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)

medial longitudinal fasciculus, and defined the course of the brainstem's tracts including vestibulo-ocular connections which control the horizontal gaze. 2. The symptomatology of aphasias and of focal cortical lesions. In the 19

th century the researchers of aphasia and speech disorders considered the speech ability as an executive action of circumscribed centres that are connected by unidirectional tracts. Lichtheim (1885) postulated, following Wernicke (1874) an auditory, and, following Broca (1865), a motor centre, and placed the centre of concept above these. The motor centre could get impulses only from the auditory and concept centres, while the concept centre only from the auditory one. Realizing the absurdity of this postulate concerning the loud speech, Lichtheim modified the scheme so that between the concept and auditory centres reciprocal connections must exist. Környey turned his attention first in 1956 to the problems of aphasia (Környey, 1956). His study on speech disorders following the damage of the corpus callosum and the medial part of the frontal lobe was presented as a lecture at the medical section of the Hungarian Academy of Sciences and it was published in 1957. He quoted and analyzed a case of Picks atrophy, published earlier by Simonyi (1951). Környey initiated his description as follows: "The basic observation, from which we started, was the echolalia that can sometimes be observed in some cases with aphasia. In the literature a few cases are known, in which aphasia combined with echolalia occurred when a focal lesion was situated in the supplying territory of the anterior cerebral artery"

. In the following he explained that this sign could not be the result of the sole destruction of the corpus callosum and mentioned: "that we may artificially produce e.g. in the course of several surgical interventions and the agenesis of the corpus callosum does not evoke a speech disorder". After having criticized Liepmann's cases (1913), he presented three of his own. The speech disorder of Case 1 corresponded with a transcortical motor aphasia. It was difficult to explain, why echolalia developes in motor aphasia despite the severely inhibited spontaneous speech. According to Környey "this can be interpreted as a forced or liberation phenomenon"

. He cited here the human experiments of Penfield and Roberts (1959), who could elicit vocalisation as well as speech inhibition using electrical stimulation of the frontal supplementary motor areas. In Case 2 forced crying and laughing were observed, but in the last three days "his aphasia became complete" (akinetic mutism?). X-ray studies disclosed bilateral infarcts involving the areas supplied by the anterior cerebral arteries. The patient performed the nonverbal logical tests with remarkable speed, in contrast to the severe disturbance of the loud verbal output. Környey recognized that the injury of the left (dominant) hemisphere more frequently induced echolalia. In agreement with Penfield he realized that the lesion of the supplementary motor area is responsible for the decreased speech initiative. The precedent of this topic can be found in a publication of his, written in Miskolczy's clinic in Szeged (Környey, 1940). In this study he cited the experience of Poppen (1939) who ligated the left anterior cerebral artery, in the course of tumour operations in 8 patients, and observed a "permanent stale of coma" in all of them, which according to his description most probably was the clinical manifestation of akinetic mutism. Poppen, the neurosurgeon, emphasised that the ligation of the left arterial branch is dangerous for the conscious state,