Macmillan Malcolm
School of Psychology, Deakin University, Burwood, Vic. 3125, Australia.
Brain Cogn. 2004 Oct;56(1):63-76. doi: 10.1016/j.bandc.2004.05.007.
Two little noticed cases in which William Macewen used symptoms of visual agnosia to plan brain surgery on the angular gyrus are reviewed and evaluated. Following a head injury, Macewen's first patient had an immediate and severe visual object agnosia that lasted for about 2 weeks. After that he gradually became homicidal and depressed and it was for those symptoms that Macewen first saw him, some 11 months after the accident. From his examination, Macewen concluded that the agnosia clearly indicated a lesion in "the posterior portion of the operculum or in the angular gyrus." When he removed parts of the internal table that had penetrated those structures the homicidal impulses disappeared. Macewen's second patient was seen for a chronic middle ear infection and, although neither aphasic nor deaf, was 'word deaf.' Slightly later he became 'psychically blind' as well. Macewen suspected a cerebral abscess pressing on both the angular gyrus and the first temporal convolution. A large subdural abscess was found there and the symptoms disappeared after it was treated. The patients are discussed and Macewen's positive results analysed in the historical context of the dispute over the proposed role of the angular gyrus as the visual centre.
回顾并评估了两例鲜为人知的病例，威廉·麦克斯韦恩利用视觉失认症的症状来计划对角回进行脑部手术。头部受伤后，麦克斯韦恩的第一位患者立即出现严重的视觉物体失认症，持续了约两周。之后，他逐渐变得有杀人倾向且情绪低落，正是由于这些症状，麦克斯韦恩在事故发生约11个月后首次见到了他。通过检查，麦克斯韦恩得出结论，失认症清楚地表明“脑盖后部或角回”存在病变。当他切除穿透这些结构的内板部分时，杀人冲动消失了。麦克斯韦恩的第二位患者因慢性中耳感染前来就诊，尽管既无失语也无耳聋，但存在“词聋”症状。稍晚些时候，他也出现了“精神性失明”。麦克斯韦恩怀疑是一个脑脓肿压迫了角回和第一颞回。在那里发现了一个大的硬膜下脓肿，治疗后症状消失。在关于角回作为视觉中枢的提议作用的争议的历史背景下，对这些患者进行了讨论，并分析了麦克斯韦恩的积极结果。
