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 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.
Natbrainlab, Department of FANS, Institute of Psychiatry, Psychology and Neuroscience and Brain Connectivity and Behaviour, Brain and Spine Institute, Paris, France Inserm U 1127; UPMC-Paris6, UMR_S 1127; CNRS UMR 7225, CRICM, GH Pitié-Salpêtrière, 75013 Paris, France.
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Thiebaut de Schotten
Natbrainlab, Department of FANS, Institute of Psychiatry, Psychology and Neuroscience and Department of Neuroimaging, Institute of Psychiatry, King's College London, London, UK.
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Dell'Acqua
Natbrainlab, Department of FANS, Institute of Psychiatry, Psychology and Neuroscience and.
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Ratiu
Natbrainlab, Department of FANS, Institute of Psychiatry, Psychology and Neuroscience and Department of Neuroimaging, Institute of Psychiatry, King's College London, London, UK.
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Leslie
Natbrainlab, Department of FANS, Institute of Psychiatry, Psychology and Neuroscience and Department of Neuroimaging, Institute of Psychiatry, King's College London, London, UK.
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Howells
Centre Hospitalier National d'Ophtalmologie des Quinze-Vingts, Paris, France.
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Cabanis
Centre Hospitalier National d'Ophtalmologie des Quinze-Vingts, Paris, France.
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Iba-Zizen
University of Paris-Descartes, GH Pitié-Salpêtrière, URDIA, EA4465, Paris, France.
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Plaisant
Department of Neuroimaging, Institute of Psychiatry, King's College London, London, UK.
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Simmons
VA Northern California Health Care System, Martinez, CA, USA Department of Neurology, University of California, Davis, CA, USA National Research University Higher School of Economics, Russian Federation.
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Dronkers
Department of Brain and Cognitive Sciences, Massachusetts Institute of Technology, Cambridge, MA, USA.
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Corkin
Natbrainlab, Department of FANS, Institute of Psychiatry, Psychology and Neuroscience and Department of Neuroimaging, Institute of Psychiatry, King's College London, London, UK.
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Catani
D001921:Brain / Q000473:pathology*; D003657:Decision Making / Q000502:physiology; D004644:Emotions / Q000502:physiology; D049672:History, 19th Century; D049673:History, 20th Century; D049674:History, 21st Century; D006801:Humans; D007802:Language; D008279:Magnetic Resonance Imaging; D008297:Male; D008568:Memory / Q000502:physiology; D009462:Neurology / Q000266:history*; D012886:Skull / Q000473:pathology*; D013577:Syndrome; D066127:White Matter / Q000473:pathology*
behavioral neurology; brain lesion; diaschisis; disconnection syndromes; white matter