Short-form alternatives to the Judgment of Line Orientation Test.

The Judgment of Line Orientation Test (JLO; Benton, Hamsher, Varney, & Spreen, 1983) is frequently used as a motor-free method of evaluating visuospatial processing but can be time-consuming to administer. We investigated the internal consistency, validity, and utility of two parallel JLO short forms in a mixed clinical sample of 386 patients. Mean scores were equivalent, and correlational analyses supported the internal consistency and validity of both short forms. When compared to the standard JLO, the odd- and even-item short forms demonstrated good sensitivity, specificity, overall hit rate and predicted positive and negative accuracy. We conclude that the JLO short forms possess sufficient internal consistency, validity, and utility for serial assessment in research studies. The JLO short forms may potentially be used in clinical screening situations by applying a single cut-off score to differentiate levels of performance. However, more detailed clinical use of these JLO short forms will necessitate collection of normative data in order to generate accurate percentile rankings.

Neuroimaging criteria for vascular dementia.

OBJECTIVE: To examine published imaging criteria that separate cranial computed tomographic (CT) scans into grades of increasing support for a diagnosis of vascular dementia (VaD). DESIGN: Patients were divided into 4 grades of increasing extent of vascular lesions on CT. The frequency of VaD was compared between these grades. SETTING: A university department of neurology. PATIENTS: Forty-two consecutive patients who underwent neuropsychological assessment for possible dementia and who had a CT scan performed within 6 months following any stroke causing dementia. Patients with delirium, severe aphasia, and motor and/or sensory deficits that impaired neuropsychological testing and patients with mass lesions or nonvascular white matter disease shown on CT were excluded. MAIN OUTCOME MEASURE: The National Institute of Neurological Disorders and Stroke and the Association Internationale pour la Recherche et l'Enseignement en Neurosciences criteria for probable VaD. RESULTS: The frequency of VaD was greater in patients with grade 1 (7 [50%] of 14, P = .01), grade 2 (2[50%] of 4, P = .2), and grade 3(7[78%] of 9, P = .002) scans than the frequency of VaD with grade O scans (1[7%] of 15). There was a linear association of the frequencies of VaD between imaging grades (P = .0008). In a subgroup of patients with neuropsychological deficits caused by cerebrovascular disease, there was a linear association of the severity of the deficits between imaging grades (P = .007). CONCLUSIONS: We conclude that our criteria can separate CTs into increasing levels of support for a diagnosis of VaD. The extent of vascular lesions on CT reflects the severity of associated neuropsychological deficts.

Reversible amnesia associated with a left temporal hematoma in a case of right temporal complex partial seizures.

We report the case of a 44-year-old woman with complex partial seizures (CPS) of right frontotemporal origin who developed generalized amnesia after undergoing intracranial electrode implantation complicated by left hippocampal hemorrhage. Serial memory testing disclosed recovery from the amnesic disorder, while repeated magnetic resonance imaging (MRI) showed resolution of her left hippocampal hemorrhage in a 2-month period. A second intracarotid amytal procedure confirmed the capability of her left temporal region to support memory. Consequently, a right orbitofrontotemporal lobectomy was performed without complication.

Cognitive impairment following closed head injury.

Cognitive impairments are usually the most disabling sequelae of CHI. The earliest stage of recovery from moderate to severe closed head injury is a period of PTA that typically includes memory loss for events preceding and surrounding the injury and memory loss for events occurring since the injury. Following resolution of PTA, deficits may be present in a number of cognitive domains. Memory and attention/information processing speed and efficiency are typically the cognitive domains most severely affected by head injury. Intellectual, language, and perceptual skills tend to be relatively preserved. Neurologic variables such as pupillary reactivity and worst GCS score are prognostic of cognitive impairment at 1 to 2 years postinjury. Following mild head injury, impairments of memory and information processing may be apparent within the first week of recovery. These deficits usually resolve in 1 to 3 months, although chronic complaints persist in a minority of individuals. The long-term cognitive effects of CHI are typically more severe for younger children than older children. Neuropsychologic assessment provides an objective way to measure the presence and severity of cognitive impairment.

Visuospatial judgment and right hemisphere disease.

The performances of patients with stroke-produced unilateral hemispheric lesions on a test requiring the identification of lines were examined in the light of a recent report that contradicted previous observations. The study confirmed the results of earlier studies that patients with lesions of the right hemisphere show a remarkably high frequency of defective performances while those with lesions of the left hemisphere do not. Possible reasons for findings that deviate from this rule are discussed.