[Verbal memory disorders provoked by a variety of stokes]. / Topisch-neuropsychologische Diagnostik sprachlicher Gedächtnisdefizite nach kortikalen Durchblutungsstörungen.

In recent years a consensus has been reached about the neuroanatomical substrate of verbal memory, but this state of knowledge has not yet been implemented in clinical practice. One reason for this may be that most of the neuroscientific studies on verbal memory used different neuropsychological instruments and that only a small set of patient groups with the same etiology but different lesion sites were analysed. Returning to three earlier studies, we analyse the possibility to make differential judgements on the verbal memory impairments of four different patient groups by using the California Verbal Learning Test (CVLT). We compare patients with left-sided (n = 16) and right-sided (n = 10) posterior cerebral artery infarcts and patients with infarcts of the left (n = 10) or right (n = 21) frontal lobe, and we integrated data about their retention errors that had not been analysed so far. Our findings reveal significant differences between these patient groups, concerning the quantitative aspects of impairments, and also the profiles of memory errors (recall, interference and perseverations). Our study documents a relation between the site of the lesion and the type of verbal memory impairment, agreeing with some of the most recent neuroscientific findings. Starting from this observation we try to define a neuropsychological pattern of memory impairment which enables differential clinical diagnoses using the CVLT as a memory test.

Dysregulation of immune response following neurosurgical operations.

BACKGROUND: Postoperative infections are common and potentially fatal complications in neurosurgical intensive care medicine. An impairment of immune function has been described after central nervous system surgery and in patients harboring malignant brain tumors. The aim of our study was to investigate whether differences in cell-mediated immunity can be found in patients undergoing craniotomy for surgery of glioblastoma or clipping of an intracerebral aneurysm. METHODS: In order to determine the influence of the underlying disease on the immune system, we measured changes in cytokine concentrations (IL-6, IL-10, TGF-beta1) and lymphocyte-subsets (CD3+, CD3+HLA-DR+, CD4+, CD8+, CD19+, and CD16+56+) in 8 patients with glioblastoma and in 8 patients with an intracerebral aneurysm before, during and after the neurosurgical procedure. RESULTS: In the comparison of glioblastoma and aneurysm patients, we could show that IL-6 plasma levels were pre- and intraoperatively higher in the aneurysm-group (P<0.05), and the plasma concentrations of IL-10 and TGF-beta were significantly elevated in the glioma-group. The lymphocyte-subsets showed a significantly lower percentage of NK-cells and activated T-cells in the glioma-group. CONCLUSION: Our results document a significant dysregulation of immune response in glioma patients. This may be induced by elevated plasma concentrations of immunoinhibiting cytokines IL-10 and transforming growth factor-beta 1.

Visual search and visual target detection in patients with infarctions of the left or right posterior or the right middle brain artery.

We compared visual target detection and search performance of patient groups with infarctions of (1) the right middle brain artery (R-MBA) and with neglect; (2) the left posterior artery (L-PBA), (3) the right posterior artery (R-PBA), the latter two groups had contralesional hemianopias, or (4) with right hemisphere lesions without hemianopia or neglect. We found that: (1) The first three groups differed from the fourth (control) group in omissions. (2) The first three groups differed only in horizontal search but not in target detection. (3) No vertical search deficit was present for either group. (4) R-MBA patients found increasingly more targets in visual search from left to right, R-PBA patients had problems with the outermost contralesional column, L-PBA patients showed a generally slowed and more variable search pattern. Infarctions of left and R-PBA therefore resulted in different visual search patterns. The behavior of the patients with R-MBA is consistent with Kinsbourne's (1992) interactive inhibition theory of neglect.