MEMORY DISTURBANCES IN THIRD VENTRICLE TUMOURS
MEMORY DISTURBANCES IN THIRD VENTRICLE TUMOURS
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第三脑室肿瘤的记忆障碍
DOI：
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发表时间：
1954
影响因子：
11
通讯作者：
J. Pennybacker
中科院分区：
文献类型：
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作者：
M. Williams;J. Pennybacker
正如布希(1940)所指出的，脑局部疾病的研究一直具有特殊的兴趣，因为它提出了对伴随的心理障碍的分析可以澄清精神和大脑之间的一些联系的可能性。记忆是一种具有基本兴趣和重要性的精神功能，人们已经做出了相当大的努力来确定这一功能受损所涉及的损害。虽然现在人们广泛认识到，所有形式的智力行为都涉及某种程度的记忆，同时，某种程度的记忆损害总是伴随着智力退化，但我们经常可以观察到，记忆和回忆最近发生的事件的能力似乎受到了与其他精神缺陷完全不成比例的损害。这种病例最早由Korsakov(1889)描述，可以发生在各种不同的临床情况下，但有相当数量的文献表明，伴随的损害往往集中在第三脑室的底部和两侧。因此，在对那些一生中表现出慢性酒精中毒所致Kors‘ak；v’s精神病的患者的尸检研究中，Gamper(1928)发现大多数病变集中在这一区域，而Campbelj1d Russell(1941)指出，在韦尼克病变的临床病史中，急性混乱和健忘症状态非常常见。同样，布希(1940)通过对662例未选定肿瘤患者的精神障碍的分析得出结论，记忆受损虽然与颅内压升高没有密切关系，但在第三脑室周围的脑内病变中最常见。也不时有论文报道因局部损害而导致的个别健忘症病例，这些病例均经手术或尸检证实。在这些情况下。病变一直是深中线病变，累及第三脑室周围的灰质(Foerster和Gagel，1934；Lhermitte，Doussinet和Ajuiaguera，1937；Hermann，1950；Benedek和Juba，1941；Conrad和Ule，1951；Sprokin和Sciarra，1952)。在Foerster和Gagel报告的颅咽囊肿病例中，一旦囊肿排空并手术切除囊壁，精神症状就会消失。然而，与这些报告相比，还有许多其他观察表明，记忆障碍是弥漫性和广泛性脑损伤的常见和非特异性后遗症。Carmichael和Stern(1931)检查了五名据说表现出科萨科夫综合症的患者的大脑，并注意到组织学变化主要出现在前额叶的皮质。只有一例在丘脑有额外的病变。Walther-Biiel(1951)研究了600例未经选择的肿瘤患者的精神障碍，发现主要由记忆障碍组成的“器质性心理综合症”发生在所有40岁以上的人中的绝大多数。McFie和Piercy(1952)对局限性脑损伤患者进行了系统的心理学研究，他们还得出结论，无论要保留的材料或病变的位置，普遍的保留失败是最常见的缺陷。最后，对与第三脑室胶体囊肿相关的精神症状的具体研究表明，尽管记忆障碍在少数情况下可能是严重和突出的症状，但通常完全不存在，除非作为手术后立即的短暂体征(凯恩斯和莫斯伯格，1951；波彭，雷耶斯和霍拉克，1953)。然而，这些肿瘤生长在脑室的前上部，并可能阻塞脑室的孔。脑室的侧壁可能受到压力，但底部通常会逃逸。本文的目的是报告进一步的观察结果，我们认为这些观察结果可能表明特殊的记忆障碍可能是由第三脑室区域的局灶性病变引起的。自1950年6月至1952年6月，180例手术证实为颅内病变的患者中，有115例发生颅内病变。
As has been stated by Busch (1940), the study of localized disease of the brain has always had especial interest because it raises the possibility that analysis of the concomitant psychological disorders may clarify some of the connexions between mind and brain. A mental function of basic interest and importance is that of memorizing, and considerable efforts have been made to define the lesions involved in impairment of this function. Although it is now widely recognized that some degree of memory is involved in all forms of intellectual behaviour, and, at the same time, some degree of memory impairment always accompanies intellectual deterioration, cases are not infrequently observed in which the ability to retain and recall recent events seems to be impaired out of all proportion to other mental defects. Such cases, first described by Korsakov (1889), can occur in a variety of different clinical conditions, but there is a considerable volume of literature suggesting that the accompanying lesions tend to centre around the floor and sides of the third ventricle. Thus, in the necropsy studies of patients who during their lives had shown Kors'ak;v's psychosis from chronic alcoholism Gamper (1928) found that the majority of lesions were concentrated around this area, while conversely Campbellj1d Russell (1941) noted that in the cffinical history of patients with Wernicke's lesions acute confusional and amnesic states were extremely frequent. Again, Busch (1940) concluded from his analysis of the mental disturbances seen in 662 unselected tumour cases that impaired memory, while not closely associated with raised intracranial pressure, .was most frequent in the intracerebral lesions surrounding the third ventTicle. Papers have also appeared from time to time reporting individual cases of amnesic statesOdue to localized lesions which were verified by operation or at necropsy. In these instances. the lesion has always been a deep mid-line one,'involving the grey matter around the third ventricle (Foerster and Gagel, 1934; Lhermitte, Doussinet, and Ajuriaguerra, 1937; Hermann, 1950; Benedek and Juba, 1941; Conrad and Ule, 1951; Sprofkin and Sciarra, 1952). In the case reported by Foerster and Gagel, that of a cranio-pharyngeal cyst, the mental symptoms cleared up as soon as the cyst was emptied and the cyst wall surgically removed. As against these reports, however, there are also a great many other observations indicating that the impairment of memory is a frequent and nonspecific sequel to diffuse and widespread brain damage. Carmichael and Stern (1931) examined the brains of five patients said to have exhibited Korsakov's syndrome and noted that the histological changes were chiefly seen in the cortex of the prefrontal areas. In only one case were there additional lesions in the thalamus. Walther-Biiel (1951) studied the psychiatric disturbances in 600 unselected tumour cases and found that the " organic psycho-syndrome ", consisting largely of memory impairment, occurred in the vast majority of all those over 40 years old. McFie and Piercy (1952), from a systematic psychological study of patients with localized brain lesions, also concluded that general failure of retention, irrespective of the material to be retained or locus of the lesion, was the most common defect. Finally, specific studies of the mental symptoms associated with colloid cysts of the third ventricle indicate that, although memory disorders may be severe and outstanding symptoms in a few cases, they are more usually completely absent except as transitory signs immediately after operation (Cairns and Mosberg, 1951; Poppen, Reyes, and Horrax, 1953). These tumours, however, grow fronm the anterior-superior part of the thi;d ventricle and may occlude the foramina of Mon The side walls of the ventricle may be subjected to pressure, but the floor usually escapes. It is the aim of this paper to report further observations which we consider may indicate that specific disorders of memory may arise from focal lesions in the region of the third ventricle. Between June, 1950, and June, 1952, 180 patients in whom intracranial lesions were verified at operation, 115 P rocted by coright.