Estrategias para el empleo optimizado de la neuroimagenología en pacientes con traumatismo encéfalo craneano: puesta al día / Strategies for the optimized use of neuroimaging in patients with head trauma cranial: update

INTRODUCTION: Introduction of current neuroimaging technologies has been essential for the agile and effective diagnosis of cranial brain injuries. However, for various reasons there is a tendency to indiscriminate use. A review of the topic was made aimed at providing an update on the recommended strategies for the optimized use of these technologies. Material and method: A review of the topic of the last five years was made, using the Medline / Pubmed and SciELO platforms of complete articles, in English and Spanish. We also included relevant articles, published in previous years, located in previous bibliographic reviews carried out by the authors. CONCLUSIONS: Routine study with CT scan in all patients with head trauma is not cost effective, should be used in patients with Glasgow less than 15 points or in those with Glasgow of 15 points and risk factors of intracranial injury. Its use as a form of neuromonitoring is similarly useful, but on a selective basis. Magnetic Resonance Imaging is especially useful in the mediate or late periods of cranial trauma, in patients with clinical tomographic incongruences, very useful to establish prognosis in diffuse traumas and intracranial complications. Neurosonology is a useful tool for therapeutic decision.

Protective effects of Ganoderma lucidum on the changes made in the retinal damage induced by traumatic head injury / Efectos protectores de Ganoderma lucidum sobre los cambios producidos en el daño retinal inducido por lesión traumática en la cabeza

Head trauma affects the optic nerve visual function and visual acuity. As a result of head trauma occurring in the retina of the various biochemical, histological and immunohistochemical effects were investigated. The protective effect of Ganoderma lucidum was evaluated on the damage to the retina of the rats. Sprague-Dawley rats were subjected to traumatic brain injury with a weight-drop device using 300 g-1 m weight-height impact. Thirty rats were divided into three groups as group 1 control, 2 group trauma, 3 group trauma+Gonoderma lucidum (20 mL/kg per day via gastric gavage) Ganoderma lucidum was administered for 7 days after trauma.All rats were decapitated 5 days after the induction of trauma, and the protective effects of Ganoderma lucidum in retina were evaluated by histological, immunohistochemical and biochemical analyses. The antioxidant effect of Ganoderma lucidum on the cellular degeneration extracellular matrix and retinal barrier in retina after head trauma was investigated.

El traumatismo craneal afecta al nervio óptico en relación a su función y la agudeza visual. Se estudiaron los diversos efectos bioquímicos, histológicos e inmunohistoquímicos en la retina producidos por una lesión y trauma a la cabeza. En esta investigación se evaluó el efecto protector de Gonaderin lucidum sobre el daño a la retina de ratas. Ratas Sprague-Dawley fueron sometidas a una lesión cerebral traumática con un dispositivo de caída de peso usando un impacto de 300 g-1 m de peso-altura. Treinta ratas se dividieron en tres grupos: grupo 1, de control; grupo 2, trauma; grupo 3, de trauma + Gonoderma lucidum (20 ml / kg día, a través de una sonda gástrica). Ganoderma lucidum se administró durante 7 días después del trauma. Todas las ratas fueron decapitadas 5 días después. La inducción del trauma y los efectos protectores de Ganoderma lucidum en la retina fueron evaluados mediante análisis histológicos, inmunohistoquímicos y bioquímicos. Se investigó el efecto antioxidante de Ganoderma lucidum sobre la degeneración celular en la matriz extracelular y la barrera retiniana en la retina después del traumatismo craneal.

Reconstrução de calota craniana com prótese customizada de PMMA após craniectomias descompressivas / Skull reconstruction with PMMA customized prostheses after decompressive craniectomies

Introdução: A craniectomia descompressiva é uma cirurgia indicada no tratamento da hipertensão intracraniana em situações graves de traumas cranioencefálicos. Esta cirurgia confere uma aparência bizarra ao paciente, como se "parte da cabeça" houvesse sido retirada. Após a regressão do edema cerebral e quando o paciente reunir boas condições clínicas, a reconstrução craniana está indicada. A reconstrução da calota craniana poderá ser realizada com osso autólogo ou com materiais aloplásticos. Este estudo objetiva apresentar a experiência do autor com reconstruções de calota craniana utilizando próteses customizadas de PMMA. Métodos: Foram selecionados 14 pacientes submetidos à craniectomia descompressiva que, após serem liberados clinicamente pela Neurocirurgia, realizaram a reconstrução da calota craniana com próteses de PMMA customizadas por prototipagem entre os anos de 2014 e 2015 e com, no mínimo, 6 meses de pós-operatório. Sinais e sintomas de síndrome do Trefinado, tomografia computadorizada e aparência estética dos pacientes foram analisadas no pré e no 6º mês pós-operatório. Resultados: Todos os pacientes apresentaram melhora sintomatológica, melhora estética e expansão cerebral após a cirurgia. Conclusão: A reconstrução da calota craniana com prótese customizada de PMMA promoveu a melhora dos sinais e sintomas e da aparência estética de todos os 14 pacientes operados. A utilização de protótipos para customizar próteses cranianas facilitou a técnica operatória e possibilitou a recuperação de um contorno craniano muito próximo da normalidade.

Introduction: Decompressive craniectomy is indicated for the treatment of intracranial hypertension in cases of serious traumatic brain injury. This surgery results in a bizarre appearance, as if "part of the head" had been. After regression of cerebral edema and when the patient is in good clinical condition, the reconstruction of the skull is indicated. Reconstruction of the skull can be performed with autologous bone or with alloplastic materials. This study sought to present the experience of the author with skull reconstructions using custom PMMA prostheses. Methods: In between 2014 and 2015, fourteen patients with previous (longer than 6 months) decompressive craniectomies were selected after Neurosurgery medical clearance and underwent skull reconstruction with customized PMMA prototyped prostheses. Signs and symptoms of syndrome of the trephined, computed tomography, and aesthetic appearance of the patients were analyzed preoperatively and at 6 months after reconstruction. Results: All patients presented with improved symptomatology, aesthetic improvement and expansion of the brain after surgery. Conclusion: Reconstruction of the skull with customized prototyped PMMA prostheses improved the signs and symptoms and the aesthetic appearance in all 14 patients of this series. The use of prototypes to customize cranial prostheses facilitates the operative technique and enables patients to develop a nearly normal cranial contour.

Forensic Psychiatric Assessment for Organic Personality Disorders after Craniocerebral Trauma / 法医学杂志

OBJECTIVES@#To explore the occurrence and the differences of clinical manifestations of organic personality disorder with varying degrees of craniocerebral trauma.@*METHODS@#According to the International Classification of Diseases-10, 396 subjects with craniocerebral trauma caused by traffic accidents were diagnosed, and the degrees of craniocerebral trauma were graded. The personality characteristics of all patients were evaluated using the simplified Neuroticism Extraversion Openness Five-Factor Inventory （NEO-FFI）.@*RESULTS@#The occurrence rate of organic personality disorder was 34.6% while it was 34.9% and 49.5% in the patients with moderate and severe craniocerebral trauma, respectively, which significantly higher than that in the patients （18.7%） of mild craniocerebral trauma （P<0.05）. Compared with the patients without personality disorder, the neuroticism, extraversion and agreeableness scores all showed significantly differences （P<0.05） in the patients of mild craniocerebral trauma with personality disorder; the neuroticism, extraversion, agreeableness and conscientiousness scores showed significantly differences （ P>0.05） in the patients of moderate and severe craniocerebral trauma with personality disorder. The agreeableness and conscientiousness scores in the patients of moderate and severe craniocerebral trauma with personality disorder were significantly lower than that of mild craniocerebral trauma, and the patients of severe craniocerebral trauma had a lower score in extraversion than in the patients of mild craniocerebral trauma.@*CONCLUSIONS@#The severity of craniocerebral trauma is closely related to the incidence of organic personality disorder, and it also affects the clinical features of the latter, which provides a certain significance and help for forensic psychiatric assessment.

Pediatric minor head trauma: do cranial CT scans change the therapeutic approach?

OBJECTIVES: 1) To verify clinical signs correlated with appropriate cranial computed tomography scan indications and changes in the therapeutic approach in pediatric minor head trauma scenarios. 2) To estimate the radiation exposure of computed tomography scans with low dose protocols in the context of trauma and the additional associated risk. METHODS: Investigators reviewed the medical records of all children with minor head trauma, which was defined as a Glasgow coma scale ≥13 at the time of admission to the emergency room, who underwent computed tomography scans during the years of 2013 and 2014. A change in the therapeutic approach was defined as a neurosurgical intervention performed within 30 days, hospitalization, >12 hours of observation, or neuro-specialist evaluation. RESULTS: Of the 1006 children evaluated, 101 showed some abnormality on head computed tomography scans, including 49 who were hospitalized, 16 who remained under observation and 36 who were dismissed. No patient underwent neurosurgery. No statistically significant relationship was observed between patient age, time between trauma and admission, or signs/symptoms related to trauma and abnormal imaging results. A statistically significant relationship between abnormal image results and a fall higher than 1.0 meter was observed (p=0.044). The mean effective dose was 2.0 mSv (0.1 to 6.8 mSv), corresponding to an estimated additional cancer risk of 0.05%. CONCLUSION: A computed tomography scan after minor head injury in pediatric patients did not show clinically relevant abnormalities that could lead to neurosurgical indications. Patients who fell more than 1.0 m were more likely to have changes in imaging tests, although these changes did not require neurosurgical intervention; therefore, the use of computed tomography scans may be questioned in this group. The results support the trend of more careful indications for cranial computed tomography scans for children with minor head trauma.

Traumatic arteriovenous fistula of the superficial temporal artery / Fístula arteriovenosa traumática de artéria temporal superficial

Arteriovenous fistulae of the superficial temporal artery are rare, and their principal cause is traumas. Complications include pulsatile mass, headache, hemorrhage and deformities that compromise esthetics. Treatment can be performed using conventional surgery or endovascular methods. The authors describe a case of a 44-year-old male patient who developed a large pulsating mass, extending from the preauricular region to the right parietotemporal and frontal regions after a motorcycle accident. The treatment chosen was complete surgical removal of the pulsatile mass and ligature of the vessels feeding the fistula.

As fístulas arteriovenosas de artéria temporal superficial são raras, sendo o trauma sua etiologia principal. Suas complicações incluem massa pulsátil, cefaleia, hemorragia e deformidade estética. O tratamento pode ser realizado por cirurgia convencional ou endovascular. Os autores relatam o caso de um paciente de 44 anos que evoluiu com massa pulsátil extensa desde região pré-auricular até região parietotemporal e frontal direita após acidente motociclístico. Optou-se por remoção cirúrgica completa da massa pulsátil e ligadura dos vasos nutridores da fístula.

Visibility of Sutures of the Orbit and Periorbital Region Using Multidetector Computed Tomography

OBJECTIVE: Knowledge of cranial suture morphology is crucial in emergency medicine, forensic medicine, and maxillofacial reconstructive surgery. This study assessed the visibility of sutures of the orbit and periorbital region on multidetector computed tomography. MATERIALS AND METHODS: Multidetector computed tomography scans of 200 patients (127 males, 73 females; mean age 51.3 years; range, 6-92 years) were evaluated retrospectively. The slice thicknesses varied from 0.5 to 1 mm, and the tube current from 25 to 370 mAs, depending on the CT indication. The visibility of sutures was estimated according to a 4-point scale from "not visible" to "well visible". The chi-squared test was used to test the association of the visibility of sutures with the slice thickness, tube current, and age of patients. Statistical significance was assumed at p < 0.05. RESULTS: Overall, best visibility was found for the sutura frontozygomatica (98%), sutura frontonasalis (88.5%), and sutura sphenozygomatica (71.5%), followed by the sutura zygomaticomaxillaris (65.8%), sutura temporozygomatica (41.8%), sutura frontomaxillaris (44.5%), and sutura sphenofrontalis (31%). Poor visibility was found for the sutura frontolacrimalis (16.8%) and sutura frontoethmoidalis (1.3%). The sutura ethmoidomaxillaris, sutura lacrimomaxillaris, and sutura ethmoidolacrimalis were not visible. CONCLUSION: Although the sutures of the superior, lateral, and inferior orbit are well visible, those of the medial orbit are poorly visible on CT scans.

Analysis of 28 death cases involved with tumbling injury / 法医学杂志

OBJECTIVE@#To explore the general features and the keypoints of forensic medical examination in tumbling injury cases.@*METHODS@#Twenty-eight cases dying of tumbling injury were collected and the locations and features of injury were analyzed.@*RESULTS@#The occiput of head was the common position for the tumbling injury cases. Force, disease and alcohol were the main reasons for tumbling injury.@*CONCLUSION@#The injury is mild outside and severe inside from tumbling injury cases. The craniocerebral contrecoup is the significant feature in tumbling injury cases.

Numerical reconstruction and injury biomechanism in a car-pedestrian crash accident / 法医学杂志

OBJECTIVE@#To reconstruct a car-pedestrian crash accident using numerical simulation technology and explore the injury biomechanism as forensic evidence for injury identification.@*METHODS@#An integration of multi-body dynamic, finite element (FE), and classical method was applied to a car-pedestrian crash accident. The location of the collision and the details of the traffic accident were determined by vehicle trace verification and autopsy. The accident reconstruction was performed by coupling the three-dimensional car behavior from PC-CRASH with a MADYMO dummy model. The collision FE models of head and leg, developed from CT scans of human remains, were loaded with calculated dummy collision parameters. The data of the impact biomechanical responses were extracted in terms of von Mises stress, relative displacement, strain and stress fringes.@*RESULTS@#The accident reconstruction results were identical with the examined ones and the biomechanism of head and leg injuries, illustrated through the FE methods, were consistent with the classical injury theories.@*CONCLUSION@#The numerical simulation technology is proved to be effective in identifying traffic accidents and exploring of injury biomechanism.

Forensic clinical analysis on 25 cases of traumatic cerebral infarction / 法医学杂志

OBJECTIVE@#To investigate characteristics of forensic clinical identification on traumatic cerebral infarction(TCI).@*METHODS@#Twenty-five cases of TCI were analyzed retrospectively, including the general situation, location of infarction and clinical feature.@*RESULTS@#TCI occurred primarily in children and elderly. All the cases had definite cerebral trauma which was located mainly in the regions of basal ganglia-internal capsule, frontal, temporal and parietal cerebral cortex.@*CONCLUSION@#The consequence of TCI has direct correlation with location of cerebral infarction. More attention should be paid to this issue in forensic practice.

Head injuries in children resulting from the fall of television.

Case records of children admitted with head injury due to TV fall in a pediatric tertiary care hospital in Chennai, during March 2007 – February 2008 were analysed retrospectively. Out of the 11 children admitted 6 (54%) were in 1-2 yr age group. Bleeding from the ear, nose and throat was the commonest, finding followed by a skull fracture, seen on imaging studies. These were observed in 9 (81.81%) and 8(72.8%) children respectively. There was no mortality.

Application of multi-slice computed tomography in biomechanical analysis of traffic accidents / 法医学杂志

OBJECTIVE@#To study the application value of multi-slice computed tomography (MSCT) and 3D reconstruction in biomechanical analysis of traffic accidents in forensic medicine.@*METHODS@#Based on a real case, the tomoscan images were obtained from a corpse by MSCT scanning. The 3D images were reconstructed. The biomechanic process of injury manners of impacting, rolling and crushing in traffic accidents was analyzed together with autopsy, vehicle inspection, etc. The MSCT results were compared with the autopsy results.@*RESULTS@#Some characters in situ including the part of fracture on different site that suffered by force from different directions, trends of fracture line, and status of smash inner bones were obtained trough MSCT and 3D reconstruction. Some details like fracture were even better than those from autopsy.@*CONCLUSION@#MSCT and 3D reconstruction have some advantages such as in situ reconstruction, easily controlled image and fully conserved evidence. It may be a supplementary method and have a directive function for the biomechanical analysis of traffic accidents.

Disability evaluation of 204 cases of children with brain injury in road traffic accidents / 法医学杂志

OBJECTIVE@#To study the types, characteristics and common complications as well as disability assessment for the children with craniocerebral injury in the road traffic accidents.@*METHODS@#Data from 204 cases of children with cranio-injury in road traffic accidents were collected and were statistically analyzed according to the location injured, complication, the type of complication and the severity of disability.@*RESULTS@#There were 64 cases of simple diffuse primary craniocerebral injury, 80 cases of simple local primary cranio-injury, 24 cases of diffuse secondary craniocerebral injury and 36 cases of local secondary cranio-injury. The main complications included traumatic epilepsy (14, 6.9%), traumatic cerebral infarction (9, 4.4%), traumatic hydrocephalus (7, 3.4%) and traumatic mental disorder (5, 2.5%).@*CONCLUSION@#Among the children with cranio-injury due to road traffic accidents, simple primary cranio-injury was the most common result, whereas the traumatic epilepsy and traumatic cerebral infarction were the major types of complications. The assessment criteria for body impairment of the children with craniocerebral injury in the road traffic accidents should be broadened accordingly, with addition of certain specific items for children.

The quantitative analysis of Ub and UbE1 in focus of traumatic epilepsy / 法医学杂志

OBJECTIVE@#To study the expression of ubiquitin proteasome system (UPS) in the traumatic epilepsy pathogenesis and its value in traumatic epilepsy by quantitative analysis.@*METHODS@#Fifteen specimens from human epileptic temporal cortex from PTE were collected as the PTE group. Fifteen specimens from non-PTE were collected as the non-PTE group. Fifteen normal cerebral cortex specimens died from acute traffic accident were collected as the control group. The expression of mRNA and protein of Ub and UbE1 were detected by RT-PCR and Western blot. Statistical analysis was used to compare the data between three groups.@*RESULTS@#The expression of mRNA and protein of Ub and UbE1 were the following order: PTE group(high), non-PTE group(middle) and control group(low).@*CONCLUSION@#The study confirms that UPS is up-regulated in the epilepsy's focus, especially in traumatic epilepsy. The activation of UPS may be an important pathological change in neurons in pathogenesis of traumatic epilepsy.

Secuelas en las funciones ejecutivas posteriores al traumatismo craneoencefálico en el adulto / Executive functions after traumatic brain injury in adults

Las funciones cognitivas, entre ellas las ejecutivas (FE), después de un traumatismo craneoencefálico (TCE) presentan alteraciones, que afecta la vida cotidiana de los pacientes. El propósito del estudio fue evaluar las funciones ejecutivas de pacientes adultos con TCE moderado y severo, para conocer las características neuropsicológicas distintivas de la intensidad de la lesión. Participaron 26 pacientes, 10 con TCE Moderado (edad=34.80+/-14.45; escolaridad=15.20+/-2.525 años); y 16 con TCE Severo (edad=32.17+/-9.42; escolaridad= 12.11+/-4.15 años), pareados por edad y escolaridad con un grupo control sano. Evaluados individualmente con la Batería de Funciones Ejecutivas y Frontales(Flores, Ostrosky-Solís y Lozano, 2008). Los resultados indican que los pacientes con TCE presentan principalmente problemas en el WCST, torre de Hanoi, la Iowa Gambling Task, memoria de trabajo, y habilidades semánticas. Además muestran compromiso en la velocidad del procesamiento de información, comete errores perseverativos, y dificultades en la flexibilidad mental. Los resultados sugieren mayor afección en tareas de la corteza prefrontal dorso lateral. Estos datos permitirán diseñar e implementar programas dedicados a la intervención cognitiva enfocados la mejoría de las FE.

Cognitive functions including executive functions (FE) are affected following a traumatic brain injury (TBI), diminished patient’s daily life. The purpose of the present study was measuring EF of adult moderate and severe TBI patients, and knows the neuropsychological profile related with lesion intensity. Participated 26 patients, divided in 10 with Moderate TBI (age=34.80+/-14.45; education= 15.20+/-2.525 years); and 16 with Severe TBI (age=32.17+/-9.42; education= 12.11+/-4.15 years), matched by age and level of education with a healthy control group. Participants were individually assessing with the Executive Function and Frontal Lobes Neuropsychological Battery (Flores, Ostrosky-Solís y Lozano, 2008). Results show that TBI patients mainly had problems in resolve the WCST, Hanoi Tower, Iowa Gambling Task, working memory and in process semantic information. At the same time shows decreased time in processing information, perseverations,intrusions, and less mental flexibility. Data suggest a major affection on dorso lateral prefrontal cortex tasks. This data would help to design rehabilitation programs to cognitive intervention focused on EF.

Application of confocal laser scanning microscope in forensic pathology / 法医学杂志

Confocal laser scanning microscopy(CLSM) is a new technique for microscopic imaging, which can collect the transverse section image of the samples and produce three-dimensional reconstruction and present higher spatial resolution than the conventional light microscope. As a precision instrument for the microscopic image, it plays an important role in forensic pathology. The article reviews the recent research achievements from sudden cardiac death, bullet wound and nervous system damage, etc, and explores the potential applications of the forensic pathology research and forensic practice.

The application of computed tomography (CT) in postmortem examination / 法医学杂志

Since first application of computed tomography (CT) in postmortem examination in 1990, investigators have been discussing the value and advantage of CT in full-body examination in cadaver. CT examination before autopsy is able to provide not only the informations to guide the autopsy, but also the significant findings to analysis the causes of death, which may be not fount in autopsy. This review focuses on the value of CT in analysis of the death causes, injury manners, and personal identifications in postmortem examination as well as its development in the field of forensic medicine. It is our belief that CT in combination with other newly developed technologies will make more contribution to forensic medicine in the future.

Comparison between application of imaging techniques and autopsy in the identification of injury manner / 法医学杂志

OBJECTIVE@#To explore the application of imaging techniques in determining the death cause and injury manner.@*METHODS@#One case due to high fall was fully examined using multi-slice spiral computed tomography (MSCT), 3-D imaging creation and magnetic resonance imaging (MRI). The systemic and detailed autopsy was subsequently performed to compare with the results from imaging studies. The advantages and disadvantages of autopsy and imaging studies were then analyzed.@*RESULTS@#Most of the important information such as trauma, fracture and hemorrhage could be obtained by imaging techniques. Furthermore, imaging methods can predict injuries in internal body before autopsy and be minimal or non-invasive to the cadaver. However, the imaging techniques probably also can not find some details in comparison to autopsy in forensic practice and need to improve in their future application.@*CONCLUSION@#Application of imaging techniques can be used as the guidance and complimentary for the forensic autopsy in the identification of injury manner. In addition, the application can even be used to replace autopsy in some special circumstances.

El accidente de phineas gage: su legado a la neurobiología

Phineas Gage es a no dudar, uno de los pacientes más famosos de la historia de la neurología, una cita indefectible en textos neurológicos y objeto de numerosos artículos científicos a lo largo de más de ciento cincuenta años. Este caso tan excepcional ha permitido establecer el papel principal que en el pensamiento y en la capacidad de sociabilizar tienen las regiones frontales del cerebro, especialmente la porción ventromedial, así como los circuitos y sistemas relacionados con las emociones, cuya activación conjunta con las regiones frontales, participa de forma fundamental en la planificación y toma de decisiones, y contribuye a determinar el tono afectivo de nuestras relaciones sociales. Una revisión sumaria de la historia de la medicina nos indica que es inusual que el nombre de un paciente y no el del médico que describe una situación clínica, sea mencionado para la posteridad. ¿Por qué entonces se recuerda el nombre de Gage y no el de su médico tratante y acusioso descriptor de su insania, John Martyn Harlow? Quizá porque el caso es todavía considerado como una de las mejores descripciones de un desorden "psicopático" del comportamiento relacionado con una lesión traumática del córtex prefrontal, donde la correlación anatomoclínica ha sido intentada empleando diversas concepciones y métodos a la usanza de los diversos momentos históricos. La ocasión de este relato permitirá al lector pasearse a través de la fascinante evolución y perfeccionamiento de las ideas que han llevado al conocimiento actual de la localización de las funciones neurológicas, y a atisbar el desentrañamiento de los loci de la mente y del espíritu

Phineas Gage is doubtless one of the most famous patients in the history of neurology. An infallible quote in neurology textbooks and the object of numerous scientific articles for over one hundred and fifty years. This exceptional case has allowed investigators to establish the role of the frontal cortex, specifically its ventromedial portion in the development of human thought and his/her capacity to socialize and also the close relationship of these structures with emotion-related circuits and systems which participate in the decision-making process and contributes to determine the affective tone of social interaction. A brief glance at the history of medicine shows it is exceedingly infrequent for a patient's name to transcend into posterity. Why then is the name Gage remembered instead of John Martin Harlow's, the keen describer of Gage's insanity? Perhaps because Gage's case is still considered one of the salient descriptions of a "psychopathic" disorder of behavior directly related to a traumatic lesion of the prefrontal cortex in which an anatomoclinical correlation has been attempted through diverse conceptions and methods tailored to each historical period of time. Gage's tale will take the reader for a ride along the fascinating evolutional pathways of medical thinking that have permitted the acquisition of knowledgeable localization of neurological function and allowed scientists to peep into the entangled realm of the mind and spirit