Focal brain dysfunction in a 41-year old man with familial alternating hemiplegia.

The acute pathophysiologic changes during hemiplegic spells and the long-term outcome of alternating hemiplegia remain obscure. In a 41-year-old male with familial alternating hemiplegia we found an increase in right frontal cerebral blood flow 3 h into a 5-h left hemiplegic episode. A repeat high-resolution brain SPECT study performed 26 h after the resolution of the left hemiplegia revealed normalization of the frontal blood flow accompanied by hyperperfusion in the right parietal lobe. An interictal SPECT scan several weeks later showed no asymmetries. Head CT and MRI scans were negative. Neuropsychologic assessment and neurologic examination revealed evidence of a diffuse disorder which predominantly involved the right hemisphere. To our knowledge, there are no previous correlative studies of serial high-resolution brain SPECT with MRI, or of detailed neuropsychologic assessment, in adult patients with such an advanced course of alternating hemiplegia of childhood.

Neuropsychological assessment in preoperative and postoperative evaluation.

Neuropsychological assessment in the surgical management of the epilepsies includes comprehensive neuropsychological examination for baseline, diagnostic, and follow up purposes, and specialized diagnostic procedures. The developmental competence of the individual provides an organizing principle for psychological work and is reflected in the neurosurgical strategy. Adaptive functioning and psychosocial adjustment are as important in determining outcome as performance on neuropsychological tasks. The techniques and tools of neuropsychological assessment are discussed in this article; presurgical functioning and post-surgical status and management affect outcome.