1/36. akinetic mutism and mixed transcortical aphasia following left thalamo-mesencephalic infarction.A 54-year-old man developed somnolent akinetic mutism and acute mixed transcortical aphasia following a left thalamo-mesencephalic infarction. He also exhibited behavioural changes, namely apathy, slowness, lack of spontaneity, disinhibition, perseveration, gait apraxia and incontinence consistent with frontal lobe dysfunction. Presumably the akinetic mutism and language dysfunction were due to the thalamic stroke. All the manifestations could be related to interruption of the frontal-subcortical circuitry.- - - - - - - - - - ranking = 1keywords = behaviour (Clic here for more details about this article) |
2/36. Psychological management of intractable seizures in an adolescent with a learning disability.Psychological interventions aimed at seizure management are described with a 14-year-old boy with a learning disability and intractable epilepsy. Baseline records suggested that a majority of tonic seizures and 'drop attacks' were associated with going off to sleep and by environmental 'startles'. Psychological formulation implicated sudden changes in arousal levels as an underlying mechanism of action. Cognitive-behavioural countermeasures were employed to alter arousal levels and processes in different ways in different 'at-risk' situations. A multiple baseline design was used to control for non-specific effects of interventions on non-targeted seizures. Results suggested significant declines in the number of sleep onset and startle-response seizures were attained by these methods. Gains were maintained at 2-month follow-up.- - - - - - - - - - ranking = 1keywords = behaviour (Clic here for more details about this article) |
3/36. Forced hyperphasia and environmental dependency syndrome.A distinctive, language related fragment of the environmental dependency syndrome is described: compulsive, involuntary, environmentally dependent speaking. Because this syndrome represents the observe of aphasia, it is named forced hyperphasia. An 84 year old woman with acute left frontal infarction was admitted to hospital with gait disturbance, forced grasp reflex, and striking imitation behaviour. After 2 weeks her imitation behaviour disappeared, but an equally striking new behaviour emerged. In the presence of others she would call out the names of objects in the room, and also call out the actions and gestures of people in the room, even though she was not asked to do so, and even though she was asked to stop. For example, if the doctor scratched his nose, she said, "The doctor is scratching his nose." brain CT, MRI, and SPECT showed cerebral atrophy and a left superior frontal subcortical infarct. It is suggested that "forced hyperphasia" is a clinical fragment of the environmental dependency syndrome and that her compulsive, impulsive, involuntary release of spoken language resulted from the release of frontal inhibition of the complex reflex linking environmental cues to the set of motor, limbic, spatial, and linguistic associations underlying spoken language.- - - - - - - - - - ranking = 3keywords = behaviour (Clic here for more details about this article) |
4/36. brain activation during reading in deep dyslexia: an MEG study.Magnetoencephalographic (MEG) changes in cortical activity were studied in a chronic Finnish-speaking deep dyslexic patient during single-word and sentence reading. It has been hypothesized that in deep dyslexia, written word recognition and its lexical-semantic analysis are subserved by the intact right hemisphere. However, in our patient, as well as in most nonimpaired readers, lexical-semantic processing as measured by sentence-final semantic-incongruency detection was related to the left superior-temporal cortex activation. Activations around this same cortical area could be identified in single-word reading as well. Another factor relevant to deep dyslexic reading, the morphological complexity of the presented words, was also studied. The effect of morphology was observed only during the preparation for oral output. By performing repeated recordings 1 year apart, we were able to document significant variability in both the spontaneous activity and the evoked responses in the lesioned left hemisphere even though at the behavioural level, the patient's performance was stable. The observed variability emphasizes the importance of estimating consistency of brain activity both within and between measurements in brain-damaged individuals.- - - - - - - - - - ranking = 1keywords = behaviour (Clic here for more details about this article) |
5/36. Rule-abstraction deficits following a basal ganglia lesion.The cognitive profile of a patient, PM, who had damage to the right basal ganglia as the result of a stroke was investigated. Whilst most cognitive functions were intact, she showed specific neuropsychological deficits, most notably a difficulty in developing, through abstraction of the relevant information, a higher-level rule by which to guide behaviour. The types of rule affected were those based upon an attentional set (attending to a particular dimension of stimulus features, such as 'shape') or a response strategy (continuing to apply a previously successful pattern of responses). The learning of lower-level rules based on stimulus-reward values was spared, as was the ability to apply an instructed rule and to discontinue use of rules which were no longer appropriate. These data provide evidence for the dissociability of cognitive functions within the basal ganglia.- - - - - - - - - - ranking = 1keywords = behaviour (Clic here for more details about this article) |
6/36. Preserved prism adaptation in bilateral optic ataxia: strategic versus adaptive reaction to prisms.To date the anatomical substrate(s) of prism adaptation remain(s) particularly debated, with two main candidates emerging from the literature: the posterior parietal cortex (PPC) and the cerebellum. The functional processes involved in the acquisition of the adaptive aftereffects also remain largely unknown. The main result shown here is that a patient with a bilateral optic ataxia can adapt to an optical deviation, which allows us to make a step forward on these two issues. First, it demonstrates that the corresponding part of the PPC is not a necessary substrate for prism adaptation. Second, since this patient exhibits deficit for fast visuo-motor guidance, it provides direct evidence for a dissociation between on-line visuo-motor control and visuo-motor plasticity. Since the intermanual transfer rate of adaptation is larger in this patient than in control subjects, the PPC may still have an influence on adaptation under normal conditions. We propose a model of the relative contribution of the PPC and the cerebellum during prism exposure, associating these two structures with the two interacting behavioural components of prism adaptation described by previous psychophysical experiments: the strategic component would be linked to the PPC and the adaptive component to the cerebellum. In this model, the strategic component enters in conflict with the development and the generalisation of the adaptive aftereffects. This idea is compatible with the fact that a lesion of the PPC increases the transfer rate and the generalisation of the adaptation, as is also observed in unilateral neglect.- - - - - - - - - - ranking = 1keywords = behaviour (Clic here for more details about this article) |
7/36. Dissociated perceptual-sensory and exploratory-motor neglect.A patient with a right sided parietal lobe infarction manifested left sided sensory extinction in the visual, auditory, and tactile modalities but had only mild exploratory-motor neglect. In contrast, another patient with a right frontal haemorrhage demonstrated only left sided exploratory-motor hemispatial neglect. Tasks that combined perceptual and exploratory features elicited varying degrees of neglect in each patient. These two cases with dissociated neglect behaviour lend further evidence for behavioural specialisation within components of a cortical network for directed attention: sensory-representational aspects mediated primarily by the parietal component, motor-exploratory primarily by the frontal component. These cases also highlight the need to include and distinguish among several different measures of neglect in the clinical investigation of patients with hemispatial inattention.- - - - - - - - - - ranking = 2keywords = behaviour (Clic here for more details about this article) |
8/36. The environmental dependency syndrome, imitation behaviour and utilisation behaviour as presenting symptoms of bilateral frontal lobe infarction due to moyamoya disease.The environmental dependency syndrome, imitation behaviour and utilisation behaviour may be the earliest and most subtle signs of bifrontal lobe dysfunction. A case is described in which these signs constituted the predominant deficits. The lesions responsible were bifrontal infarcts caused by moyamoya disease. The patient made an excellent recovery.- - - - - - - - - - ranking = 10keywords = behaviour (Clic here for more details about this article) |
9/36. Abnormal eye movement behaviour during text reading in neglect syndrome: a case study.The eye movement behaviour of a patient suffering from a right basal ganglia infarction with a left-sided hemineglect but without any visual field defects was investigated during reading. The eye movements were registered by means of an i.r. light technique (pupil-corneal reflection method). The main findings were abnormal return sweeps. Whereas in normal readers the end of one line of text is linked to the beginning of the new line by a long leftward saccade, the return sweeps of the hemineglect patient stereotypically ended in the middle of the next line. They were followed by sequences of short saccades indicating silent backward reading until a linguistically plausible continuation of sentences from the previous line was found, irrespective of the actual beginning of text. The shortened return sweeps could not be attributed to a general oculomotor disturbance. The spatial border for the occurrence of the patient's abnormal scanning pattern (left half of texts) clearly did not depend on a retinal coordinate frame of reference but rather has to be attributed to a different body-centred reference system.- - - - - - - - - - ranking = 5keywords = behaviour (Clic here for more details about this article) |
10/36. Loss of psychic self-activation with bithalamic infarction. Neurobehavioural, CT, MRI and SPECT correlates.Two patients with bilateral thalamo-mesencephalic infarct in the paramedian territory developed vertical gaze dysfunction and marked behavioural changes, in the absence of significant motor inability and formal neuropsychological impairment. While they were physically and emotionally active before stroke, they became apathetic, aspontaneous, indifferent, and seemed to have lost motor and affectic drive, as well as the need itself for any psychic activity. However, this mental and motor inertia was reversible when the patients were repeatedly stimulated by another person. This need for constant external programming, together with a lack of emotional reactivity, made the patients resemble robots. CT and MRI suggested involvement of the dorsomedial and midline nuclei of the thalamus, and SPECT showed remote frontomesial hypoperfusion. A disturbance of the striatal-ventral pallidal-thalamic-frontomesial limbic loop is suggested by previous reports of a similar "loss of psychic self-activation", "pure psychic akinesia", or "athymhormia" with bipallidal, bistriatal, or subcortical bifrontal lesions.- - - - - - - - - - ranking = 5keywords = behaviour (Clic here for more details about this article) |
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