The role of the thalamus in amnesia: a tractography, high-resolution MRI and neuropsychological study.

Although it is well established that thalamic lesions may lead to profound amnesia, the precise contribution of thalamic sub-regions to memory remains unclear. In an influential article Aggleton and Brown proposed that recognition memory depends on two processes supported by distinct thalamic and cortical structures. Familiarity is mediated by the mediodorsal (MD) thalamic nucleus and the entorhinal/perirhinal cortex. Recollection is mediated by the anterior thalamic nucleus (AN), the mamillothalamic tract (MTT) and the hippocampus. The authors also suggested that the lateral dorsal nucleus (LD) may contribute to the thalamic/hippocampus system, thereby implying that the LD may play a role in recollection. Given the finding that material specific amnesia can occur following thalamic lesions, we tested an extension of the Aggleton and Brown model. We predicted that patients with bilateral lesions with a bias to the left or right MD or AN/MTT/LD may exhibit impaired familiarity or recollection on verbal or non-verbal memoranda. We report two patients with highly focal thalamic lesions and profound memory impairments affecting verbal and non-verbal memoranda. For the first time, diffusion-weighted imaging was employed to perform tractography of the MTT along with high-resolution anatomical MRI and detailed assessments of verbal and non-verbal memory. Our data support only some aspects of the Aggleton and Brown model. Both patients had left MD nucleus and AN/MTT lesions and performed poorly on familiarity and recall for verbal memoranda, just as predicted by the model. However, both patients' performance for non-verbal memoranda (human faces and topography) is more difficult to reconcile with the model. Patient 1 had damage to the right AN/MTT/LD with sparing of the MD: familiarity should therefore have been preserved but was not. Patient 2 had damage to the right MD with sparing of AN/MTT: recollection should have been preserved but was not. This finding raises the possibility that fractionation of familiarity and recollection to separate thalamic nuclei may not fully capture the role of thalamic sub-regions in memory function.

Visual neglect after right posterior cerebral artery infarction.

OBJECTIVES: To investigate the characteristics and neuroanatomical correlates of visual neglect after right-sided posterior cerebral artery (PCA) infarction. METHODS: 15 patients with acute PCA strokes were screened for the presence of neglect on a comprehensive battery of cognitive tests. Extra tests of visual perception were also carried out on six patients. To establish which areas were critically associated with neglect, the lesions of patients with and without neglect were compared. RESULTS: Neglect of varying severity was documented in 8 patients. In addition, higher-order visual perception was impaired in 5 of the 6 patients. Neglect was critically associated with damage to an area of white matter in the occipital lobe corresponding to a white matter tract connecting the parahippocampal gyrus with the angular gyrus of the parietal lobe. Lesions of the thalamus or splenium of the corpus callosum did not appear necessary or sufficient to cause neglect, but may mediate its severity in these patients. CONCLUSIONS: PCA stroke can result in visual neglect. Interruption of the white matter fibres connecting the parahippocampal gyrus to the angular gyrus may be important in determining whether a patient will manifest neglect.

The impact of deep dysgraphia on graphemic buffer disorders.

This article describes an investigation into the residual writing skills of a severely dysgraphic patient (DA). We found that they were powerfully influenced by a number of lexical variables (lexicality, frequency, imageability, length and geminates). His error pattern was characterized by semantic, lexical, substitution, deletion errors and fragment responses that preserved the first letter. Thus, DA's written spelling was characterized by both deep dysgraphic and graphemic output buffer effects. It is proposed that this pattern of performance represents a new"putative functional syndrome."

Contrast discrimination with pulse trains in pink noise.

Detection performance was measured with sinusoidal and pulse-train gratings. Although the 2.09-cycles-per-degree pulse-train, or line, grating contained at least eight harmonics all at equal contrast, it was no more detectable than its most detectable component. The addition of broadband pink noise designed to equalize the detectability of the components of the pulse train made the pulse train approximately a factor of 4 more detectable than any of its components. However, in contrast-discrimination experiments, with a pedestal or masking grating of the same form and phase as the signal and with 15% contrast, the noise did not affect the discrimination performance of the pulse train relative to that obtained with its sinusoidal components. We discuss the implications of these observations for models of early vision, in particular the implications for possible sources of internal noise.

Contrast discrimination with sinusoidal gratings of different spatial frequency.

The detectability of contrast increments was measured as a function of the contrast of a masking or "pedestal" grating at a number of different spatial frequencies ranging from 2 to 16 cycles per degree of visual angle. The pedestal grating always had the same orientation, spatial frequency, and phase as the signal. The shape of the contrast-increment threshold versus pedestal contrast (TvC) functions depends on the performance level used to define the "threshold," but when both axes are normalized by the contrast corresponding to 75% correct detection at each frequency, the TvC functions at a given performance level are identical. Confidence intervals on the slope of the rising part of the TvC functions are so wide that it is not possible with our data to reject Weber's law.

The effect of a time delay on the measurement of capillary blood gases.

Patients using domiciliary nasal ventilation, or long-term oxygen, require regular assessment which could be carried out in the home. Blood gas analysis may be regarded as an essential part of the assessment. The present study investigated the effect of a 1-h time delay on the measurement of capillary blood gases. Four samples of arterialized earlobe blood were collected from 15 outpatients. One sample was analysed immediately, the other three were stored on crushed ice and analysed at intervals of 30, 45, and 60 min post-collection. In order to examine any range effect, a wide range of PaO2 values were examined. The delay, at all levels, resulted in minor changes in the measurement of PaO2, which would be unlikely to alter clinical management. The technique might be used for the reliable assessment of patients in the home.