Anatomy of Neuropsychiatry: The New Anatomy of the Basal Forebrain and its Implications for Neuropsychiatric Illness

207 Pages·2007·3.98 MB·English

by  Lennart Heimer

ANATOMY OF
NEUROPSYCHIATRY
THE NEW ANATOMY OF THE BASAL
FOREBRAIN AND ITS IMPLICATIONS
FOR NEUROPSYCHIATRIC ILLNESS
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ANATOMY OF
NEUROPSYCHIATRY
THE NEW ANATOMY OF THE BASAL
FOREBRAIN AND ITS IMPLICATIONS
FOR NEUROPSYCHIATRIC ILLNESS
Lennart Heimer, M.D.
Professor Emeritus, Department of Neurological Surgery
University of Virginia, Charlottesville, Virginia
Gary W. Van Hoesen, Ph.D.
Professor Emeritus, Departments of Anatomy and Cell Biology
and Neurology
University of lowa, lowa City, lowa
Michael Trimble, M.D.
Professor of Behavioural Neurology
Institute of Neurology, Queen’s Square, London
Daniel S. Zahm, Ph.D.
Professor, Department of Pharmacological and Physiological Science
Saint Louis University, St. Louis, Missouri
AMSTERDAM (cid:129) BOSTON (cid:129) HEIDELBERG (cid:129) LONDON
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Library of Congress Cataloging-in-Publication Data
Anatomy of neuropsychiatry / Lennart Heimer . . . [et al.].
p. ; cm.
Includes bibliographical references.
ISBN 978-0-12-374239-1 (alk. paper)
1. Neurobehavioral disorders—Physiological aspects. I. Heimer, Lennart.
[DNLM: 1. Mental Disorders. 2. Brain—anatomy & histology. 3. Brain—physiology.
4. Nervous System Diseases. 5. Neural Pathways—anatomy & histology. 6. Neural
Pathways—physiology. WM 140 A535 2007]
RC386.2.A48 2007
616.8—dc22
2007031556
British Library Cataloguing-in-Publication Data
A catalogue record for this book is available from the British Library.
ISBN: 978-0-12-374239-1
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to Lennart in memoriam
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TABLE OF CONTENTS
PREFACE xi
ABOUT LENNART HEIMER xvii
ACKNOWLEDGMENTS xix
1
The Limbic System: A Concept in Perpetual Search for
a Defi nition 1
1.1 The Birth of the Limbic System 1
Clinical Box 1. History of the Limbic System 4
1.2 The Continuing Evolution of the Limbic System 6
1.3 Why Isn’t the Cerebellum an Integral Part of
the Limbic System? 9
1.4 The Evolution of the Limbic System: No End
in Sight 10
Clinical Box 2. Cerebellum and Limbic System from a
Clinical Perspective 10
2
The Eroding Relevance of the Limbic System 15
2.1 The Triune Brain Concept and the Controversy
Surrounding It 15
vii
viii TABLE OF CONTENTS
Basic Science Box 1. Neuroanatomical Methods 17
2.2 The Limbic System and the Controversy Surrounding It 19
Clinical Box 3. The Problem with the Limbic System 21
2.3 New Anatomical Discoveries Provide an Alternative to
the Limbic System 23
2.4 Conclusion 26
3
The Anatomy of the Basal Forebrain 27
3.1 Introduction 27
3.2 The Ventral Striatopallidal System 37
Basic Science Box 2. Discovery of the Ventral
Striatopallidal System 39
3.3 Parallel Cortico-Subcortical Reentrant Circuits
(“Basal Ganglia Loops”) 47
Clinical Box 4. Small-Celled Islands: Clinical-Anatomical
Correlations 49
Clinical Box 5. Reentrant Circuits in a Clinical Context 54
3.4 The Extended Amygdala 56
Basic Science Box 3. Discovery of the Extended Amygdala 58
3.5 Septal-Preoptic System 62
Basic Science Box 4. The Extended Amygdala:
A Contested Concept 63
3.6 The Magnocellular Basal Forebrain System
(Basal Nucleus of Meynert) 65
3.7 Summary 67
4
The Greater Limbic Lobe 69
4.1 Limits, Topography, and Related Concepts 69
4.2 The Greater Limbic Lobe 71
4.3 The Nonisocortical Character of the Limbic Lobe 74
Clinical Box 6. The Insula 74
Clinical Box 7. Cingulate Gyrus 77
TABLE OF CONTENTS ix
4.4 The Olfactory System of the Limbic Lobe 79
4.5 Other Sensory Input to the Limbic Lobe 82
Clinical Box 8. Smell and Its Signifi cance in the Clinical Setting 82
Basic Science Box 5. Precuneus 85
4.6 Limbic Lobe Output 86
Clinical Box 9. Limbic Lobe in a Clinical Context 86
Clinical Box 10. Entorhinal Cortex 90
Clinical Box 11. Amygdala 93
4.7 Concluding Remarks 95
Clinical Box 12. Hippocampus 96
Clinical Box 13. Interictal Personality Disorder 99
5
Cooperation and Competition of Macrosystem Outputs 101
5.1 Basal Forebrain Functional-Anatomical Systems
(Macrosystems) Revisited 101
5.2 Reticular Formation and Behavioral Synthesis 105
Clinical Box 14. Pontine and Mesencephalic Lesions 107
5.3 Macrosystem Outputs 108
Basic Science Box 6. An Instructive Corner of the Rat
Magnocellular Basal Forebrain 115
Basic Science Box 7. A Question of Direct Projections 122
5.4 Interactions between Macrosystems 125
Basic Science Box 8. Some Examples of Relevant
Technical Considerations 127
5.5 The Problems of Subdivision, Boundaries, and
the Reductionist Approach 130
5.6 Some Functional Considerations and Concluding Comments 132
Clinical Box 15. Disorders of Motivation 134
Clinical Box 16. Subcortical Versus Cortical Psychopathologies 135
LITERATURE CITED 141
INDEX 171