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Ron C. Kupers, PhD; Audrey Fortin, PhD; Jens Astrup, MD; Albert Gjedde, MD; Maurice Ptito, PhD, DM

Arch Neurol. 2004;61:1948-1952.

Background  Studies of the amnesic syndrome have indicated that telencephalic and diencephalic structures are critical components of the memory system. The exact role of the mammillary bodies (MBs) in human memory remains elusive, since few cases of selective MB damage have been reported.

Objective  To study a case of severe anterograde amnesia due to a third-ventricle craniopharyngioma with severe MB compression.

Design  Case report.

Setting  Neurosurgery clinic of an academic hospital.

Patient  A 53-year old woman who developed severe anterograde amnesia due to a third-ventricle craniopharyngioma strongly compressing the MBs and, to a lesser extent, the right hippocampus.

Interventions  Surgical excision of the tumor and neuropsychological testing and positron emission tomography during an associative memory test before and 2 months after tumor removal. A postsurgical magnetic resonance image did not show evidence of damage to the hypothalamus, thalamus, hippocampus, or MBs.

Main Outcome Measures  Changes in brain imaging data and results of neuropsychological testing.

Results  After tumor removal, the patient showed a complete recovery of memory functions. Performance on the associative memory test was at chance level before surgery and dramatically improved postoperatively. Results of the preoperative positron emission tomographic study showed no activity in memory-related structures. In contrast, a significant blood flow increase occurred in the anterior thalamic nuclei postoperatively.

Conclusions  These behavioral and brain imaging data stress the importance of the MBs in this patient’s amnesia. Our data further suggest that the clinical prognosis of decompressing the mammillothalamic tract is excellent, even in cases of massive compression.

Author Affiliations: PET Center (Drs Kupers, Gjedde, and Ptito), Center for Functionally Integrative Neuroscience (Drs Kupers and Gjedde), and Department of Neurosurgery (Dr Astrup), Aarhus University and Aarhus University Hospitals, Aarhus, Denmark; and Ecole d’Optométrie, Université de Montréal, Montréal, Québec (Drs Fortin and Ptito).

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