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The case of the amnesic intelligence officer

Published online by Cambridge University Press:  09 July 2009

M. D. Kopelman ,
R. E. A. Green ,
E. M. Green ,
P. D. R. Lewis  and
N. Stanhope
M. D. Kopelman*
Affiliation:
Neuropsychiatry and Memory Disorders Clinic, Academic Unit of Psychiatry, United Medical and Dental Schools, St Thomas's Hospital, London
R. E. A. Green
Affiliation:
Neuropsychiatry and Memory Disorders Clinic, Academic Unit of Psychiatry, United Medical and Dental Schools, St Thomas's Hospital, London
E. M. Green
Affiliation:
Neuropsychiatry and Memory Disorders Clinic, Academic Unit of Psychiatry, United Medical and Dental Schools, St Thomas's Hospital, London
P. D. R. Lewis
Affiliation:
Neuropsychiatry and Memory Disorders Clinic, Academic Unit of Psychiatry, United Medical and Dental Schools, St Thomas's Hospital, London
N. Stanhope
Affiliation:
Neuropsychiatry and Memory Disorders Clinic, Academic Unit of Psychiatry, United Medical and Dental Schools, St Thomas's Hospital, London
*
1Address for correspondence: Dr Michael D. Kopelman, The Neuropsychiatry and Memory Disorders Clinic, Academic Unit of Psychiatry, United Medical and Dental Schools, St Thomas's Hospital, London SE1 7EH.
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Synopsis

This paper describes a patient whose amnesia for an offence (fraud) and two fugue episodes occurred against the background of an underlying organic amnesia. The fugue states conformed in their duration and precipitating factors to previous accounts in the literature. The organic, anterograde memory impairment was attributed to multiple small infarcts and a larger infarction in the left medial temporal lobe, which were evident on MRI and PET scans after the patient had developed transient neurological signs. At follow-up, the anterograde amnesia had persisted, and the patient also showed some difficulty in retrieving autobiographical memories of past incidents or events, although other aspects of his retrograde memory were intact (including his knowledge of facts about his past life and his general knowledge of public events). The difficulty in retrieving autobiographical incidents may have resulted from the presence of a moderate degree of frontal lobe dysfunction or, just possibly, from ischaemia in the left anterior temporal lobe. The persistence of the organic memory impairment and the importance of both the clinical history and neuropsychological testing in assessment are discussed, as well as the need to examine for possible organic factors in patients who may initially appear to manifest purely ‘psychogenic’ memory loss.

Type
Case Report
Information
Psychological Medicine , Volume 24 , Issue 4 , November 1994 , pp. 1037 - 1045
Copyright
Copyright © Cambridge University Press 1994

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