Brain lateralization and neural plasticity for musical and cognitive abilities in an epileptic musician.

The use of intracarotid propofol procedure (IPP) when assessing musical lateralization has not been reported in literature up to now. This procedure (similar to Wada Test) has provided the opportunity to investigate not only lateralization of language and memory functions on epileptic patients but also offers a functional mapping approach with superior spatial and temporal resolution to analyze the lateralization of musical abilities. Findings in literature suggest that musical training modifies functional and structural brain organization. We studied hemispheric lateralization in a professional musician, a 33 years old woman with refractory left medial temporal lobe (MTL) epilepsy (TLE). A longitudinal neuropsychological study was performed over a period of 21 months. Before epilepsy surgery, musical abilities, language and memory were tested during IPP by means of a novel and exhaustive neuropsychological battery focusing on the processing of music. We used a selection of stimuli to analyze listening, score reading, and tempo discrimination. Our results suggested that IPP is an excellent method to determine not only language, semantic, and episodic memory, but also musical dominance in a professional musician who may be candidate for epilepsy surgery. Neuropsychological testing revealed that right hemisphere's patient is involved in semantic and episodic musical memory processes, whereas her score reading and tempo processing require contribution from both hemispheres. At one-year follow-up, outcome was excellent with respect to seizures and professional skills, meanwhile cognitive abilities improved. These findings indicate that IPP helps to predict who might be at risk for postoperative musical, language, and memory deficits after epilepsy surgery. Our research suggests that musical expertise and epilepsy critically modifies long-term memory processes and induces brain structural and functional plasticity.

Nonglial tumors of the brainstem.

Nonglial tumors of the brainstem constitute a histologically heterogeneous group of lesions with quite a different behavior and aggressiveness. Therefore, the diverse therapeutic options depend on a correct and prompt diagnosis. We can limit their differential diagnosis by using clinical and demographic data and imaging findings, which in most cases will be a translation of their histologic characteristics. The main clinical, neuroimaging, and pathologic features of these lesions are described according to the last updated classification of the World Health Organization for central nervous system tumors. We provide some useful clues, based on the direct correlation of the imaging appearance with its gross pathologic and histologic appearance, for a comprehensive diagnostic approach. Embryonic tumors (medulloblastoma and primitive neuroectodermal tumor), cavernoma, lymphoma, hemangioblastoma, and ganglionic and mixed tumors as long as lesions affecting the central nervous system by external compression (arising from the skull, cerebrospinal fluid spaces, or extraaxial nervous and vascular elements) are included. All cases presented belong to the archive data of our hospital.

Development of an acute ischemic stroke management course for hospital physicians in emergency departments and intensive care units.

The objective of this study was to evaluate a training course on acute ischemic stroke (AIS) for hospital physicians, part of a regional strategy on AIS patient care. The course comprised an initial self-study (e-Learning) stage and 1-day theoretical-practical course on initial AIS management for Critical Care and Emergency physicians in the Andalusian Health Service (Spain). Data were collected on regional implementation of the stroke code and intravenous thrombolysis treatment. Between 2006 and 2009, 12 courses were attended by 356 physicians from emergency (n=148) and critical care (n=208) departments in the Andalusian health system. The initial stage was failed by 46.4% of trainees; the 1-day AIS course was successfully completed by all trainees, who reported a high satisfaction level. By the end of 2009, all hospitals had adopted the stroke code and approximately 5-6% of patients with AIS received intravenous thrombolysis. This type of healthcare strategy proved effective to improve AIS care in our setting.

El osteoma en la mastoides, ¿un hallazgo incidental? / The mastoid osteoma, an incidental feature?

Los osteomas mastoideos son tumores óseos benignos que excepcionalmente aparecen en la mastoides, habiendo sido descritos 137 casos en la literatura actual. Suelen presentarse de un modo asintomático, aunque no siempre es así. Presentamos 3 casos de osteomas mastoideos: un osteoma pediculado con base de implantación en el antro mastoideo y con extensión hacia el canal ático antral, que coexistía con una otitis media colesteatomatosa, un osteoma mastoideo superficial asintomático y un osteoma sesil dependiente de la tabla interna de la escama del hueso temporal, en una paciente con un cuadro vertiginoso. Hacemos una revisión de esta rara entidad, y planteamos una posible asociación entre el osteoma mastoideo, el síndrome vertiginoso y la otitis media colesteatomatosa (AU)

Osteoma in the mastoid is a rare benign osteogenic tumour that has been described in literature in only 137 cases. It usually appears in asymptomatic patients, although a few cases are described associated with clinical manifestations. We report three cases of mastoid osteoma: a pedunculated osteoma in the aditus ad antrum (associated with a cholesteatoma), a superficial osteoma of the mastoid surface and a sessile osteoma that progressed to the temporal lobe (associated with vertigo). A brief review of this rare entity is presented and a possible association between mastoid osteoma, cholesteatoma otitis and vertigo is posed (AU)

[The mastoid osteoma, an incidental feature?]. / El osteoma en la mastoides, ¿un hallazgo incidental?

Osteoma in the mastoid is a rare benign osteogenic tumour that has been described in literature in only 137 cases. It usually appears in asymptomatic patients, although a few cases are described associated with clinical manifestations. We report three cases of mastoid osteoma: a pedunculated osteoma in the aditus ad antrum (associated with a cholesteatoma), a superficial osteoma of the mastoid surface and a sessile osteoma that progressed to the temporal lobe (associated with vertigo). A brief review of this rare entity is presented and a possible association between mastoid osteoma, cholesteatoma otitis and vertigo is posed.

Reduction of basal forebrain cholinergic system parallels cognitive impairment in patients at high risk of developing Alzheimer's disease.

Neuropathological studies suggest that the basal forebrain cholinergic system (BFCS) is affected in Alzheimer's disease (AD), but there is no in vivo evidence of early damage to this system in subjects at high risk of developing AD. Here, we found that mild cognitive impairment (MCI) patients exhibited significant volume reduction of the nucleus basalis of Meynert (NbM) using recently developed probabilistic maps of the BFCS space. In addition, volumes of different magnocellular compartments varied significantly with regional gray matter atrophy in regions known to be affected by AD and were found to correlate with cognitive decline in MCI patients. Bilateral reductions of the horizontal nucleus of the diagonal band of Broca (Ch3) and frontal lobe (medial frontal, orbital, subcallosal gyrus, anterior cingulate, and middle frontal gyrus) were significantly associated with a global decline in cognitive status, whereas volume reduction of the posterior compartment of Ch4 (NbM) and temporal lobe (including hippocampus, entorhinal cortex, and amygdala) were associated with impaired delayed recall in MCI patients. These findings establish, for the first time, a link between degeneration of specific cholinergic compartments of the BFCS and cognitive-related deficits in subjects at high risk of developing AD.

Functional integrity of thalamocortical circuits differentiates normal aging from mild cognitive impairment.

Resonance in thalamocortical networks is critically involved in sculpting oscillatory behavior in large ensembles of neocortical cells. Neocortical oscillations provide critical information about the integrity of thalamocortical circuits and functional connectivity of cortical networks, which seem to be significantly disrupted by the neuronal death and synapse loss characterizing Alzheimer's disease (AD). By applying a novel analysis methodology to overcome volume conduction effects between scalp electroencephalographic (EEG) measurements, we were able to estimate the temporal activation of EEG-alpha sources in the thalamus and parieto-occipital regions of the cortex. We found that synaptic flow underlying the lower alpha band (7.5-10 Hz) was abnormally facilitated in patients with mild cognitive impairment (MCI) as compared to healthy elderly individuals, particularly from thalamus to cortex (approximately 38% higher). In addition, the thalamic generator of lower alpha oscillations was also abnormally activated in patients with MCI. Regarding the upper alpha subdivision (10.1-12.5 Hz), both controls and patients with MCI showed a bidirectional decrease of thalamocortical synaptic transmission, which was age-dependent only in the control group. Altogether, our results suggest that functional dynamics of thalamocortical networks differentiate individuals at high risk of developing AD from healthy elderly subjects, supporting the hypothesis that neurodegeneration mechanisms are active years before the patient is clinically diagnosed with dementia.