1/33. hyperalgesia with reduced laser evoked potentials in neuropathic pain.Nociceptive evoked potentials to laser stimuli (LEPs) are able to detect lesions of pain and temperature pathways at peripheral, spinal and supraspinal levels. It is commonly accepted that LEP attenuation correlates with the loss of pain and temperature sensations, while pathological heat-pain hypersensitivity has been associated with increased LEP amplitude. Here we present two patients in whom increased pain sensation (hyperalgesia) to laser stimuli was, on the contrary, associated to delayed, desynchronized and attenuated LEPs. Both patients experienced increased unpleasantness and affective reactions to laser, associated to poor ability to localize the stimulus. In both cases the results may be explained by an overactivation of the 'medial pain system', in one patient due to deafferentation of cortical sensory areas by a capsular lesion, and in the other to imbalance between A-delta and C fiber excitation due to peripheral nerve injury. Our results suggest that LEPs, as currently recorded, reflect the activity of a 'lateral' pain system subserved by rapidly conducting fibers. They may therefore, assess the sensory and cognitive dimensions of pain, but may not index adequately the affective-emotional aspects of pain sensation conveyed by the 'medial' pain system. The dissociation between pain sensation and cortical EPs deserve to be added to the current semiology of LEPs, as the presence of abnormal pain to laser on the background of reduced LEPs substantiates the neuropathic nature of the pain.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
2/33. The experience of transition for a daughter caregiver of a stroke survivor.The purpose of this study was to describe the experience of transition for a daughter caregiver of a stroke survivor. A phenomenologic, longitudinal case study of a woman in her late twenties provided the means by which the lived experience of transition could be studied and understood. The eleven unstructured, audiotaped interviews took place approximately every two weeks over a six and a half month period. They began six weeks after her mother's stroke and lasted until three months after her mother returned home, when life became more organized and predictable for a time. The interviews were transcribed verbatim and analyzed according to a modified version of Colaizzi's descriptive phenomenologic methodology. Since there was a temporal consideration, a time-ordered matrix was used to identify themes over time. The themes that emerged over time included: (a) changing relationships, (b) becoming a caregiver then stepping back, (c) enduring emotional turbulence, (d) taking one day at a time and (e) struggling to hang onto hope. Integration of the themes provided an exhaustive description. The experience of transition was a process that involved disruptions in close relations and daily living. The connection to a network of relationships changed to disconnection, and the fabric of interrelated lives began to unravel. The many sensations experienced were different and conflicting, revealing a rapidly changing perception of the world. An unknown future threatened to become overwhelming. Focusing on the present helped to quell the turbulent sensations experienced. An unknown future temporarily provided the opportunity to hope that daily life could once again become familiar and comfortable. The extent and object of hope changed over time. A pattern of chaos exemplified the process of transition. The passage of time revealed that life as it was known before the transition had changed. A new way of being in the world was experienced.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
3/33. Complete mutism after midbrain periaqueductal gray lesion.Several neurophysiological studies have highlighted the role of the midbrain periaqueductal gray matter (PAG) in the initiation of vocalization in various animal species, from frogs to primates. With regard to humans, only two cases of complete mutism following a lesion to the PAG have been reported so far. This article describes a new case of a patient (GM) who, following an ischemic lesion to the periaqueductal gray region of the midbrain, presented with complete and irreversible mutism, though her language comprehension functions and her non-verbal expression capacity were preserved. This clinical case provides evidence that in humans the PAG also acts as a link between different vocalization-eliciting external and internal stimuli (which reach the PAG from sensory and emotional structures) and the vocal-motor coordinating mechanisms in the lower brain stem.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
4/33. Persistent kluver-bucy syndrome after bilateral thalamic infarction.OBJECTIVE: To describe a patient who exhibited a partial kluver-bucy syndrome after small bilateral ischemic lesions in the thalami. BACKGROUND: Previously reported patients with kluver-bucy syndrome had very large, mostly bilateral lesions in the limbic system and could not provide sufficient information about its anatomo-functional correlate. METHOD: Behavioral assessments and clinical examinations, including magnetic resonance imaging and positron emission tomography, were conducted. RESULTS: The patient was severely amnestic, distractible, hyperoral, and affectively dyscontrolled, and she behaved socially inappropriately. magnetic resonance imaging showed bilateral infarctions in the territories of both thalamoperforating arteries, and positron emission tomography revealed bilaterally decreased fluorodeoxyglucose uptake in the anterior parts of the ventral thalami and, to a lesser extent, in the fronto-temporal cortices. CONCLUSIONS: This behavioral syndrome has not yet been reported with isolated diencephalic lesions, but it has been observed after bilateral temporal lobe lesions. The authors conjecture that this syndrome resulted from a disruption of the pathways connecting the dorsomedial thalami with the prefrontal cortices and with other limbic areas, systems essential for memory and the regulation of impulses and emotions.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
5/33. Crossed apraxia: implications for handedness.Liepmann posited that right hand preference relates to left hemisphere dominance for learned skilled movements. Limb apraxia, impairment of skilled movement, typically occurs in individuals with left hemisphere (LH) lesions. The occurrence of apraxia in right-handed individuals following right-hemisphere lesions appears to refute Liepmann's hypothesis. We studied the apraxia of a right-handed man, RF, following a right frontal lesion to determine whether his apraxia paralleled the apraxia seen following LH lesions. Results of behavioral testing indicated that, like individuals with apraxia following left frontal lesions, RF was better at gesture recognition than gesture production which was significantly impaired across tasks. Kinematic motion analyses of movement linearity, planarity, and the coupling of temporospatial aspects of movements substantiated the parallel impairments in RF and patients with LH apraxia. The impairment seen in our patient with crossed apraxia provides evidence for the fractionation of systems underlying hand preference and skilled movement.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
6/33. Troubled reaching after right occipito-temporal damage.We encountered a man with an unusual reaching disturbance due to a stroke in the right occipito-temporal cortex and subjacent white matter. We studied his behavior in detail including vision and hand control. He had a left homonymous hemianopia. In his remaining fields static visual acuity and stereoacuity were normal, but he could not detect a coherent motion signal or follow moving targets with smooth pursuit. Transduction of limb movements using an optoelectronic technique showed abnormal morphology, increased variability and markedly prolonged latencies for transport to external visual targets, yet he achieved these targets with precision. Reaching to self-bound targets, and to the remembered locations of external targets with vision blocked was 5 x faster. The findings may be explained by: (1) damage in regions homologous to areas TF and TH in the monkey, which provide visual inputs to hand and forelimb representations in the cortex; (2) injury in human regions homologous to the monkey's MT complex, with inability to use visual information on the movement of the limb due to a visual motion processing defect; and (3) disruption of visual cortical-subcortical connections mediating crucial transformations among limb and target representations.- - - - - - - - - - ranking = 2keywords = motion (Clic here for more details about this article) |
7/33. Antidepressant treatment of pathologic laughing or crying in elderly stroke patients.Pathologic laughing or crying (PLC), a complication of many neurologic disorders, involves behavior that is either inappropriate to the context or to the patient's subjective feeling state. It is due to a dysregulation of the motoric components of emotional experience. PLC is distinct from, but often associated with, major depression. The relatively few reports on treatment of PLC are primarily with tricyclic antidepressants. We report the effective treatment of PLC due to stroke in three patients with nortriptyline or fluoxetine. The cases also illustrate the broad spectrum of depressive symptoms (from none to a major depression) seen in patients with PLC. We discuss treatment implications and directions for future research.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
8/33. phenol block for hip flexor muscle spasticity under ultrasonic monitoring.Hip flexor spasticity, which is often associated with central nervous system (CNS) diseases, is a major impediment in rehabilitation. In order to cope with this problem, lumbar nerve blocking techniques developed by Meelhuysen and major and minor psoas muscle blocking techniques developed by Awad have been used in combination with physical therapies. Based on these techniques, we conducted major and minor psoas muscle phenol block (motor point block or intramuscular nerve block) under ultrasonic monitoring. phenol block was conducted in nine patients with cerebral infarction (13 blocking procedures) and three with spinal cord injuries (six blocking procedures) while keeping them in a lateral position with the operation side upside. The beginning of the femoral nerves and part of the lumbar artery were visualized by ultrasound in some patients. As a result of the improvement of hip flexor spasticity, the range of hip joint motion (determined by the Mundale technique, prone hip extension and Thomas test) improved shortly after blocking. When physical therapy was conducted after blocking, improvement of skin care management was observed in eight cases, ability to keep in a stable sitting position in nine, improvement of a standing posture in three, increases in the ability to walk in two and alleviation of pain in three. Although nerve block is reported to result in hematoma, decreases in muscle force, pain, cystic/rectal disorders and hypogonadism, we have observed no such complication in our patients.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
9/33. Intracardiac rhabdomyosarcoma: transesophageal echocardiographic findings and diagnosis.Transesophageal echocardiography (TEE) was performed on a 41-year-old woman who presented with a cerebrovascular accident. TEE confirmed the presence of a morphologically bizarre biatrial tumor with precarious, vigorous motion throughout the cardiac cycle. Surgical intervention was decided on, and the patient underwent cardiac surgery for tumor excision 16 hours after TEE. Intraoperative frozen section diagnosis was spindle cell sarcoma, and subsequent immunohistochemical analysis showed the tumor to be a rhabdomyosarcoma. The data are presented here, and the role of TEE to establish a preoperative diagnosis of intracardiac tumor is discussed.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
10/33. Interaction of neuropsychological and psychological factors in two cases of "space phobia".Recent theories of psychological disorders are beginning to break down the traditional dichotomy between mental and physical processes. The present paper reports on two cases of space phobia in which this is especially apparent. Neuropsychological assessment indicated subtle disturbance in visuospatial functioning. The emotional response to this dysfunction appeared, however, to be somewhat excessive given the subtlety of the deficit. This is seen as a psychological reaction to a neuropsychological dysfunction.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
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