Fischer David B, Perez David L, Prasad Sashank, Rigolo Laura, O'Donnell Lauren, Acar Diler, Meadows Mary-Ellen, Baslet Gaston, Boes Aaron D, Golby Alexandra J, Dworetzky Barbara A
Harvard Medical School, Boston, MA 02115, USA, Department of Neurology, Berenson-Allen Center for Noninvasive Brain Stimulation, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA,
Department of Neurology and Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA and Department of Psychiatry.
Soc Cogn Affect Neurosci. 2016 Jun;11(6):945-51. doi: 10.1093/scan/nsw011. Epub 2016 Mar 3.
The mechanism by which the brain integrates visual and emotional information remains incompletely understood, and can be studied through focal lesions that selectively disrupt this process. To date, three reported cases of visual hypoemotionality, a vision-specific form of derealization, have resulted from lesions of the temporo-occipital junction. We present a fourth case of this rare phenomenon, and investigate the role of the inferior longitudinal fasciculus (ILF) in the underlying pathophysiology. A 50-year-old right-handed male was found to have a right medial temporal lobe tumor following new-onset seizures. Interstitial laser ablation of the lesion was complicated by a right temporo-parieto-occipital intraparenchymal hemorrhage. The patient subsequently experienced emotional estrangement from visual stimuli. A lesion overlap analysis was conducted to assess involvement of the ILF by this patient's lesion and those of the three previously described cases, and diffusion tensor imaging was acquired in our case to further investigate ILF disruption. All four lesions specifically overlapped with the expected trajectory of the right ILF, and diminished structural integrity of the right ILF was observed in our case. These findings implicate the ILF in visual hypoemotionality, suggesting that the ILF is critical for integrating visual information with its emotional content.
大脑整合视觉和情感信息的机制仍未完全明了，可通过选择性破坏这一过程的局灶性病变来进行研究。迄今为止，有三例视觉低情感症（一种特定于视觉的现实解体形式）的报道病例是由颞枕交界区的病变引起的。我们报告第四例这种罕见现象，并研究下纵束（ILF）在潜在病理生理学中的作用。一名50岁右利手男性在新发癫痫发作后被发现患有右侧颞叶内侧肿瘤。病变的间质激光消融并发右侧颞顶枕脑实质内出血。患者随后出现对视觉刺激的情感疏离。进行了病变重叠分析，以评估该患者的病变以及之前描述的三例病例的病变对ILF的累及情况，并在我们的病例中进行了扩散张量成像，以进一步研究ILF的破坏情况。所有四个病变均与右侧ILF的预期轨迹特异性重叠，并且在我们的病例中观察到右侧ILF的结构完整性降低。这些发现表明ILF与视觉低情感症有关，提示ILF对于将视觉信息与其情感内容进行整合至关重要。
