Atrophy and decreased activation of fronto-parietal attention areas contribute to higher visual dysfunction in posterior cortical atrophy.

Voxel-based morphometry and functional magnetic resonance imaging demonstrated severe atrophy and decreased activation of visual attention areas and occipital lobes in a patient with early posterior cortical atrophy compared with healthy controls and patients with early Alzheimer's disease. Our complex approach indicates that structures responsible for attention can be damaged early in posterior cortical atrophy and may contribute to the characteristic decline in higher visual functions.

Morphometric changes of gray matter in Parkinson's disease with depression: a voxel-based morphometry study.

The origin of the high rate of depression in idiopathic Parkinson's disease (PD) is unknown. We applied voxel-based morphometry (VBM), as a sensitive tool in detection of gray matter MR density alterations, to find differences in depressed and nondepressed PD patients. Patients with idiopathic PD were classified into depressed (DPD) and nondepressed (NDPD) groups based on the Montgomery-Asberg Depression Rating Scale (MADRS). Subsequently, a group comparisons were performed between depressed PD (n = 23), nondepressed PD (n = 27) and normal healthy controls (NC, n = 16). There was no difference in gray matter density comparing healthy controls to any PD groups. However, when NDPD and DPD cohorts were compared, density alteration of the bilateral orbitofrontal, bilateral rectal gyrus, and also the right superior temporal pole was detected in the depressed subgroup. Exploratory analyses revealed an inverse correlation of MADRS scores and severity of VBM alteration in these regions beside the right medial temporal gyrus, anterior and medial cingular gyrus, and parahippocampal gyrus. These results suggest that depression in PD is related to gray matter decrease in the bilateral orbitofrontal and right temporal regions as well as the limbic system.

Diurnal alterations of brain electrical activity in healthy adults: a LORETA study.

EEG background activity was investigated by low resolution brain electromagnetic tomography (LORETA) to test the diurnal alterations of brain electrical activity in healthy adults. Fourteen right-handed healthy male postgraduate medical students were examined four times (8 a.m., 2 p.m., 8 p.m. and next day 2 p.m.). LORETA was computed to localize generators of EEG frequency components. Comparing the EEG activity between 2 p.m. and 8 a.m., increased activity was seen (1) in theta band (6.5-8 Hz) in the left prefrontal, bilateral mesial frontal and anterior cingulate cortex; (2) in alpha2 band (10.5-12 Hz) in the bilateral precuneus and posterior parietal cortex as well as in the right temporo-occipital cortex; (3) in beta1-2-3 band (12.5-30 Hz) in the right hippocampus and parieto-occipital cortex, left frontal and bilateral cingulate cortex. Comparing the brain activity between 8 p.m. and 8 a.m., (1) midline theta activity disappeared; (2) increased alpha2 band activity was seen in the left hemisphere (including the left hippocampus); and (3) increased beta bands activity was found over almost the whole cortex (including both of hippocampi) with the exception of left temporo-occipital region. There were no significant changes between the background activities of 2 p.m. and next day 2 p.m. Characteristic distribution of increased activity of cortex (no change in delta band, and massive changes in the upper frequency bands) may mirror increasing activation of reticular formation and thus evoked thalamocortical feedback mechanisms as a sign of maintenance of arousal.

[Application of functional MR-images acquired at low field in planning of neurosurgical operation close to an eloquent brain area]. / Alacsony téreron nyert funkcionalis MR-képek alkalmazása elokvens terület közelében végzett idegsebészeti mutétek tervezésénél.

AIM OF THE STUDY: Presentation of functional MRI performed at low magnetic field (1 Tesla) for planning microsurgical operation in a patient suffering from tumor close to an eloquent brain area. METHODS: Microsurgical removal navigated by frameless stereotaxy of an intrinsic tumor located in eloquent area is indicated if speech function is not damaged, i.e. exact localisation and relationship of the tumor and speech area can be defined. Before operation an optimized EPI based 2D sequence was applied to yield functional MR images. At the planning of the operation the paradigm used for the localization of the sensory language cortex contained passive listening to a text. Control investigations were performed one month postoperatively. A specific psychological test, as an additional investigation to estimate the accurate level of the sensory language function, was also conducted. RESULTS: Low resolution (matrix of 64x 64) functional MR images visualized sensory speech center and auditory cortex satisfactorily. The scans showed clearly that the Wernicke's region was situated just above the tumor (WHO grade II glioma), and this finding increased the safety of intraoperative localization and reduced the risk of morbidity. Control examinations revealed minimal decrease in sensory language function, however, it was not noticeable for either the patient or her surroundings. CONCLUSION: Optimized functional MR imaging performed at low magnetic field can support planning of neurosurgical operations and reduce the morbidity of microsurgical interventions.

[Diagnosis and therapy of myotonic dystrophy in our practice of neuromuscular care]. / Neuromuscularis gondozásunkban észlelt dystrophia myotonicában szenvedó betegek ismertetése.

INTRODUCTION: Myotonic dystrophy is the most frequent, autosomal dominantly inherited muscular dystrophy. The typical neurological picture (facial myopathy, myotonia, muscle atrophy) may be associated with cardial, endocrine and ocular symptoms. METHODS: The diagnosis is based on electromyography, muscle biopsy and genetical tests. Muscle histology is characterized by high frequency of central nuclei. Genetical tests detect CTG repeat expansion of the involved gene. AIMS: Authors summarize 9 cases found in the Neurology Clinic of Pecs University in the last three years. RESULTS: The prevalence is lower than expected, therefore some cases might be unrecognized. After recognizing the typical clinical picture, electrophysiological, muscle biopsy, brain MRI, psychologic and molecular genetic studies were performed. Six patients belonged to 3 families and 3 sporadic cases were found. In all except one patient mild neurocognitive deficit was detected. Three patients had cataract and cardiac involvement. CONCLUSIONS: The authors emphasize that in cases of cardial, endocrine and central nervous system involvement myotonic dystrophy must be considered and detailed examinations are necessary for early detection of the specific organ manifestations.

[Early onset dementias: three cases]. / Fiatalkori dementiák--Három beteg kórtörténetének ismertetése.

INTRODUCTION: Dementia is a decline of intellectual abilities. The etiology of dementia syndrome is diverse. The authors describe three patients with early-onset dementia. CASE REPORTS: The first patient was a 44 years old male with mild gait, body ataxia, memory loss, slowness and apathy Investigations proved AIDS dementia syndrome. In the second case of a 37 years old female patient, herpes simplex encephalitis was suspected due to sudden onset of speech arrest and to brain MRI and CSF findings. Her symptoms improved during antiviral treatment but later progressive dementia developed. CSF serological tests proved the presence of neurolues-dementia paralytica. The third patient was a 38-years-old female. Neurological examination was performed because of progressive memory loss, changed behaviour and impaired attention. Neuropsychological test showed severe dementia. Metachromatic leukodystrophy was proven by decreased arylsulfatase activity. CONCLUSIONS: It is not easy to recognize the early symptoms of dementia. In these cases, besides detailed history, neurological examination and neuropsychological tests, brain MRI and cerebral spinal fluid serological tests were indispensable for a correct diagnosis, especially in the young patients.

Subgroup analysis of sex difference on the Vandenberg-Kuse mental rotation test.

A large sex difference has been elicited on the Vandenberg-Kuse mental rotation test. Prior research emphasizes the biological root of this sex difference. In recent experiments we confirmed this viewpoint. A large sample was administered the test, and the distributions of scores for men and women (N = 138; 68 men and 70 women: ages 19 to 23 years). The mean scores were used as cut-off points to group the men and the women in different subgroups (Low/Women, High/Women, Low/Men, High/Men). There were large differences among all subgroups, reinforcing Kimura's testosterone hypothesis for sex differences in spatial ability.

[Brain atrophy and cognitive disorder in multiple sclerosis]. / Agyi atrófia és kognitív zavar sclerosis multiplexben.

Multiple sclerosis (MS) is an autoimmune disease of the central nervous system causing severe disability via the progressive damage of white matter. Beyond physical signs cognitive dysfunction might be present as well. The aim of this study was to investigate the frequency and characteristics of brain atrophy and cognitive alterations. Significant cortical and subcortical atrophy was found on brain MRI of 30 MS patients included in this study comparing to healthy controls. Abnormal findings were detected in more than 60% of patients using a cognitive test battery. Generally, verbal abstraction, visuospatial orientation, attention, short-term memory was impaired and the psychomotor speed was decreased, even in the early stage of the disease. Depression-related complaints were found in 57% of this population. The Kurtzke scale, the atrophy of corpus callosum and widening of 3rd ventricle and Sylvian fissures were related to impaired cognitive performances. The authors would like to call attention to the early cognitive deficit and the need of treatment in MS.

[Neuropsychologic outcome after bilateral pallidotomy in patients with Parkinson disease]. / Parkinson-kóros betegek neuropszichológiai teljesítményének változásai kétoldali pallidotomiát követóen.

INTRODUCTION: Although significant improvement of motor function following bilateral pallidotomy for the treatment of Parkinson's disease has been proved, the cognitive sequelae have not been clearly defined. There are recurrent loops interconnecting specific areas of the frontal cortex and the basal ganglia, suggesting the continuity or complementary functioning between these areas. PATIENTS AND METHODS: Pre- and postoperative cognitive function was evaluated in 19 Parkinsonian patients who underwent bilateral pallidotomy in order to clarify its effects on cognitive function. All patients were evaluated one day before the procedure and 12+ months after surgery using neuropsychological tests (Raven Progressive Matrices and Bergen Facial Recognition Test). Proper performance in these tests requires reasoning, abstraction and spatial memory, involving strongly the frontal functions. These functions could be described in terms of the "working memory" concept. Hand Mental Rotation Test was used as comparing task not involving frontal functions. Scores were analyzed by Student's t-test. RESULTS: Modest improvement was observed in these cognitive functions as assessed by Raven Progressive Matrices (p < 0.0688) and a significant change in the complex parts of Bergen Facial Recognition Test (p < 0.0547; p < 0.0468) was also noticed, but no change was registered in mental rotation tasks. CONCLUSION: Present data revealed that bilateral pallidotomy is associated with modest and long-lasting improvement in tasks involving the "working memory".