Neurologic Disease by Michael Andrew Meyer

Author:Michael Andrew Meyer
Language: eng
Format: epub
Publisher: Springer International Publishing, Cham

Dr Milner observed over the years that his anterograde amnesia was persistently severe and apparently permanent: “After operation this young man could no longer recognize the hospital staff nor find his way to the bathroom, and he seemed to recall nothing of the day-to-day events of his hospital life. There was also a partial retrograde amnesia, in as much as he did not remember the death of a favourite uncle 3 years previously……. His early memories were apparently vivid and intact. In conversation, the reverted constantly to boyhood events and seemed scarcely to realize that he had undergone an operation…….. In summary, this patient appears to have a complete loss of memory for events subsequent to bilateral medial temporal-lobe resection 19 months before, together with a partial retrograde amnesia for the 3 years leading up to his operation; but early memories are seemingly normal and there is no impairment of personality or general intelligence.” [13]. Dr Milner reported that he likened his problem to, “like waking from a dream … every day is alone in itself…” [14]. Detailed neuropsychological testing revealed he could in fact learn new motor skills, such as accurately tracing patterns that had been reversed by mirrors, but had no recollection learning these skills.

Almost 30 years after the seminal 1957 publication of the HM case by Scoville and Milner came an even more remarkable case report of patient RB who suffered selective ischemic damage to the CA1 sector of the hippocampus (Fig. 6.14). Although displaying little if any retrograde amnesia, the authors of the landmark 1986 paper noted he “exhibited marked anterograde amnesia,….and showed no signs of cognitive impairment other than memory. Thorough histological examination revealed a circumscribed bilateral lesion involving the entire CA1 field of the hippocampus………To our knowledge, this is the first reported case of amnesia following a lesion limited to the hippocampus in which extensive neuropsychological and neuropathological analyses have been carried out” [1].

Fig. 6.14Dark field view of Golgi impregnated silver-stained CA1 sector

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