Abstract
In humans and non-humans primates, extensive evidence supports the existence of subcortico-cortical circuits for cognition and behavior. Lesions studies are critical to understand the clinical significance of these functionally segregated circuits. Mapping these circuits from lesion studies is difficult given the heterogeneous etiology of the lesions, the lack of long-term and systematic testing of cognitive and behavioral disturbances, as well as the scarcity of neuroimaging data for identifying the precise location and extent of subcortical lesions. Here, we report the long-term follow-up study of a patient who developed a loss of psychic self-activation associated to a dysexecutive syndrome following resuscitation from cardiac arrest. Neuroimaging revealed extensive bilateral lesions in the putamen, with a relative spare of the caudate, and exhibiting a dorsoventral gradient that was predominantly rostrally to the anterior commissure and spared most of the ventral striatum. In comprehensive neuropsychological and neuropsychiatric assessments, we observed dissociation between the improvement of the self-activation deficits and the stability of the dysexecutive syndrome. The pattern of recovery after this lesion lends support to current models proposing the existence of two main subcortico-cortical circuits: a dorsal circuit, mostly mediating cognitive processes, and a ventral circuit, implicated in motivation.
Highlights
Loss of psychic self-activation (LPSA) is a syndrome characterized by striking reduction in spontaneous motion and speech, almost complete lack of initiative, absence of spontaneous mental activation of any kind, subjective “mental emptiness,” loss of interest for previously motivating activities, and apparent emotional flatness or poor expressiveness of affect (Laplane et al, 1984; Fronto-Subcortical Circuits for Cognition and MotivationDe Witte et al, 2008)
This report presents a case of LPSA and dysexecutive syndrome following a cardiac arrest. 3 years after the cardiac arrest, LD exhibited dissociated improvement of his condition
magnetic resonance imaging (MRI) scan revealed bilateral lesions predominantly in the putamen with a clear a dorsoventral gradient sparing most of the ventral striatum
Summary
Loss of psychic self-activation (LPSA) is a syndrome characterized by striking reduction in spontaneous motion and speech, almost complete lack of initiative, absence of spontaneous mental activation of any kind, subjective “mental emptiness,” loss of interest for previously motivating activities, and apparent emotional flatness or poor expressiveness of affect LPSA has been often associated with dysexecutive syndrome (Laplane, 1990), some patients show isolated behavioral disorder without cognitive dysfunction (Mori et al, 1996). We report the case of a patient suffering of LPSA associated to a dysexecutive syndrome following resuscitation from cardiac arrest. The 3-year follow-up study, comprising neuropsychological and neuropsychiatric assessments, revealed a significant regression of the behavioral symptoms without concomitant recovery of the cognitive syndrome. Simple everyday living activities, he still had significant difficulties in planning and performing more complex actions, for which he depended on external control His speech was less hypophonic, less accelerated, and more intelligible compared to previous neurological examinations. The Obsession and Compulsion Evaluation Scale scores did not change between the two examinations, with both scores reflecting the presence obsessive compulsive-like symptoms
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