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)

while on the subdominant side it does not result in such a manifestation. The left extremities of Környey's patient, a 39 year old left-handed carpenter, became paralyzed abruptly. One month later he became disinterested and absent-minded, he lost his speech initiative. Leri and Mayer reflexes appeared on the left, incontinence of stool and urine supervened. The cerebrospinal fluid was found to be xanthochrome. One and a half year later neurological examination revealed awkwardness of the left hand and severe contracture of the left lower extremity with pyramidal signs. Pneumoencephalography disclosed a cyst in the supplying territory of the left anterior cerebral artery, which involved the Brodman, the output area of cortico-reticular pathways. Based on Fulton's studies he explained by this lesion the disturbance of the fine innervation of the hand and the high grade spasticity. He raised the possibility of apraxia, since on the pneumoencephalograms the genu corporis callosi proved to be atrophic. Sixty years later the clinical consequences of the anterior cerebral artery infarcts were precisely characterized by aid of the imaging techniques. Infarcts on the subdominant side result in acute confusion, motor neglect and hemiparesis, while the infarcts on the left side lead to mutism, transcortical aphasia and hemiparesis with preponderance on the lower extremity (Kumral et al., 2002), just as Környey described the syndrome in his left handed patient. Környey highly estimated Sánthds study (1939) on the sequels of the haemorrhage destructing the corpus callosum and the pcricallosal areas. In this study Sántha described the accurate course of the corticofugal tracts, furthermore, the prefrontal medial psychosyndrome and the akinetic mutism. He regarded the speech disturbance not as an aphasia, but as a disturbance of initiative, as Sprachnegativismus (Sprachstörung welche zwischen einem vollkommenen Mutismus und einer hochgradigen Wortkargheit schwankte). The same phenomenon was denoted by Oppenmheimer as "Unlust zum Sprechen". In Környey's studies (1956, 1957, 1959b) in the treatise of speech negativism the influence of Sántha's observation can be recognized. He found the transection of the fibre system of the corpus callosum to be sufficient for the development of the alien left hand syndrome. Környey returned to the topic of aphasias in 1971 and 1978 while treating neurological syndromes of practical importance. He explained that Jhe lesion to certain cerebral areas regularly involves gnostic disturbances, consequently, the agnosia, as a pathological sign, has a localization value (Környey, 1982). Specific abilities, such as the recognition of face is bound to definite brain areas (bilateral damage of Brodmann 19 and 37)". In Környey's clinic Czopf (1972) studied aphasie patients, exhibiting improvement in their speech achievement using the Wada method. He experienced that the subdominant hemisphere had most probably a role in the course of speech restitution. Környey's standpoint in the question of localization of higher mental functions is carefully restrained: "Those, who tried to interpret memory as a derivate of function of circumscribed brain areas, drove the localization principles to the extremes. Kleist for example was eager to search a localization even for partial composits of self-awareness. He separated circumscribed locations within the orbitocingular area for the physical self consciousness for the individual and collective self

. It is noteworthy that within declarative memory the loss of definite contents can be due to the disruption of certain networks; this observation supports Kleist's view (1934). In case of a bilateral lesion to the thalamus (dorsomedial-, intralaminal nuclei and the mamillotha-