[Loss of vitality, of interest and of the affect (athymhormia syndrome) in lacunar lesions of the corpus striatum].

Two men in their 6th decade were referred for dramatic changes in their affect and personality resulting from multiple lacunar infarcts bilaterally involving the striatum, especially caudate nuclei, as shown on MRI. These changes included: specific loss of desire and interest toward previous motivations, loss of drive and search for satisfaction, lack of curiosity, loss of tastes and preferences, flattened affect. Interestingly, there were neither the necessary subjective criteria for the diagnosis of depressive syndrome nor major defect in intellectual or cognitive functioning: specifically, language, memory, and psychometric performances were roughly normal. Neither dopaminergic nor antidepressant agents could modify these patients deficits. It is suggested that this syndrome be referred to as "athymhormia syndrome" (from the Greek roots thumos: mood and horme: ardor, spirit, élan), a term coined by Dide and Guiraud to define the behavior of some schizophrenics, ascribed by these authors to a disruption of the so-called "hormothymic system" that they proposed to locate to subcortical brain structures. Referring to similar behavioral changes previously reported with lesions involving bilaterally either the globus pallidus or the periventricular white matter of the frontal lobes, it is proposed that a distinct pathway could constitute the neural substrate of the "hormothymic" system. This pathway, following a cortico-subcortical limbic loop, would include: striatal afferents from the limbic frontal cortex, striatum itself (especially its limbic component), globus pallidus, and dorso-medial thalamic nucleus.