Susan Oxbury

Amnesia in a patient with bilateral lesions to the thalamus

A case of anterograde amnesia is described in a 38-yr-old man with bilateral thalamic lesions. The patient appeared to have suffered no general intellectual loss and performed normally on standard memory tasks involving immediate recall of new material. There was, however, consistent impairment in recalling material, verbal and non-verbal, over delays as brief as a few seconds. Impairment was especially marked on tests involving free recall and partial cueing procedures; recognition memory was also impaired. Premorbid memory tested normally and susceptibility to interference was less than in other organic amnesics. Various interpretations of the patients amnesia were considered but a deficit at the initial stages of information processing appeared to be indicated.

Levels of processing for visual stimuli in an "extinguished" field.

Volpe et al. (Nature 282, 722, 1979 [19]) described an experimental study of four patients with parietal tumours who were able to judge whether two simultaneous stimuli were identical or different, even when they were unable to name the stimulus contralateral to their brain injury. We report the case of another patient, E.M., in whom we have investigated this phenomenon further. E.M. had undergone a right temporal lobectomy to prevent recurrent seizures. She could correctly name photographs of objects presented in isolation to either the left or right visual field, at 150 msec exposure (although she was impaired for single objects on the left at 10 msec exposures). She was able to judge correctly whether two simultaneous objects on the left and right had the same or different names, even though she was often unable to name the object on the left. These judgements remained above chance when same-name pairs of stimuli showed the same object but seen from two different viewpoints, or even when they showed visually dissimilar exemplars of the same name category. This implies that the patient based her same-different judgements on categorical information about the pair of objects, even though she was often unable to name the contralateral object.

The role of light scatter in the residual visual sensitivity of patients with complete cerebral hemispherectomy.

Various residual visual capacities have been reported for the phenomenally blind field of hemispherectomized patients, providing evidence for the relative roles of cortical and subcortical pathways in vision. We attempted to characterize these functions by examining the ability of five patients to detect, localize, and discriminate high-contrast flashed, flickering and moving targets. Dependent measures were verbal, manual, and oculomotor responses. As a control for light scatter, intensity thresholds for monocular detection of targets in the hemianopic field were compared with thresholds obtained when using an additional half eyepatch to occlude the blind hemiretina of the tested eye. One unilaterally destriate patient was tested on the same tasks. In photopic conditions, none of the hemispherectomized patients could respond to visual cues in their impaired fields, whereas the destriate patient could detect, discriminate, and point to targets, and appreciate the apparent motion of stimuli across his midline. Under reduced lighting, the threshold luminance required by hemispherectomized patients to detect stimuli presented monocularly was similar to that required for their detection when all visual information was occluded in the blind field, and only available to the visual system indirectly via light scatter. In contrast, the destriate patients monocular threshold in his blind field was substantially lower than that for stimuli directly occluded in the blind field. As we found no range of stimuli which the hemispherectomized patients could detect or discriminate that was not also associated with discriminable scattered light, we conclude that the subcortical pathways which survive hemispherectomy cannot mediate voluntary behavioural responses to visual information in the hemianopic field.

Persistent memory impairment following transient global amnesia

A controlled neuropsychological study of 41 patients tested at 6 months after attacks of transient global amnesia (TGA) revealed no evidence of general intellectual, immediate (short-term) memory or nonverbal memory impairment. The patient groups performance was, however, significantly worse than that of the controls on measures of verbal memory notably immediate, 30-minute and 24-hour delayed paragraph recall. In addition, tests of public and personal remote memory revealed significant impairment of naming and recognition of famous faces, and of dating famous events without evidence of a temporal gradient, and impairment of cued recall of autobiographical memories on the Modified Crovitz Test. These findings suggest that following TGA there is persistent, albeit mild, hippocampal-diencephalic dysfunction which appears to involve left-sided structures preferentially. This impairment probably results from the attack, although a pre-existent deficit cannot be excluded.

Severe amnesia : An unusual late complication after temporal lobectomy

A patient developed the severe amnesic syndrome 8 years after temporal lobe surgery for epilepsy. He underwent left temporal lobectomy (6 cm, 43.5 g; hippocampal sclerosis) aged 19, and remained seizure free for 8 years until a convulsion followed a head injury. He became severely amnesic after a fourth convulsion 16 months later. He was right-handed, pre-operative IQ was average, verbal memory poor and non-verbal memory normal. Post-operatively, these were unchanged. After the first post-operative seizure he began professional training. After onset of amnesia IQ was unchanged, anterograde memory severely impaired and retrograde amnesia dense for at least 16 months. He died 2 years later. Magnetic resonance imaging before amnesia showed absence of anterior left temporal lobe, atrophy of left fornix and mamillary body, and normal right temporal lobe. Four months after onset of amnesia, right hippocampal volume had reduced by 36%. Autopsy showed: previous left temporal lobectomy with absence of left amygdala and hippocampus, atrophy of fornix and mamillary body; neuronal loss in the right hippocampus, severe in CA1 and CA4; intact right amygdala and parahippocampal gyrus; recent diffuse damage associated with cause of death. A convulsion can cause severe hippocampal damage in adult life. Hippocampal zones CA1 and/or CA4 are critical for maintaining memory and the amygdala and parahippocampal gyrus cortex alone cannot support acquisition of new memories.

Somatosensory extinction for meaningful objects in a patient with right hemispheric stroke

Implicit, high level processing of extinguished objects has often been described in the visual modality. In the tactile domain, however, research on this topic is meagre and it is still uncertain whether processing of tactually presented stimuli can be affected by the same attentional disorders as visual stimuli. In this paper we describe a patient, ENM, with visual neglect and light touch extinction who, in a naming task of objects presented in the tactile modality, simultaneously to both hands, showed extinction for left hand objects. He was, nevertheless, able to make above chance Same/Different judgements on the two stimuli. We also tested two neurologically intact subjects who performed the test wearing a ski-glove on the left hand to impair the recognition of left hand objects. In these subjects, Same/Different judgements were at chance level when recognition rate was as low as that found in patient ENM. This happened when either the objects, although sharing the same name were different in shape (conditions Same-Different) or when the two objects were different with respect to the category name but were actually physically similar (conditions Different-Similar). However, when the objects were either identical or completely different, i.e., in a condition where judgement could be based simply on the physical analysis of the object shape (condition Same Identical and Different Dissimilar), their Same/Different judgements were above chance, despite the tactual deficit. Our conclusion was that patient ENM showed implicit recognition of left hand objects, at least in the Same Different and in the Different-Similar conditions, whereas, in the same conditions, normal subjects with an artificial sensory impairment did not. Our results also show that Same/Different judgements may be, in some conditions, less demanding than naming tasks, as suggested by Farah et al. Furthermore, patient ENM performed the test both with uncrossed and crossed hands. We found that extinction always affected the hand contralateral to the brain damage, although there was a tendency for a decrement of the ipsilesional hand performance in the crossed condition. We discuss these findings with reference to the most recent theories on the existence of a body centered spatial frame of reference.

Hemifield-specific visual recognition memory impairments in patients with unilateral temporal lobe removals

Recent evidence on visual neglect suggests that each hemisphere maintains a retinotopically organized representation of the visual world contralateral to the current fixation point and that this representation is based not only on analysis of the current retinal input but, equally importantly, on information retrieved from memory. This idea predicts that unilateral damage to memory systems should produce a lateralized impairment of memory for the retinotopically contralateral visual world. To test this prediction we examined visual recognition memory performance in the left and right visual hemifields of patients who had undergone partial unilateral temporal lobe removals for the relief of epilepsy, either in the left hemisphere (n = 5) or the right (n = 5). The patients were given complex artificial scenes to remember, constructed of independent left and right halves, and were then tested for recognition of the left and the right halves separately. Stimuli were exposed tachistoscopically throughout and fixation was maintained on a central position. Patients made significantly more errors with half-scenes in the hemifield contralateral to their removal than in the ipsilateral hemifield, an increase of 50% in the error rate on average. The effect was seen equally in patients with left and right removals. This finding supports the idea that visual memory retrieval is retinotopically organized.