Di Renzi E, Lucchelli F, Muggia S, Spinnler H
Department of Neurology, University of Modena, Italy.
Neuropsychologia. 1997 Jun;35(6):781-94. doi: 10.1016/s0028-3932(97)00018-3.
Following a car accident, a patient remained unconscious for approximately 20 min and confused for a few hours. When he could be questioned, he was found to have lost all past memories. The retrograde amnesia covered his whole life and concerned autobiographic events as well as famous facts and encyclopaedic knowledge. It also partially involved the verbal and visual lexicon. Reading, writing and counting were no longer possible. The profound impairment of retrograde memory contrasted with the preservation of anterograde memory, which permitted the patient to reacquire some of the notions he had lost, without, however, recovering the feeling of a personal experience of autobiographical information. Four years later, the retrograde deficit was unmodified, except for what had been relearnt. The search for data in support of an organic or psychological aetiology was negative. No signs of brain damage were apparent at the neurological examination and on CT, MRI and SPECT. On the other hand, there was no evidence of a psychiatric history, psychological stress or emotional precipitants that could substantiate the hypothesis that the patient derived a primary or secondary gain from amnesia. We propose that cases of focal retrograde amnesia, similar to the present one, deserve to be classified separately from organic and psychogenic forms under the label of 'functional' retrograde amnesia, a syndrome in which the threshold of activation of premorbid memories is abnormally raised by the trauma, leaving the encoding and retrieval of new memories unaffected.
一场车祸后，一名患者昏迷了约20分钟，随后又迷糊了几个小时。当能够对他进行询问时，发现他丧失了所有过去的记忆。逆行性遗忘涵盖了他的一生，涉及自传性事件以及著名事件和百科知识。它还部分涉及语言和视觉词汇。阅读、写作和计数都不再可能。逆行性记忆的严重受损与顺行性记忆的保留形成对比，顺行性记忆使患者能够重新掌握一些已丧失的概念，但却无法恢复对自传性信息的个人体验感。四年后，除了已经重新学习的内容外，逆行性缺陷没有改变。寻找支持器质性或心理性病因的数据的结果为阴性。神经学检查以及CT、MRI和SPECT检查均未发现脑损伤迹象。另一方面，没有证据表明存在精神病史、心理压力或情绪诱因能够证实患者从失忆中获得原发性或继发性获益这一假设。我们建议，类似于本例的局灶性逆行性遗忘病例，应与器质性和心因性形式分开，归类为“功能性”逆行性遗忘，这是一种综合征，其中病前记忆的激活阈值因创伤而异常升高，而新记忆的编码和检索未受影响。
