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INTRODUCTION

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Emotion may be defined as any feeling state—for example, fear, anger, excitement, love, or hate—associated with certain autonomic, mainly visceral bodily changes. If the emotion is intense, there may ensue a disturbance of intellectual functions, that is, a disorganization of rational thought and a tendency toward a more automatic behavior of unmodulated, stereotyped character.

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In its most easily recognized human form, emotion is initiated by a stimulus, real or imagined, the perception of which involves recognition, memory, and specific associations. The emotional state that is engendered is mirrored in a psychic experience, that is, a feeling, which is purely subjective and known to others only through the patient’s verbal expressions or by judging his behavioral reactions. This behavioral aspect, for which we use the term affect, is in part autonomous (hormonal–visceral) and in part somatic and shows itself in the patient’s facial expression, bodily attitude, vocalizations, or directed voluntary activity. In other words, the components of emotion appear to consist of (1) the perception of a stimulus, which may be internal (an idea) or external, (2) the feeling, (3) the autonomic–visceral changes, (4) the outward display (affect), and (5) the impulse to a certain type of activity. In many cases of neurologic disease, it is not possible to separate these components from one another.

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Anatomic Considerations

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The occurrence of abnormal emotional reactions in the course of disease is associated with lesions that preferentially involve certain parts of the nervous system. These structures are grouped under the term limbic and are among the most complex and least understood parts of the nervous system. The Latin word limbus means “border” or “margin.” Credit for introducing the term limbic to neurology is usually given to Broca, who used it to describe the ring of gray matter formed primarily by the cingulate and parahippocampal gyri that encircles the corpus callosum and underlying upper brainstem. Actually, Thomas Willis had pictured this region of the brain and referred to it as the limbus in 1664. Broca preferred his term, le grand lobe limbique, to rhinencephalon, which was the term then in vogue and referred more specifically to structures having an olfactory function. Neuroanatomists have extended the boundaries of the limbic lobe to include not only the cingulate and parahippocampal gyri but also the underlying hippocampal formation, the subcallosal gyrus, and the paraolfactory area. The terms visceral brain and limbic system, introduced by MacLean, have an even wider designation and more completely describe the structures involved in emotion and its expression; in addition to all parts of the limbic lobe, they include a number of associated subcortical nuclei such as those of the amygdaloid complex, septal region, preoptic area, hypothalamus, anterior thalamus, habenula, and central midbrain tegmentum, including the raphe nuclei and interpeduncular nucleus. The major structures that constitute the limbic system and their relationships are illustrated in Figs. 24-1 and 24-2.

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