1/102. Plasticity of language-related brain function during recovery from stroke.BACKGROUND AND PURPOSE: This study was undertaken to correlate functional recovery from aphasia after acute stroke with the temporal evolution of the anatomic, physiological, and functional changes as measured by MRI. methods: blood oxygenation level-dependent contrast and echo-planar MRI were used to map language comprehension in 6 normal adults and in 2 adult patients during recovery from acute stroke presenting with aphasia. perfusion, diffusion, sodium, and conventional anatomic MRI were used to follow physiological and structural changes. RESULTS: The normal activation pattern for language comprehension showed activation predominately in left-sided Wernicke's and Broca's areas, with laterality ratios of 0.8 and 0.3, respectively. Recovery of the patient confirmed as having a completed stroke affecting Broca's area occurred rapidly with a shift of activation to the homologous region in the right hemisphere within 3 days, with continued rightward lateralization over 6 months. In the second patient, in whom mapping was performed fortuitously before stroke, recovery of a Wernicke's aphasia showed a similar increasing rightward shift in activation recruitment over 9 months after the event. CONCLUSIONS: Recovery of aphasia in adults can occur rapidly and is concomitant with an activation pattern that changes from left to a homologous right hemispheric pattern. Such recovery occurs even when the stroke evolves to completion. Such plasticity must be considered when evaluating stroke interventions based on behavioral and neurological measurements.- - - - - - - - - - ranking = 1keywords = brain (Clic here for more details about this article) |
2/102. Interictal change in cardiac autonomic function associated with EEG abnormalities and clinical symptoms: a longitudinal study following acute deterioration in two patients with temporal lobe epilepsy.The purpose of the present study was to investigate the ictal and interictal changes in cardiac autonomic function (CAF), and the relationship between the interictal change in CAF to the electroencephalogram (EEG) and clinical findings. In two patients with temporal lobe epilepsy (TLE) showing acute deterioration, a quantitative evaluation of their interictal CAF based on heart rate variability and their EEG using spectral analysis was conducted, and the findings compared with repeated clinical evaluations during the recovery period. The ictal heart rate changes and their temporal relationship to ictal discharge were investigated using simultaneous EEG/electrocardiogram (ECG) monitoring in one of the patients. Interictal parasympathetic function was decreased during the period of acute deterioration, but was increased in association with improvements in the EEG and clinical findings. In contrast, the sympathetic function showed no specific changes. The ictal discharges were preceded by a brief bradycardia, with a long delay of up to 40s. The results demonstrated that this decrease in parasympathetic function was closely related to the interictal changes in central nervous system function. On the other hand, the ictal discharges in one of the patients were thought to have caused a transient elevation of parasympathetic function. It is strongly suggested that patients with TLE have interictal as well as ictal changes in CAF that are mediated mainly through the parasympathetic nervous system.- - - - - - - - - - ranking = 0.062579359290424keywords = central nervous system, nervous system (Clic here for more details about this article) |
3/102. Regional cerebral blood flow during temporal lobe seizures associated with ictal vomiting: an ictal SPECT study in two patients.PURPOSE: Ictal vomiting represents a rare clinical manifestation during seizures originating from the temporal lobes of the nondominant hemisphere. The precise anatomic structures responsible for generation of ictal vomiting remain to be clarified. Ictal single photon emission computed tomography (SPECT), which allows one to visualize the three-dimensional dynamic changes of regional cerebral blood flow (rCBF) associated with the ongoing epileptic activity, should be useful to study the brain areas activated during ictal vomiting. methods: We performed ictal Tc-HMPAO SPECT scans in two patients with mesial temporal lobe epilepsy (MTLE) whose seizures were characterized by ictal retching and vomiting. MTLE was documented by typical clinical seizure semiology, interictal and ictal EEG findings, hippocampal atrophy on magnetic resonance imaging (MRI) scan, and a seizure-free outcome after selective amydalohippocampectomy. In both patients, seizures originated in the nondominant temporal lobe. We obtained accurate anatomic reference of rCBF changes visible on SPECT by a special coregistration technique of MRI and SPECT. We used ictal SPECT studies in 10 patients with MTLE who had seizures without ictal vomiting as controls. RESULTS: In the two patients with ictal vomiting, we found a significant hyperperfusion of the nondominant temporal lobe (inferior, medial, and lateral superior) and of the occipital region on ictal SPECT. In patients without ictal vomiting, on the contrary, these brain regions never were hyperperfused simultaneously. CONCLUSIONS: Ictal SPECT provides further evidence that activation of a complex cortical network, including the medial and lateral superior aspects of the temporal lobe, and maybe the occipital lobes, is responsible for the generation of ictal vomiting.- - - - - - - - - - ranking = 0.5keywords = brain (Clic here for more details about this article) |
4/102. abdominal pain in children.Chronic vague abdominal pain is an extremely common complaint in children over 5 years, with a peak incidence in the 8 to 10 year group. In over 90 per cent of the cases no serious underlying organic disease will be discovered. Most disease states can be ruled out by a careful history, a meticulous physical examination, and a few simple laboratory tests such as urinalysis, sedimentation rate, hemoglobin, white blood count determination, and examination of a blood smear. If organic disease is present there are often clues in the history and the examination. The kidney is often the culprit--an intravenous pyelogram should be done if disease is suspected. barium enema is the next most valuable test. Duodenal ulcers and abdominal epilepsy are rare and are over-diagnosed. If no organic cause is found, the parents must be convinced that the pain is real, and that "functional" does not mean "imaginary." This is best explained by comparing with "headache"--the headache resulting from stress and tension hurts every bit as much as the headache caused by a brain tumor or other intracranial pathology. Having convinced the patient and his parents that no serious disease exists, no further investigation should be carried out unless new signs or symptoms appear. The child must be returned to full activity immediately.- - - - - - - - - - ranking = 0.25keywords = brain (Clic here for more details about this article) |
5/102. Functional imaging in reading epilepsy: a case report.reading epilepsy is an uncommon epileptic syndrome preferentially related to the temporoparietal region of the language dominant hemisphere. We report ictal and interictal brain perfusion SPECT images in a 28-year-old woman who was reading epilepsy.- - - - - - - - - - ranking = 0.25keywords = brain (Clic here for more details about this article) |
6/102. Partial seizures manifesting as apnea only in an adult.PURPOSE: Although several cases of apneic seizures have been reported in neonates, epileptic seizures presenting as apnea only in adults are very rare. We present a case report of a 19-year-old man with viral encephalitis and frequent episodes of apneic seizures. methods: Prolonged electroencephalograms (EEGs), respiratory monitorings, and imaging including ictal-interictal subtraction single photon emission computed tomography (SPECT) coregistered with magnetic resonance imaging (MRI) were performed. RESULTS: Ictal EEGs recorded during apneic episodes showed repetitive sharp waves or rhythmic theta activity arising from the left or right independent bitemporal region. Ictal SPECT was performed during one episode of apnea that showed ictal EEG discharges arising from the left posterior temporal area. Ictal-interictal subtraction SPECT coregistered with MRI revealed that the seizures originated from the left, posterior, midlateral temporal cortex. CONCLUSIONS: Previous studies with ictal EEG or brain stimulation suggest that apneic seizures might be mediated through the limbic and associated cortical systems. Our study reports on a very rare case of partial seizures with apnea only in an adult patient and is supported by ictal EEG and ictal-interictal subtraction SPECT coregistered with MRI.- - - - - - - - - - ranking = 0.25keywords = brain (Clic here for more details about this article) |
7/102. Changes in paroxysmal brainwave patterns of epileptics by weak-field magnetic stimulation.In order to assess the effects of weak-field magnetic stimulation on brain electrical activity in epileptics, three patients suffering from mesial temporal lobe epilepsy (MTLE) were exposed to DC magnetic fields of 0.9 and 1.8 millitesla (mT). The EEG activity was recorded simultaneously from intracranial electrodes inserted through the foramen ovale (FO) and scalp electrodes. Significant enhancement of interictal epileptiform activity was observed in two patients, while in one patient, magnetic stimulation resulted in the cessation of interictal spike/wave trains.- - - - - - - - - - ranking = 1.25keywords = brain (Clic here for more details about this article) |
8/102. Acute pancreatitis associated with temporal lobectomy and intractable seizure.We present a rare case of acute pancreatitis associated with temporal lobectomy due to intractable seizure in a 23-year-old man. The patient underwent elective right temporal lobectomy and hippocampectomy. Severe upper abdominal pain occurred just 10 hours after surgery. The diagnosis of acute pancreatitis was based on the elevation of serum amylase and lipase levels, and the findings of abdominal computerized tomography. Other possible causative factors of acute pancreatitis including alcohol, biliary tract stone, hypertriglyceridemia, hypercalcemia, hyperparathyroidism, biliary dysmotility and autoimmune disease were excluded by a series of examinations. The possibility of drug-induced pancreatitis was very low in this patient. The patient was discharged after supportive treatment. No recurrence of seizure or abdominal pain was noted in the three months after discharge. Acute abdominal pain after brain surgery deserves clinical evaluation for acute pancreatitis.- - - - - - - - - - ranking = 0.25keywords = brain (Clic here for more details about this article) |
9/102. Tests of the predictive value of EEG recording from within the brain in the partial epilepsies.The EEG, as recorded from electrodes in deep structures of the brain in cases of intractable seizures, has been surveyed to assess its predictive value in the partial epilepsies. In addition to scalp EEGs and depth EEGs in control situations, ictal recordings of tape-recorded seizures and the interictal enhancement of EEG signs by benzodiazepines have been analyzed. All results have been quantified by computer analysis. The predictive value of the EEGs has been assessed in 2 ways: (1) by comparison with the pathology found after surgery and (2) by the long-term clinical status of the patient postoperatively. Twelve cases with lesions found in limbic structures and 6 with cortical involvement are reported. In the latter cases secondary firing of the hippocampus, with its low threshold for seizures, frequently followed, though more rapidly than could be timed by visual inspection alone. Bilateral signs both in scalp EEGs and in depth were a common finding in the cases with limbic lesions. In those patients with marked clinical improvement, follow-up computerized studies of pre- and post-operative scalp EEGs revealed normalization in both hemispheres, leading to the proposal that a focus of defective tissue may impair neuronal function in widely distant regions of the brain.- - - - - - - - - - ranking = 1.5keywords = brain (Clic here for more details about this article) |
10/102. Dysphoric disorders and paroxysmal affects: recognition and treatment of epilepsy-related psychiatric disorders.Interictal dysphoric disorder is an intermittent and pleiomorphic affective-somatoform disorder that presumably occurs as a result of inhibitory mechanisms in chronic mesial temporal lobe epilepsy. Treatment with antidepressant medication, enhanced if necessary with small doses of an atypical antipsychotic, tends to be highly effective. The dysphoric disorder also occurs in the absence of epilepsy in a subictal variation, particularly in patients with brain lesions and as premenstrual dysphoric disorder. The paroxysmal affects, ranging from irritability through anger to rage, play a major role in interictal dysphoric disorder. Their manifestation among patients with mesial temporal lobe epilepsy is counterbalanced by the fact that these individuals tend to be highly ethical and religious. The paroxysmal affects that may emerge with vehemence during episodes of interictal dysphoric disorder play a role in all people, differing in prominence among individuals. For a comprehensive view of the psychiatric aspects of epilepsy, the important premodern findings are reviewed together with recent ones.- - - - - - - - - - ranking = 0.25keywords = brain (Clic here for more details about this article) |
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