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Showing posts with label H.M.. Show all posts
Showing posts with label H.M.. Show all posts

Thursday, December 3, 2009

H.M.'s Brain

The philosopher Martin Heidegger reasoned in his treatise "Sein und Zeit" that our sense of time confers our sense of being (Heidegger, 1976). Henry Gustav Molaison could attest to that. In order to relieve Henry from severe bouts of epileptic seizures, a part of his temporal lobes had been removed when he was in his late twenties.

The seizures subsided. However, as an unwanted consequence of the surgery, he had lost essential elements of his memory. He could not remember who he was and had to discover his identity anew every day. One day late in his adult life, Henry was caught curiously examining his face in a mirror. He called out in amazement, "I am not a boy!" In Heidegger's words, Henry Molaison had lost his sense of time and, with that, his sense of being.

As patient H.M., Henry volunteered for scientific research throughout his life, becoming one of the most intensely examined cases in psychology. He willed his brain to research. Yesterday a year ago, he passed away of respiratory complications at the age of 82. On the first anniversary of his passing, the histological processing of his brain was begun at the University of California San Diego. The university's Brain Observatory provides live online footage of the sectioning of the frozen whole brain on a cryotome until Dec. 4, 2009. The brain is cut coronally, that is in the transverse plane. Seventy micrometer-thin sections are collected for histology at equally-spaced intervals. At the speed maintained thus far, we shall reach the site of surgery tomorrow.

The ensuing histological examination of his brain will complete Henry's scientific journey as he willed. The findings may provide important insights into the histochemistry of memory, constituting the keystone in the arch of knowledge that H.M. allowed us to build.

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Addenda
  • At 5:00 am (CST), we are in the midst of the temporal lobe of H.M.'s brain. If you look closely at the bottom of the brain (ventral, on the left hand side of the observer), you see cauliflower-shaped protrusions on both sides. These are the temporal lobes. There is a void inside the structures. Parts of the hippocampus seem absent (12/04/09).
  • At about noon, in section 1672 (46,344 micrometers), we can see a cavity in left lingual gyrus (in the hemisphere closest to the observer) (12/04/09).
  • At 5:00 pm (CST), we are entering the occipital lobes; at 10:00 pm we passed the middle of the occipital lobes (12/04/09). 
  • We should be able to detect signs of nerve cell and nerve fiber degeneration in the brain regions that were connected to the brain tissue that was removed or damaged otherwise during surgery, particularly in the structures of the limbic system. Degenerating nerve fibers can be rendered decades after the damage and ameboid microglia may reside in the affected locations (Miklossy and others, 1991). According to von Monakow's concept of diaschisis, the affected regions can be far-flung and distant from the site of immediate damage, comprising the opposite cerebral and cerebellar hemispheres. That is why H.M.'s whole brain needed to be sectioned, and 2,401 sections were collected (12/05/09).
  • The footage covering the sectioning does not seem to be available on The Brain Observatory's site at this time. You may find a CBS report broadcast Dec. 3, 2009, instructive (01/01/10):
  • Brain sections are prepared for histology with two distinctly different methods. One way requires that the tissue is embedded in hot paraffin wax or plastic. The tissue is sectioned at room temperature on a bench top with a microtome or ultramicrotome, respectively. Paraffin embedding is widely used in routine pathology. Plastic is used to embed specimen to be cut into ultra-thin sections for electron microscopy. The other method of tissue preparation requires that the specimen are frozen. Frozen tissue has to be stored and sectioned at temperatures below 0 ℃.

    With either method of preparation, the tissue is commonly first soaked in solutions of formaldehyde, glutaraldehyde or a mixture of both. The aldehydes help bond cellular protein, preserving cellular structure during the further processing steps. H.M.'s brain was then soaked in highly concentrated sucrose solutions and embedded in dextran. Sucrose and dextran are sugars. The sucrose prevents ice crystals from forming in the cells when the tissue is frozen. The growing crystals would otherwise burst the cells. The dextran helps preserve the integrity of the sections, preventing tissue from breaking off the perimeter of the specimen during cutting. Once the brain is fixed and cryo-protected, it can be cut into sections that are only tens of micrometers thick on a microtome on which only the stage holding the brain is kept at subzero temperatures. The sections are picked up from the microtome's knife with a brush and can be processed freely floating in solutions containing the substances needed for the chosen histological staining procedure.

    There are numerous histological staining procedures. Most comprise chemical reactions. Others involve antibodies that bind specifically to cellular proteins or fluorescent dyes that fill particular cellular components. Among the oldest procedures is the silver impregnation method named after  Camillo Golgi, rendering the cell bodies of nerve cells and a good part of their processes (dendrites) and protrusions (dendritic spines). This method helped Ramón Cajal to divide the cerebral cortex into six layers, a distinction that is still used today. Golgi and Cajal were awarded the Nobel Prize for their contributions. The most commonly employed methods, however, are the Nissl stain for cell bodies and the myelin stain that stains the fatty sheeth around nerve cell fibers in the brain's white matter. These methods will certainly be used with some sections of H.M.'s brain. After staining, the sections are mounted on glass slides, dehydrated in solutions of increasing alcohol concentration, embedded in a clear organic solvent-based glue and covered with thin glass coverslips.

    The methods of tissue preparation described above cannot be used when the procedures require that fixation-sensitive cellular proteins remain functional or when water-soluble, diffusible substances are to be localized in the tissue. In that case, the tissue must remain unfixed and immersion in sucrose cannot be used. The tissue has to be shock frozen at -70 ℃ and lower, and the sections must be kept frozen during sectioning. To fulfill this need the whole microtome is encased in a refrigerated cabinet. The instrument is then called a cryostat. Ten or 20 micrometer-thick sections are cut and picked up on chilled glass slides and quickly dried on a hotplate outside the cabinet. The subsequent procedures must consequently be carried out on the slide-mounted sections. This method is used for the autoradiography of diffusible radioactively-labeled tracers. For autoradiography, the sections are exposed to x-ray films or radiation-sensitive semiconductor chips that produce gray-scale images of the distribution of the tracer in the sections. The optical densities in the images called autoradiograms are proportional to the concentration of the tracer in the tissue and can be measured.

    In order to trace metabolites in whole bodies, Sven Ullberg and colleagues at Uppsala University, Sweden, engineered a microtome sufficiently sturdy to cut thin sections through the whole body of small animals. The microtome was placed it in a chest freezer with windows in the lid (Larsson and Ullberg, 1981). The instrument is called a whole-body cryotome and was commercially available from the Swedish company LKB. I was privileged to use a LKB cryotome 30 years ago for functional imaging studies (Melzer, 1984). The picture below shows a whole rat embedded length-wise in dextran and frozen in liquid nitrogen at -173 ℃. The dextran block with the rat is mounted on the sliding stage of the cryotome for sectioning.
    The block of dextran with the rat resembles that with H.M.'s brain in the footage of the Brain Observatory which misled me initially. But as I pointed out, H.M.'s brain was fixed and protected with sucrose. Only the microtome stage had to be cooled. No freezer chest was needed. Jacopo's hands stayed warm.

    One great advantage of whole body sectioning is that the sections render the organs in their actual position inside the body. The picture below shows a the block surface of the head of a sandrat embedded in dextran and cut transversely at the level of the midbrain.
    The structure at the center is the brain. The glassy cavities on both sides of the brain are the inner and middle ears. The middle ear cavities of sandrats are remarkably enlarged compared with other rodents, serving as a low pass filter. The animal had been exposed to sound for functional imaging. Brain activation images are shown in my post entitled "The Quest for the Infrasound Acoustic Fovea" and dated Oct. 12, 2009.

    Since the brain was preserved accurately as it was situated in the scull, we were able to pinpoint brain structures with stereotaxic precision, a goal that may be achieved with structural magnetic resonance imaging today. That method did not exist then.

    In addition to functional imaging, fresh tissue tissue sections permit us to examine the distribution of radioactively-labeled ligands that bind to specific receptors on cell surface or probes that identify sequences of genetic code. These procedures can not be applied to the sections of H.M.'s brain. However, even with the histological techniques available a treasure of knowledge will be uncovered from the brain that Harvey Molaison kindly willed.

    In the past three decades most departments of anatomy have been transformed into departments of cell biology for good reason. However, gazing through a microscope at the multitude of diversely shaped nerve cells in a Golgi-stained section through cerebral cortex still remains as fascinating as gazing through a telescope at the myriad of stars in the night sky. The neuroanatomical methods that make this experience possible resemble in many ways forms of art, though rather of an artisan than of an artist. Perhaps, the work on Harvey's brain will rekindle interest in this type of expertise, paving the way for a renaissance of neuroanatomy (01/02/10).
  • The Allen Institute for Brain Science in Seattle, WA, compiled the first comprehensive atlas of local gene expression in the mouse brain five years ago and has now released a similar atlas for the human brain (04/13/2011):

References



Friday, February 20, 2009

A Theory of Mind II: H.M.'s Memory

In the first installment of this series posted on Dec. 31, 2008, I argued the importance of language for a Theory of Mind. In this installment, I discuss a role for memory.

On Dec. 2, 2008, Henry Gustav Molaison, passed away at the age of 82. H.M., as he became known to scientists around the world, developed seizure activity after an accident at the age of 9 and began to suffer from severe bouts of epilepsy from the age of 16. Since his seizures recurred progressively more frequently and gained in intensity, turning unbearable at the age of 27, the middle temporal lobe of the cerebral cortex was surgically removed from both hemispheres, including parts of the hippocampus and the amygdala.

After surgery, Henry would experience only two other severe seizures in his life, but was a changed man forever. He developed profound amnesia, becoming the subject of intense scientific study for the rest of his life and, since he dedicated his body to science, beyond.

He was well-mannered, could speak eloquently and execute daily routines of hygiene, dress and nourishment. He could mow a lawn and do small household chores. He retained memories of some major historic events before his surgery. He could remember where is family was from. He remembered his name, but he did not know how old he was. He could recall immediate events instantaneously and could judge against internalized references. That is, seeing himself in a mirror he would exclaim: "I am not a boy!" However, he was not able to remember persons or events from the day before and could not make any plans for tomorrow, as if he lived in permanent presence every day anew.

The eminent British psychologist Brenda Milner and her colleagues could demonstrate in elegant series of tests that H.M. was able to learn subconsciously procedural skills involving so-called implicit memory, but could not retrieve declarative explicit memory of episodes in the past. The hippocampus was implicated in the latter type, playing a crucial role in the processing of our conscious thoughts. H.M. retained a sense of self, but could not remember who he was. He had lost a distinct piece of his identity, an essential ingredient of his mind. His neurosurgeon William Beecher Scoville, who strongly opposed this type of surgery after this devastating outcome, and Brenda Milner published their first observations on H.M. in the Journal of Neurology, Neurosurgery and Psychiatry in the late 1950s (Scoville and Milner, 1958).

In 1985, the Swedish neuroscientist David Ingvar published a remarkable essay in the now defunct scientific journal Human Neurobiology on the role of memory and the areas in prefrontal cortex known to be involved in the processing of memory at the time(Ingvar, 1985). About 1970 he, Niels Lassen and others had successfully assembled a scanning device at Bispebjerg Hospital in Copenhagen, Denmark, with which local cerebral blood flow in human cerebral cortex could be mapped non-invasively using radioactive xenon-133 gas as tracer (Lassen, 1985), while the participants were exposed to sensory stimuli or were executing tasks. The Bispebjerg Hospital was set to become the first institution where functional brain imaging would become routine.

In collaboration with Drs. Seymour Kety and Louis Sokoloff at the National Institutes of Health, Drs. Lassen and Ingvar helped pioneer methods used to demonstrate that local cerebral blood flow changes commensurate with metabolic and electric nerve cell activity under normal physiological conditions. Based on this discovery, colleagues at Bispebjerg Hospital would be able to demonstrate later that visual mental imagery, e.g. the navigation of visual scenes in front of the mind's eye, activated many regions of cortex that are ordinarily engaged in the processing of visual input (Roland and Friberg, 1985). They would be able to identify cortical areas activated during the retrieval of memory. One compelling discovery Dr. Ingvar described in his essay in Human Neurobiology was that the same regions in the frontal lobes of cerebral cortex that were activated when people remember episodes in their past were also active when they were asked to make plans for the future. He concluded that there can be no planning of future actions without memory of the past. He called this process forming memories of the future.

Dr. Ingvar's insights inevitably posit that any human invention, any creative process, any idea we form of something unprecedented from mere mental concept to actual implementation hinges on our declarative memory. Indeed, with this wonderful gift we can make dreams come true. Hence, declarative memory must constitute another pillar of a Theory of Mind.

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Addenda
  • On occasion of H.M.'s passing, informative reports appeared in The New York Times on Dec. 4, 2008 (Bendict Carey's article entitled "H. M., an Unforgettable Amnesiac, Dies at 82"), and in the Economist on Dec. 18, 2008 ("Henry Molaison, a man without memories, died on December 2nd, aged 82").
  • National Public Radio's Weekend Edition broadcast a segment on H.M. by Brian Newhouse's with the title "H.M.'s Brain and the History of Memory" on Feb. 24, 2007.
  • In support of Dr. Ingvar's hypothesis, Hassabis and others (2007) observed that amnesic patients with hippocampal damage were unable to imagine future experiences.
  • Joshua Foer tells us about constructing memory palaces in his latest book with the title "Moonwalking with Einstein: The Art and Science of Remembering Everything" just published by Penguin Press, New York. Building memory palaces constitutes an intriguing strategy for retaining excellent memories and may possess profound bearing on a sharper mind. The method was developed in the classical age and rediscovered during the Renaissance. Perhaps, the extraordinary explosion of creativity in the arts and the sciences during that period depended on such strategies to memorize facts in a time when books were still inaccessible to most (03/08/11).
References
  • Ingvar DH (1985) "Memory of the future": an essay on the temporal organization of conscious awareness. Hum Neurobiol 4:127-136.
  • Lassen NA (1985) Cerebral blood flow tomography with xenon-133. Semin Nucl Med 15:347-356.
  • Roland PE, Friberg L (1985) Localization of cortical areas activated by thinking. J Neurophysiol 53:1219-1243.
  • Scoville WB, Milner B (1957) Loss of recent memory after bilateral hippocampal lesions. J Neurol Neurosurg Psychiat 20:11-21.
Example for the Memory of the Future at Work: Treehouse
Son's Idea
Dad's Implemention
Humans perfected this method over generations!