Thalamic thought disorder: On being ''a bit addled''
Thalamic thought disorder: On being ''a bit addled''
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DOI：
10.1016/s0010-9452(08)70228-4
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发表时间：
1997-09-01
期刊：
影响因子：
3.6
通讯作者：
Mitchell, GW
中科院分区：
文献类型：
--
作者：
Chatterjee, A;Yapundich, R;Mitchell, GW
人类可以在自然话语中产生并保持相对连贯的思维。这种能力的神经中介及其崩溃的现象学还没有得到很好的理解。我们报告一例女性旁正中丘脑中风涉及乳头丘脑束，板内核，部分背内侧和腹外侧核双边。她表现出典型的双侧丘脑旁正中核梗死综合征的严重失忆和意识模糊。她的Tc-99 m HMPAO脑SPECT扫描显示丘脑和基底节血流减少。还观察到脑血流量普遍减少，右额叶、左颞叶和左颞顶区域进一步减少。虽然她的失忆症是间脑性失忆症的特征，但她最显著的临床特征是一种奇怪的、不连贯的、有时不连贯的语言输出。分析她的讲话显示相对保存词汇和形态句法的语言生产。相比之下，对她话语宏观结构的分析揭示了频繁的不可预测的话题转移，完全不受语境因素的限制。她的许多转变都是从以前的主题中侵入的。我们将她严重紊乱的言语输出解释为思维障碍的表面表现（而不是语言障碍本身），其特征是无法保持和适当地改变通常引导话语的主题。中间和intralaminar丘脑核似乎是至关重要的丘脑皮质和纹状体皮质电路的神经生理调节，这反过来可能是至关重要的上下文适当的思维转换的功能调节。
Humans can generate and maintain relatively coherent trains of thought in natural discourse. The neural mediation of this ability and the phenomenology of its breakdown are not well understood. We report a case of a woman with paramedian thalamic strokes involving the mammillothalamic tract, intralaminar nuclei, parts of the dorsomedial and ventral lateral nuclei bilaterally. She presented with a dense amnesia and confusion typical of the syndrome of bilateral paramedian thalamic infarcts. Her Tc-99m HMPAO brain SPECT scan showed decreased thalamic and basal ganglia blood flow. General diminution of cerebral blood flow and areas of further diminution in the right frontal, left temporal and left temporoparietal regions were also observed. Although her amnesia was characteristic of diencephalic amnesia, her most striking clinical feature was a bizarre, disconnected and at times incoherent speech output. Analysis of her speech revealed relatively preserved lexical and morpho-syntactic linguistic production. By contrast, analysis of the macrostructure of her discourse revealed frequent unpredictable topic shifts that were completely unconstrained by contextual factors. Many of her shifts were intrusions from previous topics. We interpret her severely disordered speech output as representing the surface manifestations of a thought disorder (rather than as a language disorder per se) characterized by an inability to maintain and appropriately shift themes that normally guide discourse. Median and intralaminar thalamic nuclei appear to be critical for the neurophysiologic regulation of thalamocortical and striatocortical circuits, which in turn may be critical for the functional regulation of contextually appropriate transitions of thought.