Abstract
Background: Subcallosal artery infarction injures the fornix and anterior corpus callosum and sometimes causes Korsakoff’s amnesia. We hypothesized that Korsakoff’s amnesia might be caused by fornix dysfunction rather than anterior corpus callosum dysfunction in subcallosal artery infarction. Methods: A systematic review approach was applied to search PubMed and Google Scholar for articles to compare patients who had both bilateral fornix and corpus callosum infarction due to subcallosal artery territory ischemia (vascular event group; V group) with patients who had undergone anterior corpus callosotomy (callosotomy group; C group). Results: The V group comprised 10 patients (mean age, 63 years; median, 69 years; standard deviation (SD), 14.5 years; 5 males, 5 females). The C group comprised 6 patients (mean age, 23.7 years; median, 20 years; SD, 7.3 years; 3 males, 3 females). Six of 10 patients (60%) with subcallosal artery infarction exhibited Korsakoff’s amnesia. One patient showed neither confabulation nor amnesia. Conversely, no amnesia episodes were seen in any patients from the C group (p = 0.034). Conclusion: Fornix injury, rather than anterior corpus callosum injury, might be the major cause of Korsakoff’s amnesia in patients with subcallosal artery infarction.
Highlights
Wernicke’s encephalopathy due to thiamine deficiency is well known to lead to Korsakoff’s amnesia, in what is known as Wernicke-Korsakoff syndrome
Case reports have described patients with basal forebrain infarction secondary to subcallosal artery infarction resulting in amnesia [7,8,9,10]
As dysfunction of the corpus callosum itself might cause amnesia [14,15], we cannot conclude that amnesia from subcallosal artery area infarction is due to injury to the anterior fornix
Summary
Wernicke’s encephalopathy due to thiamine deficiency is well known to lead to Korsakoff’s amnesia, in what is known as Wernicke-Korsakoff syndrome. Subcallosal artery injury can exhibit variable symptoms, including amnesia, disturbance of consciousness, personality changes, dysphonia, and Korsakoff’s syndrome [11] Based on these facts, one paper pointed out that “basal forebrain amnesia” was an erroneous term [12]. According to Meila et al, patients with subcallosal artery infarction showing Korsakoff’s amnesia showed both fornix and anterior corpus callosum infarctions [16]. Another case report showed a patient with Korsakoff’s amnesia who displayed complete disconnection of the corpus callosum genu on diffusion tensor imaging [17]. Conclusion: Fornix injury, rather than anterior corpus callosum injury, might be the major cause of Korsakoff’s amnesia in patients with subcallosal artery infarction
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