Tagawa Koichi, Tokida Haruki
Higher Brain Dysfunction Center, Nagao Hospital.
Brain Nerve. 2017 Jun;69(6):591-605. doi: 10.11477/mf.1416200791.
Pure amnesia (amnesic syndrome) is an organic brain syndrome characterized by impairment in episodic memory, with either an anterograde or sometimes retrograde loss of memories. Although episodic memory is impaired, semantic memory, immediate memory, and procedural memory are preserved. The Papez circuit is a network of nerve fibers and nerve centers that starts and ends in the hippocampus travelling by way of the fornix, mammillary bodies, anterior thalamic nuclei, cingulate gyrus, and parahippocampal gyrus. A lesion restricted to this circuit often produces pure amnesia. Regions concerned with the Yakovlev circuit also have an important role in memory. Clinical cases of pure amnesia caused by cerebrovascular disease presented following brain imaging and resulted from various different lesions. The cases identified were predominantly thalamic amnesia and hippocampal amnesia. Thalamic amnesia often resulted from an infarction in the territory of the thalamotuberal artery and paramedian thalamic artery although thalamic hemorrhage in medial portion of thalamus also produced pure amnesia. Hippocampal amnesia usually occurred following an infarction in the temporal branches of posterior cerebral artery. Cases of retrosplenial amnesia caused by subcortical hematoma and infarction in the retrosplenial region are also described. In addition, cases of pure amnesia resulting from an infarction in the fornix, mammillary body hemorrhage, and caudate hemorrhage are also shown.
单纯性遗忘症(遗忘综合征)是一种器质性脑综合征,其特征为情景记忆受损,存在顺行性遗忘或有时伴有逆行性遗忘。尽管情景记忆受损,但语义记忆、即时记忆和程序性记忆得以保留。帕佩兹环路是一个由神经纤维和神经中枢组成的网络,始于海马体,经穹窿、乳头体、丘脑前核、扣带回和海马旁回,最终又回到海马体。局限于该环路的病变常导致单纯性遗忘症。与雅科夫列夫环路相关的区域在记忆方面也起着重要作用。脑血管疾病导致的单纯性遗忘症临床病例在脑部成像后得以呈现,其病因各异。确诊的病例主要为丘脑性遗忘症和海马性遗忘症。丘脑性遗忘症常由丘脑结节动脉和丘脑旁正中动脉供血区域的梗死引起,不过丘脑内侧部分的出血也可导致单纯性遗忘症。海马性遗忘症通常发生在大脑后动脉颞支梗死之后。文中还描述了扣带回后部血肿和梗死导致的扣带回后部遗忘症病例。此外,还展示了穹窿梗死、乳头体出血和尾状核出血导致的单纯性遗忘症病例。