额前皮质内侧区和眶回损伤后恐惧情绪管理改变的初步分析

目的 探讨额前皮质内侧区和眶回局限性损伤后恐惧情绪控制的变化模式及其神经结构基础.方法 对7例额前皮质内侧区和眶回损伤的病例进行MRI影像和心理测评比对分析,并进行统计描述.对照组为5例MRI影像正常的轻度颅脑创伤患者.结果 所有7例额前皮质内侧区和眶回损伤后患者均表现有情绪控制力下降,明显的反社会人格,对死亡的恐惧几近下降,攻击性显著增强,尤以2例眶回局限性损伤的患者表现突出.对照组中所有病例的情感等高级认知功能均正常,无反社会人格表现,恐惧管理表现正常,图片知觉整合能力正常,自我控制能力正常,无恐惧情绪控制异常.结论 额前皮质内侧区和眶回负责恐惧信息的评价,该部位损伤后可导致异常的主观情感状态和社会行为,因而额前皮质内侧区和眶回可能与恐惧信息的评价有关.

Initial analysis of changes in fear mangement after circumscribed injury of orbitofrontal cortex and medial region of prefrontal cortex

Objective To initially analyze the changes in fear management and neural network after circumscribed injury of the orbitofrontal cortex and medial region of prefrontal cortex. Method The correlation analysis between MRI features and psychological tests was performed in 7 cases with injury of orbitofrontal cortex and/or medial region of prefrontal cortex. The control group included 5 patients with mild brain trauma and without abnormal feature on MRI. Results Patients with injury of orbitofrontal cortex and/ or the medial region of prefrontal cortex showed obvious extinction on emotion control and fear emotion for death, obvious antisocial personality, enhancement of aggression, and depression, in which two patients with circumscribed injury of orbitofrontal cortex showed predominant changes in fear management. The control group was normal in fear management Conclusions Impairments of orbitofrontal cortex and medial region of prefrontal cortex may disrupt the evaluation of fear.