Kapronczay Károly szerk.: Orvostörténeti Közlemények 198-199. (Budapest, 2007)

TANULMÁNYOK — ARTICLES - SZIRMAI, Imre - GOSZTONYI, Georg: Conceps of Localization of Neurological Functions in István Környei 's Oeuvre. - (Az idegműködések helyhez-köthetöségének elméletei Környei István életművében)

develop in subcortical aphasias. According to Cummings (1993) in vascular dementias, due to the deconnection of the caudate nucleus, globus pallidus and thalamus, furthermore, of the basal ganglia and frontal lobe complex Psychopathologie symptoms may evolve, such as slowing of information processing, disturbance of memory and disattentive behavior. 3. Localization of the disturbances of consciousness Környey's study on the disturbances of consciousness (1965), was presented first as a lecture at a Conference of the Hungarian Medical Association excels in precision and great care. He simply surmounts the conflict between the esthetic-philosophical and biological interpretation of consciousness: "The state of consciousness can only be judged from the contents of consciousness"

. At another place he points out: "the prerequisit of the clarity of consciousness is that stimuli enter the central nervous system, and these stimuli undergo processing"

. Környey joined to Kretschmer's (1940) concept, which regards the apallic state as the consequence of a widespread damage of the cerebral cortex, with his own observation: "we frequently observe the apallic stale in pathologic conditions, in which there is a widespread destruction of the neurons of the frontal lobe"

. He mentioned the case of a patient with war injury, whose frontal lobe was destructed by a bullet. His signs were similar to "the apallic state described by Kretschmer In this context we refer to the cases of anterior cerebral artery infarcts, as mentioned earlier in Dandy's and Poppen's works. The damage to the dominant hemisphere, or its disconnection with sodium amytal results in a more severe disturbance of consciousness, than the same lesion to the subdominant hemisphere. Among the members of the Schajfer's school Hechst Horányi (1932) studied the sleep mechanism. In this publication he analyzed the case of a patient suffering from a haemangioma which destroyed the midline structures of the thalamus and the mesencephalic tectum. Based on a study by Angyal (1930) the typical signs of akinetic mutism were used to explain the organic origin of katatonia. Környey, referring to the brain stem integrative systems quoted Horányi's (1963) study, in which he criticised Penfield's "centrencephalic integrative system-theory"

. Horányi resumed that Penfield "dethroned the cerebral cortex and raised the brain stem activating system to the high position of the central integration"

. Thus, Horányi postulated that Penfield was looking for a place for the soul concept, ergo revitalized the dualistic theory. Horányi pointed out that a neurophysiological concept cannot be accepted if it contradicts certain neurohistological facts. Therefore, he studied the structure of the reticular formation. At the end of his argumentation he concluded: "The substantial part of consciousness is definitely a cortical function". At this point he reached a hazardous field, where he tried to find connections between the pathology of psychoses and delirium with the functional disturbance of the brain stem integrating system. Nowadays we learned that this theorem of Horányi was near to the truth. Környey's (1965) concept of consciousness is much more pragmatic. He cited the observations of Fischgold and Maltis, furthermore, those of Mollarel about the coma states. He interpreted the "anoxic" processes as global ischemia, when he described his observation of a patient, who was in the state of akinetic mutism for 7 days following cardiac arrest. Widespread necrosis of the thalamus was also found in this patient. Környey clearly recognized