Goldenberg G, Schuri U, Grömminger O, Arnold U
Neuropsychological Department, Bogenhausen Hospital, Munich, Germany.
J Neurol Neurosurg Psychiatry. 1999 Aug;67(2):163-8. doi: 10.1136/jnnp.67.2.163.
To analyse amnesia caused by basal forebrain lesions.
A single case study of a patient with amnesia after bleeding into the anterior portion of the left basal ganglia. Neuropsychological examination included tests of attention, executive function, working memory, recall, and recognition of verbal and non-verbal material, and recall from remote semantic and autobiographical memory. The patient's MRI and those of other published cases of basal forebrain amnesia were reviewed to specify which structures within the basal forebrain are crucial for amnesia.
Attention and executive function were largely intact. There was anterograde amnesia for verbal material which affected free recall and recognition. With both modes of testing the patient produced many false positive responses and intrusions when lists of unrelated words had been memorised. However, he confabulated neither on story recall nor in day to day memory, nor in recall from remote memory. The lesion affected mainly the nucleus accumbens, but encroached on the inferior limb of the capsula interna and the most ventral portion of the nucleus caudatus and globus pallidus, and there was evidence of some atrophy of the head of the caudate nucleus. The lesion spared the nucleus basalis Meynert, the diagnonal band, and the septum, which are the sites of cholinergic cell concentrations.
It seems unlikely that false positive responses were caused by insufficient strategic control of memory retrieval. This speaks against a major role of the capsular lesion which might disconnect the prefrontal cortex from the thalamus. It is proposed that the lesion of the nucleus accumbens caused amnesia.
分析基底前脑病变所致失忆症。
对一名左侧基底节前部出血后失忆患者进行单病例研究。神经心理学检查包括注意力、执行功能、工作记忆、言语和非言语材料的回忆与识别测试，以及远期语义和自传体记忆的回忆测试。回顾该患者的磁共振成像（MRI）以及其他已发表的基底前脑失忆病例的MRI，以明确基底前脑内哪些结构对失忆症至关重要。
注意力和执行功能基本完好。对言语材料存在顺行性失忆，影响自由回忆和识别。在两种测试模式下，当记忆不相关单词列表时，患者产生了许多假阳性反应和错误记忆。然而，他在故事回忆、日常记忆以及远期记忆回忆中均未虚构。病变主要累及伏隔核，但侵犯了内囊下肢以及尾状核和苍白球最腹侧部分，且有尾状核头部萎缩的证据。病变未累及Meynert基底核、斜角带和隔区，这些是胆碱能细胞集中的部位。
假阳性反应似乎不太可能是由记忆检索的策略控制不足所致。这与内囊病变可能使前额叶皮质与丘脑断开联系的主要作用相悖。提出伏隔核病变导致了失忆症。
