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Resumen La prosopagnosia es un tipo de agnosia visual caracterizada por la incapacidad de reconocer los rostros de las personas. Existen básicamente dos variantes, aperceptivas y asociativas. El "efecto Tortoni" es un fenómeno descripto por Bekinschtein y col. hace unos años en mozos de café en Buenos Aires, quienes utilizaban esta herramienta para recordar los pedidos de cada integrante de una mesa. Presentamos un caso de prosopagnosia asociada a lesión temporo-occipital bilateral secundaria a traumatismo encefalocra neano, manifestada en forma inicial por la falta de reconocimiento de rostros, con la utilización de una estra tegia asociativa similar a la descripta en el efecto "Tortoni" como compensación. Mujer de 62 años que sufrió un traumatismo encefalocraneano grave. Pocos meses después del evento, presentó dificultad para reconocer personas conocidas, hecho evidenciado por sus allegados cuando en una mesa los integrantes cambiaron su asiento, permanecieron callados por unos instantes, y posteriormente la paciente continuó nombrándolos por su ubicación previa. En la resonancia magnética de cerebro se objetivaron lesiones contusas de aspecto secuelar en región temporo-occipital bilateral. La prosopagnosia adquirida secundaria a lesiones focales en la región temporo-occipital generalmente bilateral, derecha, y raramente izquierda, es un cuadro poco frecuente. La es trategia utilizada en el "efecto Tortoni" fue en nuestra paciente una de las manifestaciones iniciales del cuadro. La realización de un test neuropsicológico ecológico que considere esta estrategia podría ser de utilidad en el rastreo y detección precoz de esta entidad.
Abstract Proposapnosia is a type of visual agnosia characterized by the inability to recognize people's faces. There are basically two variants, apperceptive and associative. The "Tortoni effect" is a phenomenon described by Bekinschtein et al a few years ago in waiters from Buenos Aires, who used this tool to remember the orders of each member of a table. We present a case of prosopagnosia associated with bilateral temporo-occipital injury secondary to head trauma, initially manifested by the lack of face recognition with the use of an associative strategy similar to that described in the "Tortoni effect" as compensation, in a 62-year-old female who suffered a severe head injury. A few months after this event, the patient had difficulty in recognizing familiar people, a fact evidenced by her relatives when at a restaurant table, they changed their seats, remained silent momentarily, and right after the patient kept naming them by their previous location. The magnetic resonance imaging of the brain revealed blunt sequelae lesions in the bilateral temporo-occipital region. Acquired prosopagnosia due to focal lesions in the temporo-occipital region, generally bilateral and right, and less frequently left, is a rare condition. The strategy used in the "Tortoni effect" was one of the initial manifestations of the condition in our patient. Carrying out an ecological neuropsychological test that considers this strategy could be useful in the screening and early detection of this entity.
Subject(s)
Humans , Female , Middle Aged , Prosopagnosia/diagnosis , Prosopagnosia/etiology , Brain , Magnetic Resonance Imaging , Neuropsychological TestsABSTRACT
Los traumatismos craneoencefálicos constituyen una epidemia silenciosa para la Organización Mundial de la Salud; y en específico, las fracturas de cráneo tienen una incidencia elevada en la sociedad moderna. El objetivo es presentar el caso de una embarazada con una fractura craneal antigua (fractura-hundimiento frontal) que condiciona la indicación de una cesárea electiva. Además, resulta una afectación anatómica poco habitual en la práctica de la Obstetricia. Se presenta una gestante de 22 años que a la edad de 4 años sufrió trauma craneoencefálico al caer accidentalmente desde un cuarto piso. Se impactó en la región frontal del cráneo con un recipiente de cerámica pesado. Quedó inconsciente y con sangrado profuso, se operó de urgencia y la paciente quedó sin secuela clínica de daño cerebral, pero con deformidad craneal por hundimiento de forma ovalada bien delimitada. Se determinó cesárea electiva por orientación del Programa Materno Infantil Nacional a las 40,5 semanas, peso del recién nacido 3 802 g y Apgar 9-9. Tuvo una evolución satisfactoria durante su atención prenatal y puerperio. La valoración y el manejo de una gestante con antecedentes de un traumatismo craneoencefálico antiguo requieren de un seguimiento multidisciplinario que involucre a obstetras, neurocirujanos, neurólogos y otros especialistas, con vistas a evitar las complicaciones que una afección como esta, pueden resultar letales para la madre o el feto(AU)
Cranium cerebral trauma constitutes a silent epidemic for the World Organization of the Health; and specifically skull fractures have risen incidence in the modern society. To present the case of a pregnant woman with an old cranial fracture (front fracture-sinking) that conditions the indication of elective caesarean operation. In addition, it is an unusual anatomical involvement in Obstetrics practice. We present the case of a 22 year-old pregnant that suffered encephalic skull trauma at the age of 4. This trauma is the result of her falling accidentally from a fourth floor to a heavy ceramic recipient and she impacted the front region of her skull. She was unconscious and bled profusely. She underwent urgent surgery. She survived without clinical sequel of cerebral damage but she has cranial sinking deformity in a well-defined oval way. Elective caesarean operation is determined by orientation from the national infantile maternal program to the 40,5 weeks, weight of the newly born 3 802 grams, Apgar 9-9. Satisfactory evolution during their prenatal attention and puerperium. Elective cesarean section is determined at 40.5 weeks, the newborn weight 3 802 g, Apgar 9-9, in alignment with the Cuban national program for the mother and the child. She had a satisfactory evolution during her prenatal and puerperal care. The assessment and management of a pregnant woman with a history of an old cranioencephalic trauma requires multidisciplinary monitoring involving obstetricians, neurosurgeons, neurologists and other specialists, for avoiding complications which can be lethal to the mother or the fetus(AU)
Subject(s)
Humans , Female , Pregnancy , Adult , Cesarean Section/methods , Brain Injuries, Traumatic/epidemiology , Skull Fracture, BasilarABSTRACT
Objective: To predict the targets of the main ingredients in Naozhenning Granule and explore its molecular mechanism of multi-components, multi-targets, and multi-pathways. Methods: Reverse molecular docking (DRAR-CPI) and CooLGeN database were used to predict and screen the targets of Naozhenning Granule; GO enrichment was performed in ClueGO of Cytoscape; KEGG pathway analysis was conducted in DAVID database; The herbs-ingredients-targets-pathways-disease network was constructed in the Cytoscape software. Results: A total of 33 candidate compounds were screened out, and a total of 34 potential targets were revealed for Naozhenning Granule, such as MAPK1, CASP3, and GSK3B. The results of GO enrichment and KEGG pathway analysis indicated that Naozhenning Granule was involved in a series of biological process, such as reactive oxygen species biosynthetic process and positive regulation of smooth muscle cell proliferation as well as some signaling pathways, including PI3K/Akt, MAPK, JAK/STAT, and mTOR. The herbs-ingredients-targets-pathways-disease network suggested that the mechanism of Naozhenning Granule was involved with the regulation of oxidative stress, inhibiting the inflammatory response and the apoptosis of neural cells, regulation of the formation of H2S and the activity of PLG, improving the cognitive function and post traumatic depression. Conclusion: The study suggested that the molecular mechanism of Naozhenning Granule was related with the multi-components, multi-targets, and multi-pathways, which provided a scientific basis for further elucidation of the active ingredients and pharmacological action of Naozhenning Granule.
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Objective To understand cerebral edema and development procedure of different time windows.Methods To analyze their prognosis through image document and operation findings of 52 cerebral trauma patients which were confirmed cerebral edema by CT and operation.Results he light cerebral oedema patients have a better prognosis,10 patients died and 1 patient became a plant man in 11 malignant brain dilatation patients.Conclusion The infernal circle of high brain pressure-cerebral ischemia,cerebral anoxia-cerebral edema result in cerebral edema-brain dilatation-malignant brain dilatation after cerebral trauma which leads to unremitting aggravated pathogenefic condition.So effective means should be used to interrupt the unremitting heightening ICP.
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OBJECTIVE: To evaluate the effectiveness of edaravone for survival of patients with acute cerebral trauma by meta-analysis, in order to give some evidence for dealing acute cerebral trauma. METHODS: Studies that strictly followed and compared the effects of conventional treatments in combination with edaravone and conventional treatments on the survival of patients with acute cerebral trauma were searched. The qualities of the studies were evaluated. Then a meta-analysis was carried out on the qualified studies. The odds ratio (OR) for death of the two treatment regiments was calculate. The effectiveness of edaravone for prolonging the survival of patients with acute cerebral trauma was evaluated. RevMan4.2 software was applied to process data. RESULTS: Totally 7 studies including 427 cases were analyzed. There were 219 patients who received conventional treatments in combination with edaravone, among whom 47 died; while in conventional treatments group there were 208 patients and 70 died. The pooled OR was 0.50 (95% confidence interval 0.32-0.79). CONCLUSION: From the existing clinical evidence, the combination of conventional treatments with edaravone can provide some benefit for the survival of patients with acute cerebral trauma. The overall OR for death decreased by 0.50 in patients receiving combination treatment compared with that for conventional treatments. However, large-scale randomized controlled trials with rigorous design are still needed to verify and support its clinical effectiveness. Copyright 2012 by the Chinese Pharmaceutical Association.
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Background: In Germany, lipoic acid is registered with the indication of “peripheral diabetic polyneuropathy”. This report intends to demonstrate therapeutic activity beyond this indication. In Indonesia, the substance is not registered for therapy. Methods: Three patients (two of them in Germany and one in Indonesia) with pathoneurological symptoms different from peripheral diabetic polyneuropathy were treated with α-lipoic acid: i) post-borelliosis infl ammation with arthritic and paraesthetic symptoms, ii) post-operative (mamma carcinoma) and post-chemotherapeutic sensoric and motoric neural deficits occurring in parallel with additional radiation therapy, and iii) post-traumatic (cerebral) and postoperative (brain surgery) cardiovascular and pulmonary crisis with broad pathoneurological (sensoric and motoric, visual, auditory) deficits and dysarthria. Results: All three patients improved in close correlation with the onset and continuation of lipoic acid intake, whereas other therapeutic measures did not appear very successful. It cannot be ruled out that the other therapeutic regimens applied interacted with lipoic acid in a supporting additive or synergistic manner, because three cases as reported here do not allow for such conclusion; however, separately, or with interaction, lipoic acid helped the patients to recover from their pathoneurological symptoms in the meaning of the traditional medical term “restitutio ad integrum”. Conclusion: In the three cases in this study, lipoic acid was effective in therapy of pathoneurological symptoms different from peripheral diabetic neuropathy. Further confirmative studies are suggeted.
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Cerebral Hemorrhage, Traumatic , Polyneuropathies , Diabetic NeuropathiesABSTRACT
@#Objective To investigate the effect of early hyperbaric oxygen on traumatic basal ganglia infarction in infants and children.Methods 93 cases with basal ganglia infarction after cerebral trauma were reviewed. They were divided into hyperbaric oxygen group (n=60) and control group (n=33). Results 100% of the hyperbaric oxygen group improved, and 93.33% were cured; it was 81.82% and 75.76%in the control group (P<0.05). Conclusion Early hyperbaric oxygen is safe and effective on traumatic basal ganglia infarction in infants andchildren.
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Objective To observe the cardiac function in acute brain injury patients(ABI)and the relationship between ABI and plasma neuropeptideY(NPY),and to inspect the mechanism and find the evidences for preventing cardiac impairment caused by ABI. Methods 89 patients with acute brain injury within 24 hours after the injury were divided into severe group(n =47)and mild group(n = 42)according to Glasgow Coma Scale(GCS),and 35 normal healthy adults were selected as control group.In 24 hours and 72 hours after the brain injury,all patients were examined with echocardiography to observe cardiac structure,Doppler blood flow velocity and cardiac function,and in the same time the plasma NPY were determined by radioimmunoassay.Then the results were compared with controls. Results The parameters of cardiac function such as EF、 SV.AV、CO、CI had statistical change in 24 hours and 72hours after the brain injury between severe ABI group and mild ABI group,and it also had statistical change between severe ABI group and control group(all P <0.05),but no statistical change between mild ABI group and control group(all P ＜0.05).The level of plasma NPY in ABI patients was significantly higher than that before injury,there was statistically different change between severe ABI group and mild ABI group,and it also had statistical change between severe ABI group and control group(all P＜0.05).The parameters of cardiac function was negatively correlated with the rise of plasma NPY by pearson correlation analysis(EF:r =- 0.79,P <0.01; SV:r =- 0.71,P <0.01;AV:r=-0.67,P ＜0.01 ;E/A:r =-0.63,all P ＜0.01)and(CO:r =- 0.32,P ＜0.05;CI:r =-0.35,all P ＜0.05). Conclusion The parameters of cardiac function were significantly decreased in the patients with acute brain injury,and it was closely related with the level of plasma NPY.
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@#Objective TO report a case with aphasia after electric shock and cerebral trauma. Methods A case with aphasia after electric shock and brain trauma was reported.Results and Conclusion After 3 months of speech training, the speech and practical social function of the patient significantly improved.
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@#Objective To observe the effect of therapy combined with rehabilitation approach and acupuncture on cerebral trauma during the recovery stage. Methods 48 cases were divided into two proups: 24 cases in treatment group who applied the rehabilitation combined with acupuncture, the other 24 cases in control group who applied acupuncture alone. They were evaluated with Functional Independent Measure (FIM) 3 months after treatment. Results The scores of FIM were significantly difference between these two groups (P<0.05). Conclusion The therapy combined with rehabilitation approach and acupuncture can improve the recovery of cerebral trauma.
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Objective To discuss the reasons for and preventive methods of acute encephalocele during traumatic cerebral operation.Methods Retrospective analysis of 38 patients with acute encephalocele was made.Results The main cause of acute encephalocele were delayed intracranial hematomas,acute diffuse brain swelling,cerebral contusion and laceration in Sylvain tissue and ischemic anoxia.Conclusion Complete removal of hematoma and delayed hematoma,sufficient decompression and decrease of ICP are effective methods for prevention and treatment of acute encephalocele.
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OBJECTIVE To probe the risk factors of the secondary lung infection in patients of postoperative(cranio)-(cerebral) trauma as well as the ways to control them.METHODS A prospective and review study was carried out in 718 cases with cranio-cerebral trauma admitted in our hospital for operation from Jan 2002 to Dec 2004.RESULTS Among 718 cases,39(5.43%) developed lung(infection),occupied 65% of the total number of the hospital(infection) in the neurosurgery.After an integrated(total and systemic) treatment,the cure rate was(69.23%(27 cases);) effective: 15.3%(6);improved: 7.7%(3); died: 7.7%(3).CONCLUSIONS Oxygen(inhalation,) nasal(feeding),sputum drawing out,(cannular) tracheotomy,and use of respirator after operation are the causes of the lung infection and it can be controlled effectively if keeping the surroundings clean,keeping strict ness in disinfection-isolation institution,improving the mangement of respiratory tract and the care of oral cavity,proper use of antibiotics,and improving immunity.
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@#dl-3-n-Butylphthalide can be applied in many areas of central nervous system diseases,such as cerebral ischemia,cerebral trauma,dysmnesia,convulsion,and so on.This paper reviewed the effect and mechanism of it.
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@#ObjectiveTo investigate the dynamic change of cerebral aquaporin 4 (AQP4) expression level during traumatic brain injury (TBI) in rats and the relationship between AQP4 expression and traumatic brain injury and edema. MethodsThe experimental TBI model was established by bumpiness of free falling body according to Feeney's. The changes of brain water content (BWC) and permeability of blood-brain barrier (BBB) were measured by the methods of wet and dry weight and Evans blue fluorometry. Immunohistochemistry was used to determine the change of expression of AQP4 during different periods after TBI. Results6 h after TBI, water content of brain tissue and EB content in the contusion side significantly increased, and the protein expression of AQP4 in contusion marginal region began to increase. They reached summit 24 h after operation and did not come back normal level 5 d after operation. There was significantly positive correlation between protein expression of AQP4 and change of EB content (r=0.957486,P<0.05). ConclusionThe dynamic change of cerebral AQP4 expression level closely related to the destruction of BBB and the formation of cerebral edema during traumatic brain injury.
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@#ObjectiveTo study the change of cerebral blood flow and hemorheology in patients with brain post-traumatic syndrome (PTS) and heavy cerebral trauma.Methods122 cases(A group) of PTS and 113 cases(B group) of heavy cerebral trauma were explored the anterior cerebral artery (ACA),middle cerebral artery (MCA),posterior cerebral artery (PCA),vertebral artery (VA) and basilar artery (BA) with transcranial Doppler (TCD). Their blood viscosity, plasm viscosity, red blood cell (RBC) deformed exponent were also measured.ResultsThe blood stream in most of patients with PTS manifested slowing especially in MCA,ACA,VA and BA at left. However,most of patients with heavy cerebral trauma manifested vasospasm. The blood and plasm viscosity of both groups obviously increased, but RBC deformed exponent decreased.ConclusionPatients with PTS suffered organic brain damage, mainly in levo-hemisphere.The patients with PTS or with heavy cerebral trauma present disorder in hemorheology.
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Study on 106 patients with mental disorder caused by advanced cranio-cerebral trauma (aged from 16 to 55), treated in the Military Hospital No.103 and National Mental Hospital from 1998 to 2002. These patients have had a history of cranio-cerebral trauma at the age of over 6 years old, with medium and serious level. Results: the prevalence of epilepsy post-injury patients were 16.04%, mental disorders accounted 83.86%. Electroencephalogram (EEG) images were recorded mainly as theta and delta slow waves, amplitude from medium to high, local appearance. It is likely to have an exacerbated image simultaneously and the whole with slow waves or waving thorns, however, there was still a local sign before or after exacerbated stage
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Epilepsy , Craniocerebral Trauma , ElectroencephalographyABSTRACT
Objective To assess the effects of Baclofen plus comprehensive rehabilitation therapy in treating patients with hemiplegic muscle spasticity after cerebral trauma and stroke. Methods Thirty-four patients were divided randomly into two groups. Seventeen patients of therapy group were treated by combining Baclofen and comprehensive rehabilitation therapy, and 17 patients of control group were treated only with comprehensive rehabi-litation therapy. The muscular tension and self-care ability between pretreatment and post-treatment in two groups were assessed by Modified Ashworth Scale and Modified Barthel Index. Results The muscular tension was signi-ficant decreased in patients after treatment ~P
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extensive injury group.The intelligence quotient level of left frontal lobe group was lower than that of the right;PIQ of right temporal lobe group was lower than that of the left,VIQ of right temporal lobe group was higher than that of the left(P
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This paper reports 11 cases died of cerebral injuury. Grossly,various degree of cerebral contusions and subardchnoul hemorrhages were found in 10 cases, hemorrhags of brainstem in 3 cases and of hy-pohalamus in 1 case' Under light and scanning electron microscope, cerebral cortex contusions werefound in 10 cases, contusions and hemorrhages of white matter 3 cm far from the area of cerebral cortex contusbos in 6 cases, contusions of hypohalamus in 8 cases, of pons in 5 cases, of bulb in 4 cas-es, of lateral vertricular wall in 8 cases and of optic nerve in 4 cases. Degeneration, necrosis and is-chemical changes of nerve cells were found in 10 cases. Degeneration, disarrangement, breakage and necrosis of axon and myelin sheath in cerebrun and brainstems were Observed in 9 cases. In 7 out of 9cases, retfract balls of broken axons were seen. The causes of death of the cerebral trauma and the diffrential diagnosis were briefly discussed.
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The astrocyte reaction to cerebral trauma was reviewed in this paper,which included the study model,detection technique,as well as the astrocyte changes in the morphology and metabolism.It was also prospected to their significance in medicolegal expertise.