org/10.1016/0014-4886(89)90168-4 Get rights and content

Abstract

N.A. has been amnesic since 1960 when at the age of 22 years he sustained a penetrating brain injury with a miniature fencing foil. The amnesia primarily affects verbal material and occurs in the absence of other detectable cognitive deficits. Previous CT scans demonstrated a lucency in the region of the left mediodorsal thalamic nucleus, but no additional damage was revealed. Beginning in 1986 when he was 48 years old, N.A. was evaluated with a series of magnetic resonance imaging (MR) studies. Three major areas of damage were identified. In the left thalamus there is a prominent 3- to 4-mm-wide linear lesion that approximates the position and orientation of the internal medullary lamina. The defect extends for approximately 20 mm anteroposteriorly and likely involves the rostral group of intralaminar nuclei (central medial, paracentral, central lateral, rhomboid, and reuniens nuclei), the caudal group of intralaminar nuclei (centrum medianum and parafascicular nuclei), the ventral aspects of the mediodorsal nucleus, and the ventral lateral and ventral anterior nuclei. It also likely interrupts the trajectories of the mammillothalamic tract and postcommissural fornix. The posterior hypothalamus is markedly disrupted and the mammillary nuclei appear to be missing bilaterally. Finally, the right anterior temporal lobe is damaged for a distance of about 3.5 cm from the pole to midway through the amygdaloid complex. This damage probably occurred during exploratory neurosurgery done at the time of N.A.'s injury. The hippocampal formation appears intact on both sides. A comparison of these findings with those from other patients with diencephalic amnesia suggests that amnesia can result when several diencephalic structures are damaged conjointly, including the internal medullary lamina, the intralaminar nuclei, the mediodorsal nucleus, and the mammillothalamic tract. Whether amnesia as severe as N.A.'s would result from selective damage to any one of these structures remains to be determined.

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Behavioral evidence indicates that patients who became amnestic following mild hypoxia may exhibit selective impairments in recollection with a sparing of familiarity (Aly et al., 2010; Diana et al., 2008; Quamme et al., 2007, 2004; Simons et al., 2004; Vann et al., 2009). Several anatomical and histological studies have indicated that mild cases of hypoxia can lead to hippocampal damage that often leaves the surrounding medial temporal lobe structures intact (Cummings, Tomiyasu, Read, & Benson, 1984; Di Paola et al., 2008; Duzel, Vargha-Khadem, Heinze, & Mishkin, 2001; Hopkins, Kesner, & Goldstein, 1995a; Hopkins, Kesner, & Goldstein, 1995b; Mecklinger, von Cramon, & Matthes-von Cramon, 1998; Press, Amaral, & Squire, 1989; Rempel-Clower, Zola, Squire, & Amaral, 1996; Squire, Amaral, & Press, 1990; Squire, Amaral, Zola-Morgan, Kritchevsky, & Press, 1989; Zola-Morgan, Squire, & Amaral, 1986). Accordingly, evidence of selective recollection deficits in mild hypoxia patients can permit inferences about the relative roles of the human hippocampus and surrounding medial temporal lobe structures in recollection and familiarity.
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Description of brain injury in the amnesic patient N.A. Based on magnetic resonance imaging

Abstract

Neuropsychologia

Brain Lang.

Brain Lang.

Neuropsychologia

Neuropsychologia

Neuropsychologia

Neuropsychologia

Neuropsychologia

Memory impairments following restricted medial thalamic lesions in monkeys

Exp. Brain Res.

Multilingual aphasia examination

A simple objective technique for measuring flexibility in thinking

J. Gen. Psychol.

The syndrome of unilateral tuberothalamic artery territory infarction

Stroke

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Paramedian thalamic and midbrain infarcts: Clinical and neuropathological study

Ann. Neurol.

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Arch. Neurol.

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Bull. Psychon. Soc.

A preliminary report on a new memory scale

Percept. Mot. Skills

Nonhaemorrhagic thalamic infarction

Brain

The syndrome of bilateral paramedian thalamic infarction

Neurology

Klinische und anatomische Beitrage zur Kenntniss der multiplen Alkoholneuritis nebst Bemerkungen uber die Regenerationsvorgange im peripheren Nervensystem

Arch. Psychiatr. Nervenkr.

Recovery from anterograde and retrograde amnesia after percutaneous drainage of a cystic craniopharyngioma

J. Neurol. Neurosurg. Psychiaty

Selective memory loss and global intellectual deficits in alcoholic Korsakoff's syndrome

Psychol. Med.