From Phineas Gage and Monsieur Leborgne to H.M.: Revisiting Disconnection Syndromes

On the 50th anniversary of Norman Geschwind's seminal paper entitled 'Disconnexion syndrome in animal and man', we pay tribute to his ideas by applying contemporary tractography methods to understand white matter disconnection in 3 classic cases that made history in behavioral neurolo...

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Published in:Cerebral cortex (New York, N.Y. 1991) N.Y. 1991), 2015-12, Vol.25 (12), p.4812-4827
Main Authors: Thiebaut de Schotten, M, Dell'Acqua, F, Ratiu, P, Leslie, A, Howells, H, Cabanis, E, Iba-Zizen, M T, Plaisant, O, Simmons, A, Dronkers, N F, Corkin, S, Catani, M
Format: Article
Language:English
Subjects:
Brain - pathology
Decision Making - physiology
Emotions - physiology
History, 19th Century
History, 20th Century
History, 21st Century
Humans
Language
Magnetic Resonance Imaging
Male
Memory - physiology
Neurology - history
Skull - pathology
Syndrome
White Matter - pathology
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Summary:On the 50th anniversary of Norman Geschwind's seminal paper entitled 'Disconnexion syndrome in animal and man', we pay tribute to his ideas by applying contemporary tractography methods to understand white matter disconnection in 3 classic cases that made history in behavioral neurology. We first documented the locus and extent of the brain lesion from the computerized tomography of Phineas Gage's skull and the magnetic resonance images of Louis Victor Leborgne's brain, Broca's first patient, and Henry Gustave Molaison. We then applied the reconstructed lesions to an atlas of white matter connections obtained from diffusion tractography of 129 healthy adults. Our results showed that in all 3 patients, disruption extended to connections projecting to areas distant from the lesion. We confirmed that the damaged tracts link areas that in contemporary neuroscience are considered functionally engaged for tasks related to emotion and decision-making (Gage), language production (Leborgne), and declarative memory (Molaison). Our findings suggest that even historic cases should be reappraised within a disconnection framework whose principles were plainly established by the associationist schools in the last 2 centuries.
ISSN:1047-3211
1460-2199
DOI:10.1093/cercor/bhv173