Bilateral limbic system destruction in man

Abstract

We report here a case study of a rare neurological patient with bilateral brain damage encompassing a substantial portion of the so-called "limbic system." The patient, Roger, has been studied in our laboratory for over 14 years, and the current article presents his complete neuroanatomical and neuropsychological profiles. The brain damage occurred in 1980 following an episode of herpes simplex encephalitis. The amount of destroyed neural tissue is extensive and includes bilateral damage to core limbic and paralimbic regions, including the hippocampus, amygdala, parahippocampal gyrus, temporal poles, orbitofrontal cortex, basal forebrain, anterior cingulate cortex, and insular cortex. The right hemisphere is more extensively affected than the left, although the lesions are largely bilateral. Despite the magnitude of his brain damage, Roger has a normal IQ, average to above-average attention, working memory, and executive functioning skills, and very good speech and language abilities. In fact, his only obvious presenting deficits are a dense global amnesia and a severe anosmia and ageusia. Roger's case presents a rare opportunity to advance our understanding of the critical functions underlying the human limbic system, and the neuropsychological and neuroanatomical data presented here provide a critical foundation for such investigations.

Figure 1

Coronal slices of Roger's brain. Note: All MRI images use standard radiological convention (left side=right hemisphere & right side=left hemisphere)

Figure 2

Sagittal slices of Roger's brain. Note: All MRI images use standard radiological convention (left side=right hemisphere & right side=left hemisphere)

Figure 3

Axial slices of Roger's brain. Note: All MRI images use standard radiological convention (left side=right hemisphere & right side=left hemisphere)