A 21-year-old lady is found wandering at a public place. She is unaware of her address or any other personal details. She was admitted and later found to be on the missing persons register at a police station 100 miles away. After 4 weeks, she regains normal memory and remembers having lost her mother in a fire accident 6 weeks ago.
Which of the following is true about the nature of her memory problems?
A. The given history is consistent with dissociative fugue. Fugue states are associated with stressful life events wherein total amnesia for the recent past can be seen. More often the amnesia related to dissociation is circumscribed to events of personal importance. During the fugue, the patient may retain normal functional activities and may even learn new verbal and nonverbal materials. Following recovery from the fugue, one may not remember the activities carried out during the fugue state.
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A 63-year-old man with alcohol dependence suffers a serious head injury. On recovery he is found to have unusual behaviours. When a tooth brush is placed in front of him, he immediately begins to brush his teeth, even in entirely inappropriate contexts.
He is exhibiting:
C. This is an example of utilization behaviour. A patient with utilization behaviour will be forced to ‘utilize’ objects presented to him despite the absence of obvious need for such usage. An extreme form of this is seen in ‘environmental dependence syndrome’—the patient becomes compelled to make use of all that is seen in his immediate environment resulting in an array of serial complex behaviour. Klüver–Bucy syndrome occurs in the context of bilateral temporal lobe damage. It is associated with hyper-orality, inappropriate sexuality, and increased exploratory behaviour (hypermetamorphosis). Alien hand syndrome refers to loss of control of limb movements resulting in ‘automatic’ coordinated hand movements. The patient is usually aware of this and may try to exercise control using the other hand. Balint’s syndrome is characterized by oculomotor apraxia, optic ataxia, and simultanagnosia.
The most probable site of a lesion for this patient is:
A. Utilization behaviour is seen in patients with frontal lobe damage. Dominant parietal lobe lesions result in apraxia, right–left confusion, acalculia, and finger agnosia. Balint’s syndrome occurs in bilateral parieto-occipital damage.
A 32-year-old woman with complex partial seizures is referred to a psychiatrist to exclude psychosis. She experiences olfactory hallucinations and intense anxiety.
Which of the following is not correct with regard to complex partial seizures?
D. Temporal lobe is the most common site of origin of complex partial seizures; in very few cases parietal focus has been demonstrated. When accompanied by hallucinations, intense emotional reactions may be seen during the seizure. Fear is the most common emotion noted. Curiously, patients are often aware of the unreal nature of their hallucinatory experiences, but this awareness is not specific to complex seizures. Pathology of familiarity characterized by déjà vu and jamais vu are commonly reported in temporal lobe epilepsy.
A 78-year-old woman presents with fluent progressive aphasia with preservation of new learning and orientation. On follow up she is observed to have progressive difficulties in understanding the meaning of words used during normal conversation.
She is most likely to have:
B. Progressive fluent aphasia early in the course of a dementing illness is a feature of semantic dementia. Semantic dementia is a type of frontotemporal degenerative disorder. The pathological finding is predominantly frontotemporal degeneration with ubiquitin inclusions. Motor neurone disease type inclusions may also be noted. Semantic memory refers to representation of meanings, understanding concepts, and knowledge unrelated to temporal events (cf. episodic memory). Focal cortical deficits, especially progressive aphasia, can be presenting features of Alzheimer’s disease but this is uncommon.
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