Psychic tonus, body schema and the parietal lobes: a multiple lesion case analysis.

The psychic tonus model (Braun and colleagues, 1999, 2002, 2003, 2006) states that the left hemisphere is a "booster" of internal experience and behavior in general, and that the right hemisphere is a "dampener". Twenty-five patients with a "positive" extreme disturbance of body schema (somatoparaphrenia) and 37 patients with a "negative" disturbance of body schema (autotopagnosia or Gerstmann's syndrome), all following a unilateral parietal lesion, were found in the literature and were analyzed to test predictions from Braun's "psychic tonus" model. As expected, patients with a positive syndrome had a right hemisphere lesion significantly more frequently, and those with a negative syndrome had a left hemisphere lesion significantly more frequently. Thus the psychic tonus model of hemispheric specialization, previously supported with regard to psychomotor baseline, libido, talkativeness, memory, auditory and visual perceptual tonus, now incorporates the tonus of representation of the body (body schema) in the parietal lobes.

Cognitive structure of executive deficits in patients with frontal lesions performing activities of daily living.

OBJECTIVE: Executive function in activities of daily living (ADL) were investigated in 10 patients with excised frontal lobe tumours. METHOD: The patients with frontal lesions were compared to 10 normal controls with a neuropsychological test battery, a script generation task and a realistic implementation of complex multi-task ADL (planning and preparing a meal). RESULTS: The patients manifested numerous basic executive deficits on the paper-pencil tests, were unimpaired on the script generation task despite an aberrant semantic structure and manifested marked anomalies in the meal preparation task. CONCLUSION: Frontal lobe deficits in lengthy complex multi-task ADL can be explained by impairment of several executive functions, generalized slowness of performance and paucity of behaviour.

Script generation following frontal and parietal lesions.

The purpose of this investigation was to distinguish putative effects of parietal lobe lesions on script generation, in distinction from the better known and established effects of frontal lobe lesions. Nine patients, most with excised parietal lesions, were compared to nine age, gender and education matched normal participants. Eleven patients with excised tumors of the frontal lobe were compared to twelve age, gender and education matched normal subjects. Participants were requested to generate, out loud, scripts corresponding to everyday activities. Half the scripts were relatively more demanding with respect to temporal representation (understanding the time line of events) and the other half with respect to spatial representation (understanding the layout of the actions in space). These two conditions were further broken down into conditions of high and low demands on working memory (reciting the scripts backwards versus forward). The frontal lobe patients enunciated significantly fewer actions overall. They were also significantly more impaired than the normal participants on all tasks with high demands on working memory, and more often, high temporal demands (sequencing and perseverative errors). The parietal lobe patients had significant difficulty in sequencing in all conditions, and manifested no perseveration. Though script generation tasks have been primarily associated with frontal lobe function until now, consideration should be given to the type of activity being scripted as a function of relative demands on spatial or temporal representation, as well as working memory, and the contributions of other lobes ought to be taken into consideration.

Does the child behavior checklist reveal psychopathological profiles of children with focal unilateral cortical lesions?

Psychopathological profiles were investigated in children with focal unilateral radiologically documented cortical lesions (15 right lesions and 22 left lesions). The 8 clinical subscales of the Child Behavior Checklist Parent Form (CBCL-P) and the Internalizing and Externalizing subscales were the dependent measures. The Internalizing and Externalizing scores did not dissociate as a function of lesion side. There were more Internalizing than Externalizing symptoms. Only the Attention Problems subscale yielded a significant difference as a function of lesion side; children with left lesions unexpectedly presented more problems. No significant differences were observed as a function offrontal versus nonfrontal lesion site, gender, or neurological variables on the Child Behavior Checklist (CBCL) subscales. Although sensitive to the presence of a focal lesion, the CBCL-P scarcely or misleadingly reflects any of the characteristics offocal unilateral cortical lesions in children. As suggested by the literature, most of the CBCL elevations in children with brain lesions could derive from the parent's and child's emotional response to any threatening medical condition.

Recovery of intellectual function after a brain injury: a comparison of longitudinal and cross-sectional approaches.

The goal of this study was to investigate recovery of intellectual function as a function of age at the time of a brain lesion. Participants with unilateral cortical lesions were selected from an initial data base of 685 patients. Ninety-six participants formed a longitudinal cohort for a first study and 314 participants formed a cross-sectional cohort for a second study. Participants of each study were split into two age groups according to the age at the time of the lesion: (1) before 7 years, (2) 7 years or more. Results showed a significantly different recovery profile as a function of age in the longitudinal study. Older participants manifested recovery on VIQ and PIQ, while younger participants presented stable profiles. The longitudinal and cross-sectional studies revealed differing recovery profiles as a function of age. Results are discussed in the context of the Kennard principle and with regard to the methodological approaches.

Strategic sequence planning and prospective memory impairments in frontally lesioned head trauma patients performing activities of daily living.

The aim of this research was to study strategic sequence planning and prospective memory in activities of daily living (ADL) in 10 patients with frontal lobe lesions after a mild to moderate closed head injury (CHI). The lesions were documented radiologically. The CHI patients were compared to 12 normal controls with a neuropsychological test battery and a realistic simulation of complex multitask ADL (planning and preparing a meal). Though the CHI patients were significantly slow on one test and subject to interference on an attention test, they manifested no basic executive or memory deficit on the paper-pencil tests. However, the CHI patients manifested marked anomalies in the organization of behavior in the meal preparation task. While small sequences of actions were easily produced, large action sets could not be correctly executed. An outstanding difficulty in strategic planning and prospective memory, particularly time-based more than event-based, appears to be an important underpinning of the impairment of ADL observed in the CHI patients with frontal lobe lesions.

Brain metabolic differences as a function of hemisphere, writing hand preference, and gender.

A total of 35 university-educated normal men (24 right handwriters and 11 left handwriters) and 36 age- and education-matched women (25 right handwriters and 11 left handwriters) underwent a proton magnetic resonance spectroscopy examination in seven 8 cm(3) voxels including the right and left frontal lobe tips, the right and left mid-temporal lobes, the right and left thalami, and the hypothalamus. Dependent measures were N-acetylaspartate (NAA), choline-containing compounds (Cho) and creatine/phosphocreatine (Cr) metabolite peak area ratios relative to total H(2)O. As expected, thalamic grey matter contained higher NAA ratios than telencephalic voxels (containing white and grey matter) (p < .001). The thalamic Cr/ H(2)O ratio was higher on the right, but the opposite asymmetry was observed for the temporal lobe (p < .05). Women had a higher left frontal NAA/ H(2)O ratio than men, but men had a higher hypothalamic NAA/ H(2)O ratio than women. Right-handers had a higher temporal lobe NAA/H(2)O ratio than left-handers, particularly in the left hemisphere. In addition, several significant 2- and 3-way interactions between writing hand preference, gender, and hemisphere were observed, but only in the frontal lobe.

Liver lipid accumulation in duck embryos and hatchlings change with parental age.

The purpose of this study was to investigate the effects of duck breeder age on liver lipid accumulation and yolk absorption and utilization in duck embryos (day 25 of incubation) and newly hatched ducklings. One breeder flock was monitored at 24 (young breeders), 31 (mature breeders and near peak egg production) and 47 (post peak egg production) weeks of age. Electron microscopy images of duck embryo liver slices revealed a significant change in hepatic lipid accumulation as a function of breeder age. More specifically, as breeder age increased both the relative number of liver lipid droplets as well as the size of the lipid droplets increased in duck embryos (day 25 of incubation). At hatch, however, newly hatched ducklings from 31-week-old breeders exhibited the lowest number as well as the smallest sized lipid droplets when compared to ducklings from 24 or 47-week-old breeders. The trend in yolk absorption at day 25 as a function of breeder age paralleled that in liver lipid accumulation. That is, day 25 maintained a higher percentage of unabsorbed yolk when compared to embryos from 31- or 47-week-old breeders. In contrast to breeder age, time of incubation (day 25 vs. day 28 or hatch) had little effect on yolk fatty acid profiles when compared to breeder age. Although there were no clear trends in yolk fatty acid usage among the various ages of breeders, newly hatched ducklings from 31-week-old breeders did have a significantly higher proportion of 18:2 n6 compared to those from breeders at 24 or 47 weeks of age. These data would suggest that breeder age subsequently affects the relative number and size of liver lipid droplets in embryos and newly hatched ducklings.

Refutation of Poffenberger's inference: an existence proof and a countermodel.

Interhemispheric relay time (IHRT) is inferred from simple (visual) reaction time (SRT) by subtracting SRTs in ipsilateral hand-field conditions from SRTs in contralateral hand-field conditions. This index, the "crossed-uncrossed differential" (CUD) is a synonym of IHRT in the current literature. The CUD has been shown to be significantly moderated by experimental variables, including attentional. One reason the CUD = IHRT hypostasy persists today is that no experimental manipulation has yet been able to generate a significantly negative CUD in a subject manifesting a significant positive CUD in classical conditions. We implemented an experimental manipulation, in SRT, consisting of increasing complexity of the response after the initial key press required at detection. In a very large scale single-case experiment, we found that the CUD thus went from significantly positive in classical SRT to significantly negative in the increased response load condition.

Cancer care in Nepal: variables that affect diagnosis, treatment, and prognosis: a case study.

This manuscript presents a case study of a Nepalese woman experiencing breast cancer. Six themes were identified to have an impact on the diagnosis, treatment, and prognosis. They include: cultural impact on women's roles, socioeconomic status and education, surgical oncologist-patient relationship, surgical oncologist-nurse relationship, nurses' lack of oncology knowledge, and lack of a cancer screening and prevention program in Nepal. Cancer care is on the rise in Nepal. However, many of the variables identified above are not considered in the cancer care provided. Nepal has just opened its first national cancer center with the intent to improve cancer care throughout the country.

Prevalence, and intellectual outcome of unilateral focal cortical brain damage as a function of age, sex and aetiology.

Neurologists and neuropsychologists are aware that aging men are more at risk than women for brain damage, principally because of the well known male-predominant risk for cardiovascular disease and related cerebrovascular accidents. However, a disproportion in prevalence of brain damage between the sexes in childhood may be less suspected. Furthermore, sex-specific risk for other aetiologies of brain damage may be little known, whether in the pediatric or adult populations. Proposals of a sex difference in cognitive recovery from brain damage have also been controversial. Six hundred and thirty five "consecutive" cases with cortical focal lesions including cases of all ages and both sexes were reviewed. Aetiology of the lesion was determined for each case as was postlesion IQ. Risk was highly male prevalent in all age groups, with a predominance of cardiovascular aetiology explaining much of the adult male prevalence. However, several other aetiological categories were significantly male prevalent in juveniles (mitotic, traumatic, dysplasic) and adults (mitotic, traumatic). There was no sex difference in outcome (i.e., postlesion IQ) of these cortical brain lesions for the cohort as a whole, after statistical removal of the influence of lesion extent, aetiology and presence of epilepsy. Mechanisms potentially responsible for sex differences in prevalence, aetiology of brain damage, and recovery, are reviewed and discussed.

Comparison of two progressive treadmill tests in patients with peripheral arterial disease.

In a vascular rehabilitation program, 28% of our frail elderly patients are unable to be tested with traditional progressive exercise protocols at program entry due to the high (2.0 miles/h or 3.2 km/h) initial treadmill speeds. The purpose of this investigation was to compare a new progressive treadmill protocol which has a reduced initial speed (1.0 mile/h or 1.6 km/h) to an established protocol performed at 2.0 miles/h (3.2 km/h) to determine the comparability and reproducibility of the new protocol. Eleven patients with arterial claudication performed three symptom-limited exercise tests in random order. Two tests used the new protocol while the remaining trial used the established protocol. Claudication pain was measured using a 5-point scale. Oxygen consumption, heart rate, minute ventilation, respiratory exchange ratio and blood pressure at peak exercise were similar among the three trials. There were strong intraclass correlations for peak oxygen consumption (r = 0.97), onset of claudication (r = 0.96) and maximum walking time (r = 0.98) between the two trials using the new protocol. There was also a significant correlation between the new protocol and the established protocol for peak oxygen consumption (r = 0.90) and maximum walking time (r = 0.89). The new progressive treadmill protocol represents a valid, reliable protocol for patients with arterial claudication. This protocol may be useful for testing patients with a low functional capacity so that clinically appropriate exercise prescriptions can be established and the efficacy of treatments can be determined.

Right body side performance decrement in congenitally dyslexic children and left body side performance decrement in congenitally hyperactive children.

OBJECTIVE: Simple and complex visuomotor performance of the right and left sides of the body was investigated in 37 children with left hemisphere lesions, 35 children with right hemisphere lesions, 53 developmentally dyslexic children, 29 developmentally hyperactive children, and 35 "normal" children who had endured a very mild head injury with no sequelae. BACKGROUND: Lateralized soft signs, EEG topography, metabolic brain imaging, and neuropsychological test profiles suggest a predominance of left hemisphere dysfunction in dyslexia and right hemisphere dysfunction in hyperactivity. METHOD: Nine measures of lateralized performance were drawn from the Purdue pegboard, Letter cancellation, Rey complex figure, Wechsler Intelligence Scale for Children (WISC) Mazes, and WISC Picture completion tests. RESULTS: The children with left hemisphere lesions manifested significantly weaker performance on test components involving the right body side, relative to the normal controls, on the Purdue pegboard, Rey complex figure (delayed recall condition), and WISC Picture completion tests, and the dyslexic children on the former two. The children with right hemisphere lesions manifested significantly weaker performance on test components involving the left body side, relative to the normal controls, on the WISC Mazes test, as did the hyperactive children. CONCLUSIONS: We propose that (1) contralateral performance decrement results from a unilateral cortical lesion in children, and (2) developmental dyslexia may comprise a slight predominance of left hemisphere dysfunction and developmental hyperactivity of right hemisphere dysfunction.

Components of an optimal exercise program for the treatment of patients with claudication.

Research in vascular exercise has demonstrated remarkable improvement in symptoms of claudication without more expensive and invasive interventions. During the past 5 years, 86 patients have graduated from The Brown University Supervised Vascular Exercise Program. Patients demonstrate a threefold improvement in maximum walking distance after 12 weeks of training. Information available on 22 patients at 1-year and 2-year follow-ups show walking distance is improved or maintained with continued training. Components of the program are presented in 3 phases. Phase 1 addresses the comprehensive nursing assessment, cardiac screening, and progressive treadmill testing. Phase II includes specific method of exercise prescription and educational needs of peripheral vascular disease patients. Phase III discusses the importance of maintenance and motivating patients to continue.

[Hypothalamic hamartoma: detailed presentation of a case]. / Hamartome hypothalamique: présentation détaillée d'un cas.

We describe a seven year old child with a hypothalamic hamartoma. Classical symptoms of hypothalamic hamartoma include gelastic epileptic laughter, precocious puberty, aggressiveness, and progressively worsening epilepsy. After a normal first few years of life, this case presents all these symptoms except the precocious puberty. He has a markedly morbid personality disorder: he assaults strangers and relatives, bites people, spits in their faces unpredictably, is coprolalic and coprophagic, has gelastic laughter, puts pencils, erasers, and other non-comestible objects in his mouth, chews and ingests them, has tics (plays noisily with his saliva, empty chewing, compulsive spitting) and is self-injurious. None of the medications attempted to date have been of any help. Medical prognosis is somber, and this case is difficult to institutionalize, the more "congenial" institutions being insufficiently equipped to protect him and the beneficiaries and staff from his aggressive behavior. MRI showed the typical profile of hypothalamic hamartoma, and the diagnosis was confirmed with partial resection. This case illustrates that a tiny lesion, the size of a small cherry, can have extremely morbid psychological consequences. Detailed neuropsychological evaluation, certain unusual electroencephalographic traits and neurosurgical issues are discussed.

Topographical analysis of homotopic interhemispheric "relay" asymmetries in visual evoked potentials.

Brown and colleagues (1994) found that most evoked potential studies provide evidence of faster interhemispheric relay from the right to the left hemisphere, as determined from N160 latencies derived from parietal and occipital electrode sites. The experiment reported here was designed to complement those findings by 1) analyzing more electrode sites (several frontal, temporal, and central sites in addition to the previously investigated sites) and more waveforms (P1 and P2 waves); 3) introducing analysis of amplitude data; 4) carrying out site-specific and experiment-wise inference tests of putative interhemispheric relay asymmetry. We found that all of the conclusions of Brown and colleagues, regarding latency effects, could be extended to the ensemble of electrode sites and waveforms. However, amplitude effects were significantly compatible with stronger (though slower) relay from the left to the right hemisphere.

Topography of averaged electrical brain activity relating to interhemispheric dynamics in normal humans: where does the critical relay take place?

Interhemispheric relay time (IHRT) was investigated using a 16-electrode montage in 10 normal subjects during a simple visual reaction time task (Poffenberger paradigm). The P1 latency was the dependent measure. Response-locked components were separated from the stimulus-locked components based on the reaction times using a Woldorff-like filter. The issues of theoretical interest were the following: (1) does the responding hand modulate IHRT estimates as a function of electrode site, or stimulated field?; (2) what are the respective advantages of various pairs of symmetrical across-midline electrode sites for tracking IHRT?; and (3) what are the respective advantages of symmetrical vs. asymmetrical across-midline electrode site-pair configurations for tracking IHRT? There were significant lags attributable to IHRT in both evoked potential P1 latencies and in reaction times--but these were uncorrelated. The responding hand was not found to significantly modulate IHRT estimates derived from the P1 peak latency of response-corrected ERPs. Anterior sites yielded more precocious components and briefer estimates of IHRT which were closer to those observed in reaction time estimates. However, posterior leads yielded more reliable estimates. Various analyses suggested that IHRT can be tracked, very vaguely, with asymmetric configurations as well as symmetric ones, each for different reasons.

Mania, pseudomania, depression, and pseudodepression resulting from focal unilateral cortical lesions.

OBJECTIVE: This consecutive multiple case study was designed to determine whether cortical lesion sites can predict occurrence of mood or psychomotor disorders in adults and children. BACKGROUND: Most of a large body of research supports the contention that left hemisphere lesions result more often than right ones in depression, and that the inverse occurs in mania. However, it is not clear how psychomotor status fits into this picture, nor whether children respond to the same lesions in a similar manner. METHOD: Published (n = 88) and unpublished (n = 31) cases of school-aged child and adult patients with focal unilateral cortical lesions and psychomotor agitation or lethargy with or without corresponding mania or depression were reviewed systematically to determine whether lesion location relates systematically to any of those psychiatric conditions. No patients had symptoms prior to detection of their lesion. Manic-depressives and agitated depressives were also excluded. RESULTS: Patients with mania and/or psychomotor agitation had predominantly right hemisphere lesions. Postlesion hyperactivity (without mania) in children was common but was not more related to lesions in one or the other hemisphere. Adult and child patients with depression and/or psychomotor lethargy had predominantly left hemisphere lesions. The intrahemispherical site of the lesion did not significantly predict the type of mood or psychomotor disorder. Nevertheless, the nonsignificant trend was for right posterorolandic lesions to predict mania or agitation and for left frontal lesions to predict depression or psychomotor lethargy. CONCLUSIONS: These findings support the neuropsychiatric approach to mood and psychomotor disorder in children and adults.

Co-regulation of antigen-specific T lymphocyte responses by type I and type II cyclic AMP-dependent protein kinases (cAK).

While a differential sensitivity to cyclic AMP (cAMP)-mediated signaling between Th1 and Th2 cells has been hypothesized, differential activity of downstream signaling through cAMP-dependent protein kinase (cAK) isoforms remains unexplored. We herein report the effects of type 1- and type 2-specific cAK agonists and antagonists on proliferative responses and cytokine generation from ragweed-driven peripheral blood mononuclear cells (PBMCs) and Amb a 1-specific Th1 and Th2 clones. Rp-8-Cl- and Rp-8-CPT-cAMP were utilized as single agent antagonists of cAKI and cAKII, respectively; 8-AHA-cAMP, with and without 8-PIP-cAMP, and 8-CPT-cAMP, with and without 6-Bnz-cAMP, were used as synergistic agonist pairs specific for the cAKI and cAKII, respectively. Activation of either cAKI or cAKII individually was ineffective in down-regulating proliferative responses of PBMCs or T cell clones; concentration-response curves for the Th1 and Th2 clones were identical. Moreover, inhibition of either cAKI or cAKII individually was ineffective in overcoming the down-regulatory effects of phosphodiesterase inhibition. Activation of either cAKI or cAKII individually was ineffective in down-regulating proinflammatory cytokine generation from T cell clones (interleukin-4 from Th2; interferon-gamma from Th1). However, concurrent activation of both cAKI and cAKII produced down-regulatory effects equivalent to those of the phosphodiesterase inhibitor on both proliferation and cytokine generation. These data suggest a critical role for concurrent activation of cAKI and cAKII in the functional efficacy of antigen-driven downstream signaling due to elevations of intracellular cAMP and argue against differential regulation of Th1 and Th2 responses by cAK subtypes.

Pseudoakathisia from a acquired lesion.

Akathisia, "inability to remain seated", is a common condition in patients medicated with neuroleptics, and also occurs in other medication regimens. Only a few cases of akathisia resulting from focal lesions have been published. These cases suggest that differing lesion sites are sufficient for producing objective or subjective akathisia. The authors present a patient with akathisia who had no subjective complaints, suggesting that a combined basal ganglia and frontal lobe lesion may lead to objective akathisia (pseudoakathisia).