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1、,Who is this person?,G.P. is a 38 year old right handed man. He was a lawyer with a prominent company in Italy,What went wrong?,While walking, fell unconscious in February 2001. Was taken to the hospital where he regained consciousness a few hours later with anterograde and retrograde amnesia. A few
2、 days later he had enduring problems with anterograde LTM,Neuroanatomy Background Info,MTL injuries- poor episodic memory with either recall or recognition. Show normal scores on STM, semantic, procedural memory. Caused by thalamic lesions which is from disconnection between MTL structures and anter
3、ior thalamus,Background continued,Mammillo-thalamic tract: connects hippocampus of MTL to mamillary bodies and the medial and lateral nuclei of mamillary bodies to anterior thalamic nuclei, which project to limbic cortical areas such as cingulate cortex. VAF pathway: intrathalamic portion of pathway
4、 from amygdala and perirhinal cortex to MD thalamus.,Diagram of mammillo-thalamic tract,Clinical Connections,Claim that some structures in MTL involved in only recall of recent episodic memory, others in recognition Recognition: evidence that perirhinal cortex in parahippocampal gyrus impt. Receives
5、 input from all sensory areas of brain and is important in recgonition of episodic memory Recall: Hippocampus receives cortical inputs from parahippocampal gyrus and then projects to cortical and subcortical regions. Aggleton and Brown (1999): damage to MTT and anterior thalamus cause severe and sel
6、ective damage to recall Damage to MD to thalamus or VAF, problems to recognition,Whats the Nature of the damage,Bilateral thalamic damage. MRI showed two ischemic lesions in anterior medial thalamus. Lesion volumes were 316 and 217mL on right, and 57 and 22mL on left for two different scans. Right t
7、halamic lesion involved MTT Left thalamic lesion involved MTT and ventral anterior thalamic nucleus. MD nucleus spared,MRI of Ischemic Lesions,Aspects of memory impaired,Battery of neuropsychological tests all normal with exception of recognition tests compared to age matched controls Problems with
8、block design and object assembly and object decision subtest. Normal STM, immediate memory intact but delayed episodic is poor WAIS IQ=110 WAIS verbal subtest=133 Overall: impaired declarative episodic memory for verbal and visuo-spatial material. Normal recognition on two choice tests, but poor on
9、yes/no and multiple choice tests. Preserved recognition.,Discussion and Implications,Visuo-spatial problems could be due to larger damage to right hemisphere. MD nucleus spared, which is important in recognition Only damage to MTT, so only problems with recall. Hippocampus only: problems with recall Hippocampus and parahippocampal gyrus: recall and recognition problems,