Kapur N, Ellison D, Parkin A J, Hunkin N M, Burrows E, Sampson S A, Morrison E A
Wessex Neurological Centre, Southampton, UK.
Neuropsychologia. 1994 Jan;32(1):23-38. doi: 10.1016/0028-3932(94)90066-3.
The lesion sustained by the amnesic patient H.M. consisted of bilateral ablation of medial temporal lobe structures with relative sparing of more lateral white matter and neocortical structures. We present the first detailed report of a case where the reverse pattern of lesions predominated, namely bilateral pathology of white matter and neocortical temporal lobe structures, with spared medial temporal lobe structures. This damage, which was particularly severe in anterior loci in the temporal lobes, was sustained as a result of radionecrosis. High-resolution magnetic resonance imaging was carried out to document the distinctive anatomical profile of our patient, and this profile was compared to that reported for the patient H.M. At the anatomical level, there was an almost "mirror image" profile, with contrasting involvement of lateral and medial temporal lobe structures. At the neuropsychological level, our patient was not amnesic but showed patchy impairment on traditional tests of anterograde memory functioning, in the context of notable "semantic" memory loss for knowledge acquired before and after the onset of his illness. Our findings demonstrate that bilateral temporal lobe pathology by itself does not lead to a classical amnesic syndrome, but may result in a significant but more subtle "semantic" memory loss. Our data highlight the distinctive and dissociable contribution of lateral and medial temporal lobe structures to human memory processing, and suggest a major role for anterior-inferior neocortical temporal lobe mechanisms in aspects of knowledge acquisition, storage and retrieval.
遗忘症患者H.M.所遭受的损伤包括双侧内侧颞叶结构的切除，相对而言外侧白质和新皮质结构保留较多。我们首次详细报告了一例以相反损伤模式为主的病例，即双侧白质和颞叶新皮质结构病变，内侧颞叶结构未受损伤。这种损伤在颞叶前部区域尤为严重，是放射性坏死所致。我们对患者进行了高分辨率磁共振成像，以记录其独特的解剖结构，并将该结构与患者H.M.的报告结构进行比较。在解剖层面上，两者呈现出几乎“镜像”的结构，外侧和内侧颞叶结构的受累情况形成对比。在神经心理学层面，我们的患者没有失忆，但在传统的顺行性记忆功能测试中表现出零散的损伤，同时在其疾病发作前后获取的知识方面存在明显的“语义”记忆丧失。我们的研究结果表明，双侧颞叶病变本身不会导致典型的遗忘综合征，但可能会导致显著但更为微妙的“语义”记忆丧失。我们的数据突出了外侧和内侧颞叶结构对人类记忆处理的独特且可分离的贡献，并表明颞叶前下部新皮质机制在知识获取、存储和检索方面发挥着重要作用。
