Benke Th, Kurzthaler I, Schmidauer Ch, Moncayo R, Donnemiller E
University Clinic of Neurology, Anichstr. 35, 6020, Innsbruck, Austria.
Neuropsychologia. 2002;40(3):245-52. doi: 10.1016/s0028-3932(01)00108-7.
We describe the case of a young male patient, SN, who suffered a MR-documented ischaemic lesion of both dorsomedial thalami and presented with a transient maniform syndrome. SN's neuropsychological, structural and functional imaging findings are compared with similar reported cases and are discussed in the framework of fronto-subcortical circuits and their proposed behavioural disorders. SN's mania was characterized by restlessness, mood elevation, a tendency for pleasurable activities, inflated self-esteem and loss of disease awareness. Other symptoms were sexual disinhibition, tactlessness, abnormal discourse, and reduced need for food and sleep. His neuropsychological assessment revealed an anterograde amnesia, and an impairment of frontal-executive functions. A SPECT-study showed diaschisis-related areas of hypoperfusion in both prefrontal regions which were interpreted as equivalents of SN's frontal-dysexecutive syndrome. In addition, there was a perfusion deficit in the right orbitofrontal cortex, which was taken as the imaging correlate of SN's secondary mania and personality disorder. These findings suggest that SN's mania and his other symptoms result from the twofold disruption of fronto-subcortical connections, namely of the right orbitofrontal loop which is concerned with mood regulation and socially appropriate behaviour, and of the dorsolateral prefrontal loop which mediates executive cognitive functions.
我们描述了一位年轻男性患者SN的病例，他经磁共振成像（MR）证实双侧丘脑背内侧存在缺血性病变，并出现了短暂的类躁狂综合征。将SN的神经心理学、结构和功能影像学检查结果与已报道的类似病例进行了比较，并在前额叶-皮质下回路及其相关行为障碍的框架下进行了讨论。SN的躁狂表现为坐立不安、情绪高涨、倾向于进行愉悦活动、自尊心膨胀以及疾病意识丧失。其他症状包括性抑制解除、不得体、言语异常以及对食物和睡眠需求减少。他的神经心理学评估显示存在顺行性遗忘以及额叶执行功能受损。单光子发射计算机断层扫描（SPECT）研究显示双侧前额叶区域存在与交叉性神经机能联系不能相关的灌注减低区，这被解释为与SN的额叶执行功能障碍综合征等效。此外，右侧眶额皮质存在灌注不足，这被视为SN继发性躁狂和人格障碍的影像学关联。这些发现表明，SN的躁狂及其他症状是由额叶-皮质下连接的双重破坏所致，即与情绪调节和社会适宜行为相关的右侧眶额环路以及介导执行认知功能的背外侧前额叶环路的破坏。
