RESUMO
A longitudinal study of three patients with CT-scan documented paramedian thalamic infarctions (bilateral, primarily right, unilateral left) is reported and the neuropsychology of human paramedian thalamic infarction is reviewed. The neuropsychological deficits following these selected lesions, the nature of the clinical memory disorder, and the neuroanatomy of memory are discussed. The significance of cortical/subcortical relationship in explaining observed behavioral changes is emphasized. Brain damage with maximum involvement in the dorsomedial nuclei and mamillothalamic tracts appears to cause primarily a memory disorder and frontal-limbic behavioral changes, the severity and profile of deficits depending on lesion extent and location. Both anterograde and remote memory loss may be present. Asymmetry in memory at the level of the thalamus was observed, following the left-verbal, right-nonverbal dichotomy.
Assuntos
Amnésia Retrógrada/psicologia , Amnésia/psicologia , Infarto Cerebral/psicologia , Transtornos Neurocognitivos/psicologia , Testes Neuropsicológicos , Doenças Talâmicas/psicologia , Tálamo/irrigação sanguínea , Idoso , Nível de Alerta , Atenção , Aprendizagem por Discriminação , Feminino , Humanos , Masculino , Rememoração Mental , Pessoa de Meia-Idade , Orientação , Retenção PsicológicaAssuntos
Encéfalo/fisiologia , Aprendizagem , Estimulação Acústica , Adulto , Eletroencefalografia , Potenciais Evocados , Humanos , Masculino , Percepção VisualAssuntos
Lobo Frontal/fisiologia , Afasia Acinética/fisiopatologia , Afasia/fisiopatologia , Apraxias/fisiopatologia , Atenção/fisiologia , Conscientização/fisiologia , Encefalopatias/fisiopatologia , Encefalopatias/psicologia , Lesões Encefálicas/fisiopatologia , Cognição/fisiologia , Lobo Frontal/anatomia & histologia , Lobo Frontal/fisiopatologia , Humanos , Idioma , Memória/fisiologia , Córtex Motor/fisiologia , Destreza Motora/fisiologia , Vias Neurais/fisiologia , Personalidade , Psicocirurgia , Sensação/fisiologia , Tálamo/fisiologia , Percepção Visual/fisiologiaRESUMO
Bilateral anterior paramedian thalamic infarction resulting from occlusion of a bilaterally distributed thalamosubthalamic paramedian artery was demonstrated on CT in two patients. Patient 1 presented with a transient coma followed by asterixis, hypersomnia, vertical gaze disturbances, profound Korsakoff amnesic syndrome, and a subcortical dementia. Patient 2, with a predominantly right-sided thalamic infarct, showed good recovery from amnesia and vertical gaze disturbances. However, patient 1 remained with severe amnesia and mild subcortical dementia at follow-up 1 year later. These and similar reported cases constitute a lacunar syndrome with characteristic clinical and CT features.