Читать книгу A History of Neuropsychology - Группа авторов - Страница 42

In 1906, Pierre Marie published a series of three papers criticizing the classical view of aphasiology [1-3]. In these papers, he proposed a new concept of his own which was against the theory of functional localization of the cerebral cortex. According to him, aphasia was a single pathological condition of intelligence impairment caused by the lesion of the Wernicke area and the so-called Broca’s aphasia was a syndrome consisting of intelligence disturbance due to a lesion of Wernicke area combined with anarthria caused by a lesion located in the “zone lenticulaire.” Thus, he denied the role of Broca’s area the lesion of which was thought to be responsible for expressive type of aphasia crowned by the name of Broca.

The cardinal theoretical base of his new concept of aphasiology was based on 2 anatomo-pathological findings; first, lesions of the Broca’s area did not necessarily cause Broca’s aphasia and second, there were reports of patients showing Broca’s aphasia without any destructive lesion of the Broca’s area. To explain the second point, he showed the famous illustration of “zone lenticulaire” which was the site of anarthria, and also showed cases of Broca’s aphasia with lesion situated in this zone. He also described a case of small hemorrhagic lesion in this zone which had caused only anarthria without true aphasia. According to him, a lesion within the “zone lenticulaire” caused the patient severe anarthria but he did not show aphasia because his Wernicke’s area was intactly preserved, only the lesion of which was thought to produce aphasia.

All of these 3 papers of Pierre Marie showed the famous illustration of “zone lenticulaire,” the lesion of which was responsible for producing anarthria (Fig. 1). However, from the view point of a neuropathologist accustomed to the horizontal sections of autopsied brain [4], his “zone lenticulaire” seems to be very unnatural, because he had shown a big blank space at the level of Sylvian fissure between the frontal lobe and the temporal lobe outside of insula. Actual horizontal slice of human brain at this level usually does not show such vacant space as shown in Marie’s illustration, on the contrary this space is filled with pieces of cortices corresponding to the opercular part and triangular part of the inferior frontal gyrus [4]. Broca’s area consists of Brodmann’s Area 44 and Area 45, the former is located on the opercular part and the latter on the triangular part of the inferior frontal gyrus. Therefore, both of these cortices of Broca’s area are totally missing from the Marie’s illustration of “zone lenticulaire.”

Fig. 1.a Pierre Marie’s illustration showing “zone lenticulaire” (from Marie [1-3]), b the corresponding horizontal brain slice (modified from Matsui [4]).