Parietal Lobe Involvement Research Articles

Clinical, radiological, and laboratory factors associated with mortality and functional outcomes in pediatric patients presenting with intracranial gunshot wounds.

Firearm injuries are now the leading cause of death in children and young adults younger than 25 years of age in the US. Current management of these injuries is extrapolated from adult blunt and penetrating traumatic brain injury guidelines. The objectives of this study were to investigate and analyze the clinical, radiological, and laboratory factors associated with mortality and functional outcomes in pediatric patients presenting with intracranial gunshot wounds (GSWs). Medical records were screened for all patients younger than 21 years of age with an intracranial GSW who presented to the University Medical Center in New Orleans, Louisiana, from 2012 to 2022. Demographics and radiological, clinical, and laboratory data were extracted, and chi-square and Fisher's exact tests were used to evaluate individual association with mortality and functional outcome. Odds ratios were calculated from the cross tabulations for categorical variables and univariate binary logistic regression models for continuous variables. Multivariate binary logistic regression was used to adjust for effects of covariates and isolate the contributions of predictor variables for mortality and functional outcome. Ninety-six patients (82 male, 14 female) had a median age of 18 (interquartile range [IQR] 15-20) years. The 30-day inpatient, 60-day, and 6-month mortality rates among these patients were 53.1%, 0%, and 2.4%, respectively. Those who died were more likely to have an initial Glasgow Coma Scale score ≤ 8 (p < 0.001), bilateral fixed pupils (p < 0.001), transventricular trajectory (p < 0.001), deep nuclear/third ventricle involvement (p = 0.004), bihemispheric trajectory (p = 0.025), injury to ≥ 3 lobes (p = 0.015), parietal lobe involvement (p = 0.023), base deficit < -5 mEq/L (p = 0.013), international normalized ratio (INR) > 1.5 (p = 0.007), and a St. Louis Scale (SLS) score ≥ 5 (p < 0.001). The survivors with favorable functional outcome were more likely to have lower median SLS scores (p = 0.016) and injury to < 3 lobes (p < 0.001). In a multivariate analysis, bilaterally fixed nonreactive pupils were positively associated with mortality and negatively associated with favorable functional outcome, whereas the Injury Severity Score (ISS) and injury to ≥ 3 lobes were negatively associated with favorable functional outcome only. This is one of the largest series of pediatric intracranial GSWs to date. The authors identified certain clinical (bilateral fixed pupils, SLS score ≥ 5, ISS > 16), laboratory (INR > 1.5, base deficit < -5 mEq/L), and radiological (transventricular trajectory, deep nuclear/third ventricle involvement, parietal lobe involvement) factors that were associated with death and poor functional outcome in this pediatric cohort.

Posterior reversible encephalopathy syndrome in immunocompromised children - A single-center study from South India.

This study describes the profile of children diagnosed with posterior reversible encephalopathy syndrome (PRES) in the pediatric hematology oncology unit and highlights the clinical features of PRES in immunosuppressed children. This retrospective study included 10 children diagnosed with PRES with a mean age of 6.8 years. Acute lymphoblastic leukemia was the most common primary diagnosis followed by post-hematopoietic stem cell transplant patients. Most cases of PRES occurred within one month of treatment initiation. Hypertension was noted in all at the time of diagnosis. Neuroimaging revealed bilateral lesions with parietal and occipital lobe involvement being the most common. All patients received corticosteroids as part of treatment for primary diagnosis. Controlling blood pressure was critical in managing PRES. Consideration of PRES as a clinical possibility in pediatric hematology oncology unit in children presenting with symptoms such as headache, seizures, and visual disturbances will aid in early diagnosis after ruling out other causes of these symptoms.

Anomia: Deciphering Functional Neuroanatomy in Primary Progressive Aphasia Variants.

Naming decline is one of the most common symptoms of primary progressive aphasia (PPA). Most studies on anomia in PPA are performed without taking into account PPA variants, especially for action naming. Only limited data are available for the neuroanatomical basis of anomia considering differences in the pathogenesis of PPAs. The aim of our study is to investigate the associations between anomia severity for both noun and verb naming and gray matter (GM) atrophy, as well as accompanying functional connectivity (FC) changes in three PPA variants. A total of 17 patients with non-fluent (nfvPPA), 11 with semantic (svPPA), and 9 with logopenic (lvPPA) PPA variants were included in the study and underwent cognitive/naming assessments and brain MRIs. Voxel-based morphometry was performed to evaluate GM volume. A resting-state functional MRI was applied to investigate FC changes in the identified GM areas. The study shows that different brain regions are involved in naming decline in each PPA variant with a predominantly temporal lobe involvement in svPPA, parietal lobe involvement in lvPPA, and frontal lobe involvement in nfvPPA. Separate data for object and action naming in PPA variants are provided. The obtained results mainly correspond to the current understanding of language processing and indicate that the evaluation of language impairments is preferable for each PPA variant separately. A further analysis of larger cohorts of patients is necessary to confirm these preliminary results.

A PROSPECTIVE OBSERVATIONAL STUDY OF PREDICTORS OF POOR OUTCOMES IN PATIENTS WITH CEREBRAL SINUS VENOUS THROMBOSIS AT A TERTIARY CARE CENTER IN INDIA

Objective: The objective of this study was to evaluate the factors associated with poor outcome in cerebral sinus venous thrombosis (CSVT) patients at 3 and 6 months. Methods: This was a prospective observational study in which CSVT patients hospitalized at a tertiary care center in Davangere, India during November 2016–October 2018 were included and followed up for 6 months. CSVT diagnosis was confirmed with imaging findings of computed tomography, magnetic resonance imaging, and magnetic resonance venography. Modified Rankin Scale score of 0–1 was considered indicative of “good outcome,” while that of ≥2 indicated “poor outcome.” Results: Data of 44 patients were collected, of which 59% (n=26) were male, 68.2% of the patients belonged to the age group 25–45 years (mean age: 34.91±11.23 years). Fifteen patients (34.09%) had acute, 24 patients (54.55%) had sub-acute, and five patients (11.36%) had chronic symptom duration. At 3 months, age &gt;45 years (p=0.008), focal seizure (p&lt;0.001), hemiparesis (p&lt;0.001), cerebellar signs (p&lt;0.008), infarct (p=0.006), hemorrhage (p=0.049), edema (p=0.012) and midline shift (p=0.007), involvements of straight sinus (p=0.035), inferior sagittal sinus (p=0.007), frontal lobe (p=0.038), and Glasgow coma scale (GCS) score of 8–12 (p=0.008) were significantly associated with “poor outcome.” At 6 months, patients with focal seizures (p=0.001), hemiparesis (p=0.008), hemorrhage (p=0.044), midline shift (p=0.013), involvement of parietal lobe (p=0.025), presence of hemorrhage (p=0.044), and GCS score of 8–12 (p=0.001) significantly higher rate of “poor outcome.” Conclusion: This real-world observational study identifies the clinicodemographic and neuroimaging variables significantly associated with “poor outcome” in CSVT patients.

Emergence of Cerebral Mucormycosis in the Post-COVID Period: A Detailed Analysis of Risk Factors, Clinical Progression, and Management of This Opportunistic Fungal Infection.

An epidemic ofMucoraleswas reported following the second wave of COVID-19 in India, and intracranial extension of the same was one of the most dreadful complications. A total of 62 patients with cerebral mucormycosis were recruited and followed up till 12 weeksto evaluate the risk factors, incidence, clinical manifestations, management, and prognosis of cerebral mucormycosis. A median age of 51.5 yearswith male predominance (74%) was noted. The majority of subjects reported a history of COVID infection (93.5%) and diabetes mellitus (83.87%). The first symptom of mucormycosis appeared after a mean period of 17.63 ± 8.9 days following COVID. Facial swelling and ptosis were the most common symptoms. Only 55% of patients had neurological presentations, and hemiparesis was the most common neurological sign (30.6%). Radiologically, the involvement of maxillary sinus (90.32%) and ethmoid sinus (87.10%)was commonly noted. Cerebral findings included temporal lobe (50%) andparietal lobe (30.06%) involvement, cavernous sinus thrombosis (30.06%), and internal carotid artery thrombosis (22.58%). Acute cerebral infarction was notable in 37% of subjects (p-value=0.0015, significant association with the outcome). Conventional and liposomal amphotericin B were used in 91.94% and 53.23% of patients, respectively. Retrobulbar amphotericin injections used in 11.3% of subjects significantly affected the outcome (p-value=0.03, significant). Posaconazole step-downtherapy was used in72.5% of subjects (p-value=0.0005, significant). Surgical interventions were performed in53 (85.48%) subjects (p-value=0.004, significant).Functional endoscopic sinus surgery was the most common (in 64.52% of subjects), followed by maxillectomy (20.97% of subjects) and craniotomy (17.7% of subjects). At the end of 12 weeks, 33.87% of patients died and 59.68% were alive; the rest(6.45%) were lost to follow-up. The absence or late presentation of neurological symptoms led to a delayed diagnosis of cerebral mucormycosis. The presence of acute cerebral infarction indicated a worse prognosis. However, there was a significant influence of step-down posaconazole therapy, retrobulbar amphotericin injections, and surgical intervention on the prognosis of cerebral mucormycosis.

Adverse radiation effects in volume-staged radiosurgery for large arteriovenous malformations: a multiinstitutional study.

The optimal treatment paradigm for large arteriovenous malformations (AVMs) is controversial. One approach is volume-staged stereotactic radiosurgery (VS-SRS). The authors previously reported efficacy of VS-SRS for large AVMs in a multiinstitutional cohort; here they focus on risk of symptomatic adverse radiation effects (AREs). This is a multicentered retrospective review of patients treated with a planned prospective volume staging approach to stereotactically treat the entire nidus of an AVM, with volume stages separated by intervals of 3-6 months. A total of 9 radiosurgical centers treated 257 patients with VS-SRS between 1991 and 2016. The authors evaluated permanent, transient, and total ARE events that were symptomatic. Patients received 2-4 total volume stages. The median age was 33 years at the time of the first SRS volume stage, and the median follow-up was 5.7 years after VS-SRS. The median total AVM nidus volume was 23.25 cm3 (range 7.7-94.4 cm3), with a median margin dose per stage of 17 Gy (range 12-20 Gy). A total of 64 patients (25%) experienced an ARE, of which 19 were permanent. Rather than volume, maximal linear dimension in the Z (craniocaudal) dimension was associated with toxicity; a threshold length of 3.28 cm was associated with an ARE, with a 72.5% sensitivity and a 58.3% specificity. In addition, parietal lobe involvement for superficial lesions and temporal lobe involvement for deep lesions were associated with an ARE. Size remains the dominant predictor of toxicity following SRS, but overall rates of AREs were lower than anticipated based on baseline features, suggesting that dose and size were relatively dissociated through volume staging. Further techniques need to be assessed to optimize outcomes.

Outcome Analysis and Prognostic Factors in Patients of Glioblastoma Multiforme: An Indonesian Single Institution Experience

Aims: This study was done to assess the survival of patients with glioblastoma multiform and to identify factors that can affect patient survival.&#x0D; Materials and methods: From January 2015 to December 2019, 55 patients with histopathologically confirmed glioblastoma multiform and received adjuvant radiation/chemoradiation in our department were retrospectively analyzed.&#x0D; Results: The median overall survival (OS) for entire cohort was 13 months and 1-year OS and 2-year OS rate were 52.7% and 3.6% with the mean follow-up period was 12 months. In univariate analysis, age (≤50 years vs &gt;50 years, p=0.02), performance status (≥90 vs 70-80 vs &lt;70, p&lt;0.001), RTOG RPA classification (class III vs class IV vs class V-VI, p&lt;0.001), parietal lobes tumor site (vs others, p=0.02), residual tumor volume (≤20.4cm3 vs &gt;20.4cm3, p=0.001) and time to initiate adjuvant therapy (&lt;4 weeks vs 4-6 weeks vs &gt;6 weeks, p=0.01) were significantly affect overall survival. In multivariate analysis, RTOG RPA classification and involvement of parietal lobes were independent prognostic factors for overall survival.&#x0D; Conclusions: RTOG RPA classification that consisted of age and performance status is an independent prognostic factor for the clinical outcome of GBM. Besides this well-known factor, we also identified the involvement of parietal lobe gives a strong negative influence on survival of GBM patients.

Tinnitus pathophysiology – still a puzzle for medicine

Tinnitus is an auditory sensation perceived by the patient without a corresponding external sound source, which in some cases can profoundly affect the quality of life, causing anxiety or even depression. One of the most demanding areas for tinnitus research is comprehending the underlying pathophysiological mechanisms, particularly for subjective chronic tinnitus. This review provides an update on the main mechanisms involved in the genesis of tinnitus. Coch­lear impairment remains an important cause in the onset of tinnitus, especially as it may be present in in­di­vi­duals considered to have normal hearing. These people have alterations on the audiogram that can be seen only at high frequencies, above 8 kHz, undetectable by standard au­dio­metric measurements. Other triggers in­volved are emo­tio­nal trauma or neurosensory factors. The feeling of tinnitus reflects a complex interaction bet­ween peri­phe­ral and central mechanisms at the level of the au­di­tory pathway, but also the involvement of non-auditory central areas, including frontal and parietal lobe or limbic level regions. Considering these aspects, tin­nitus can be considered a result of neuroplastic response to sensory deprivation. The knowledge of the complex and mul­ti­fac­torial mechanisms involved in the genesis of tinnitus can guide clinicians to make a correct diagnosis and recommend appropriate therapy in daily medical practice.

Longitudinal anatomic, functional, and molecular characterization of Pick disease phenotypes.

To characterize longitudinal MRI and PET abnormalities in autopsy-confirmed Pick disease (PiD) and determine how patterns of neurodegeneration differ with respect to clinical syndrome. Seventeen patients with PiD were identified who had antemortem MRI (8 with behavioral variant frontotemporal dementia [bvFTD-PiD], 6 with nonfluent/agrammatic primary progressive aphasia [naPPA-PiD], 1 with semantic primary progressive aphasia, 1 with unclassified primary progressive aphasia, and 1 with corticobasal syndrome). Thirteen patients had serial MRI for a total of 56 MRIs, 7 had [18F]fluorodeoxyglucose PET, 4 had Pittsburgh compound B (PiB) PET, and 1 patient had [18F]flortaucipir PET. Cross-sectional and longitudinal comparisons of gray matter volume and metabolism were performed between bvFTD-PiD, naPPA-PiD, and controls. Cortical PiB summaries were calculated to determine β-amyloid positivity. The bvFTD-PiD and naPPA-PiD groups showed different foci of volume loss and hypometabolism early in the disease, with bvFTD-PiD involving bilateral prefrontal and anterior temporal cortices and naPPA-PiD involving left inferior frontal gyrus, insula, and orbitofrontal cortex. However, patterns merged over time, with progressive spread into prefrontal and anterior temporal lobe in naPPA-PiD, and eventual involvement of posterior temporal lobe, motor cortex, and parietal lobe in both groups. Rates of frontotemporal atrophy were faster in bvFTD-PiD than naPPA-PiD. One patient was β-amyloid-positive on PET with low Alzheimer neuropathologic changes at autopsy. Flortaucipir PET showed elevated uptake in frontotemporal white matter. Patterns of atrophy and hypometabolism differ in PiD according to presenting syndrome, although patterns of neurodegeneration appear to converge over time.

Structural Brain Lesions and Gait Pathology in Children With Spastic Cerebral Palsy.

The interaction between brain damage and motor function is not yet fully understood in children with spastic cerebral palsy (CP). Therefore, a semi-quantitative MRI (sqMRI) scale was used to explore whether identified brain lesions related to functional abilities and gait pathology in this population. A retrospective cohort of ambulatory children with spastic CP was selected [N = 104; 52 bilateral (bCP) and 52 unilateral (uCP)]. Extent and location-specific scores were defined according to the sqMRI scale guidelines. The gross motor function classification system (GMFCS), the gait profile score (GPS), GPSs per motion plane, gait variable scores (GVS) and multiple-joint (MJ) gait patterns were related to brain lesion scores. In all groups, the global total brain scores correlated to the GPS (total: rs = 0.404, p ≤ 0.001; bCP: rs = 0.335, p ≤ 0.05; uCP: rs = 0.493, p ≤ 0.001). The global total hemispheric scores correlated to the GMFCS (total: rs = 0.392, p ≤ 0.001; bCP: rs = 0.316, p ≤ 0.05; uCP: rs = 0.331, p ≤ 0.05). The laterality scores of the hemispheres in the total group correlated negatively to the GMFCS level (rs = −0.523, p ≤ 0.001) and the GVS-knee sagittal (rs = −0.311, p ≤ 0.01). Lesion location, for the total group demonstrated positive correlations between parietal lobe involvement and the GPS (rs = 0.321, p ≤ 0.001) and between periventricular layer damage and the GMFCS (rs = 0.348, p ≤ 0.001). Involvement of the anterior part of the corpus callosum (CC) was associated with the GVS-hip sagittal in all groups (total: rpb = 0.495, p ≤ 0.001; bCP: rpb = 0.357, p ≤ 0.05; uCP: rpb = 0.641, p ≤ 0.001). The global total hemispheric and laterality of the hemispheres scores differentiated between the minor and both the extension (p ≤ 0.001 and p ≤ 0.001) and flexion (p = 0.016 and p = 0.013, respectively) MJ patterns in the total group. Maximal periventricular involvement and CC intactness were associated with extension patterns (p ≤ 0.05 and p ≤ 0.001, respectively). Current findings demonstrated relationships between brain structure and motor function as well as pathological gait, in this cohort of children with CP. These results might facilitate the timely identification of gait pathology and, ultimately, guide individualized treatment planning of gait impairments in children with CP.

Cardiogenic cerebral infarction in the parietal lobe predicts the development of post-stroke epilepsy

PurposePost-stroke epilepsy (PSE) is a major late complication of cardioembolic cerebral infarction. However, few studies have examined the epileptogenicity and characteristics of first-occurrence cardioembolic cerebral infarctions. MethodsThis retrospective study included 93 consecutive patients with old cardioembolic cerebral infarctions who were classified into two groups based on their epileptic history: patients presenting with PSE or stroke without seizure (SWS). Each patient was diagnosed with an epileptic seizure subtype and treated with appropriate anti-epileptic therapy after admission. We evaluated clinical characteristics, laboratory results, and intracranial infarct areas. The sizes of these areas were measured using MRI diffusion-weighted image (DWI) of each patient after their first stroke. The volume was calculated by multiplying the total slice area with the slice thickness. ResultsPSE was diagnosed in 43 (46.2 %) of 93 patients. The mean (± SD) time from infarction onset to the first seizure in the PSE group was 22.5 ± 31.6 months. The PSE group exhibited significantly more atrial fibrillation (p = 0.022) and higher glucose levels (p < 0.001) compared with the SWS group. The most common PSE seizure type was focal to bilateral tonic-clonic seizure (61.0 %). Although DWI did not reveal any significant differences in the volume of infarctions between the two groups, the involvement of the parietal lobe in infarction of the PSE group (69.8 %) upon first admission was significantly higher (p = 0.006) than that of the SWS group (40.0 %). Multiple logistic regression analysis revealed that parietal lobe involvement in infarction (OR 4.95; 95 % CI 1.25–19.60; p = 0.023) was a significant independent predictor of PSE. ConclusionThe involvement of the parietal lobe in infarction was a significant independent predictor of PSE. Dysfunction of the parietal lobe might play a critical role in the epileptogenesis of PSE.

Posterior Reversible Encephalopathy Syndrome – A Rare Complication after Methylprednisolone

Posterior reversible encephalopathy syndrome (PRES) is a rare neurological complication. It can occur as a complication of hypertensive disease of pregnancy, autoimmune disorder or after immunosuppressant. Typical imaging features of PRES are bilateral symmetrical involvement of parietal and occipital lobe. Here, we reported a case of PRES after methylprednisolone.&#x0D; Bangladesh J Medicine Jan 2020; 31(1) : 41-42

Precuneus-Dominant Degeneration of Parietal Lobe Is at Risk of Epilepsy in Mild Alzheimer's Disease.

Introduction: Alzheimer's disease (AD) is the leading cause of cognitive decline. Epilepsy is a frequent comorbid condition of AD. While previous studies analyzed the risk factors of AD-related epileptic seizures, we still lack biomarkers of epilepsy in mild AD cases.Purpose: The aim of our study was to analyze the correlations between neuropsychology, cortical thickness, and brain volumetric measurements in mild Alzheimer patients with concomitant epileptic seizures.Materials and methods: We selected mild AD patients from our database to examine them with structural magnetic resonance imaging, 24 h electroencephalography, and detailed neuropsychology. We made the diagnosis of epilepsy based on epileptology data including neurophysiology. We retrospectively analyzed the neuropsychology pattern, clinical and epidemiologic features, cortical thickness, and volumetric values of mild AD patients with and without overt clinical seizures using covariance weighted general linear model.Results: We found epileptic seizures in 26% of mild AD patients. Patients with seizures performed worse in visuo-spatial scores than patients without (p = 0.003). Patients with seizures had smaller parietal thickness (p = 0.018), being associated to reduced thickness of left (p = 0.007), and right precunei (p = 0.005). The visuo-spatial performance positively and strongly correlated with the thickness of the parietal lobe (r = 0.67; p = 0.002) and with the volume of the precuneus (r = 0.612; p = 0.005).Conclusion: Epileptic seizures are common even in mild AD. We found that a prominent deficit in visuo-spatial skills is a red flag for epileptic seizures in the initial phase of AD, indicating the early involvement of parietal lobe in the neurodegenerative process. Because our findings suggest that the degeneration of precuneus is a sensitive marker of seizures associated to mild AD, clinicians need to pay special attention to the pattern of atrophy shown by structural MRI. Our results confirm previous data suggesting that epileptic seizures might be associated to a faster progressing type of AD with the early degeneration of posterior cortical areas.

Self-perspective in episodic memory after parietal damage and in healthy ageing

Although there is strong support from functional imaging studies for lateral parietal lobe involvement in episodic memory, patients with damage to these regions do not appear to suffer from severe deficits in this cognitive domain. As such there has been no definitive explanation of this area’s precise involvement. Here, we hypothesised that parietal regions play a crucial role in episodic memory – specifically in recollecting details from an egocentric perspective. In order to test this hypothesis systematically, we designed a novel experimental task utilising a head-mounted camera to record images from the participant’s perspective, enabling us to evaluate the integrity of memory from the individual’s own point of view. In the first study we examined patients with parietal damage and in a second study, using fMRI, we examined young and older healthy participants. Right-hemisphere patients with parietal damage were able to recall information accurately when recollecting what items had been present and where these items had been. However, patients were significantly impaired when attempting to judge from which perspective they had viewed the scenes. Critically, the patient group showed no evidence of impairment on standard tests of episodic and working memory. Examination of healthy participants in the second study utilised multi-voxel pattern analysis on neural activity during the recognition phase of a similar task. This revealed sensitivity to be highest around the angular gyrus of the lateral parietal cortex for our critical comparison - that is, when viewing stimuli that were the same as their egocentric view during encoding versus the identical scene but presented from an alternative angle. Our results provide important evidence that parietal cortex is directly involved in egocentric spatial perspective aspects of episodic memory and demonstrate for the first time a specific deficit in episodic memory in patients with right parietal damage.

Síndrome de Gerstman secundario a malformación arteriovenosa del lóbulo parietal izquierdo. Reporte de caso

El síndrome de Gerstman se caracteriza porque los pacientes presentan 4 síntomas: alteraciones en la capacidad de expresar ideas por la escritura (agrafia), incapacidad para contar y realizar operaciones aritméticas sencillas (acalculia), imposibilidad de reconocer los dedos de la mano (agnosia digital) y desorientación derecha izquierda.&#x0D; Se asocia habitualmente con la lesión de una parte específica del cerebro, el giro angular del lóbulo parietal del hemisferio izquierdo. Habitualmente suele ser secundario a un accidentecerebro-vascular cerebral que afecta el territorio de la arteria cerebral media. La importancia del cuadro radica en su pronta detección por las consecuencias como afectación del lóbulo parietal posterior dominante para el lenguaje.&#x0D; El objetivo: es hacer una correlación anátomo-clínico-quirúrgica de este síndrome. A continuación se enmarca un caso de malformación arteriovenosa en la región parietal izquierda una paciente que consultó al departamento de Neurocirugía del Hospital Roosevelt por cefalea y alteración conductual.

Auditory neglect in children following perinatal stroke

Auditory neglect has been found in adults with right hemisphere focal brain lesions following strokes. Visual and tactile neglect has been found in children following both left and right hemisphere lesions resulting from perinatal strokes. The present cross-sectional study assessed auditory neglect in children with early unilateral brain damage from perinatal stroke. Twenty-six children with perinatal stroke and matched controls participated. All were asked to identify the location of a pure tone presented in left or right auditory fields. We found that children who had experienced left hemisphere perinatal strokes were significantly better at localizing sounds on the left side of space than the right side of space, and that response times improved with age on a normal trajectory relative to controls in left hemispace, while they did not improve normally in right hemispace. Children with right hemisphere perinatal strokes were significantly worse at localizing sounds on the right side of space relative to typically developing controls, and did not follow control trajectories for improvement in response times on the left or the right sides of space. Our preliminary results suggest that left hemisphere perinatal strokes may result in contralateral auditory neglect, while right hemisphere perinatal strokes may result in bilateral auditory neglect. Neglect was more severe in children with parietal lobe involvement, suggesting that the parietal lobe may play a dominant role in auditory attention in the developing brain.

125 Short Duration Monoballismus

AbstractStudy ObjectiveWhile monoballismus has been reported to be associated with hemorrhagic lesions in the subthalamic nucleus (Ohnishi, 2009) and multiple sclerosis (MS) (Rosa, 2011), the duration has been reported to be at least six days (Soysal, 2012). A patient with epochs of monoballismus lasting for 45 minutes is presented.MethodsCase Study: A 57 year old right handed female with attention deficit hereditary disorder predominantly inattentive on amphetamine sulphate, presented with two years of memory loss. For instance, after ordering food in restaurants, by the time the food arrives, she could not recall what she ordered. At the onset of this symptom, she noted three epochs of her left arm jerking for 45 minutes. The jerking would begin with low amplitude and low frequency and rapidly progress to the forearm and arm of greater magnitude and low frequency. With her right hand she would try to hold down her left arm without success. There was no associated paresis, sensory phenomena, headaches, dizziness, presyncope, loss of consciousness, or strong emotions. She admitted to frequent jamais vu.ResultsAbnormalities: Neurological Examination: Mental Status Examination: Memory: Immediate Recall: 5 digits forward and 2 digits backwards. Cranial Nerve (CN) Examination: CN I: Alcohol Sniff Test 8 (hyposmia). CN XII: tongue tremor on protrusion. Motor Examination: Drift Test: positive right pronator drift. Gait Examination: Tandem Gait: unstable. Reflexes: 0-1 throughout. Neuropsychiatric Examination: Go-No-Go Test: 6/6 (normal). Animal Fluency Test: 15 (normal). Clock Drawing Test: 3 (abnormal). Center for Neurologic Study Lability Scale: 16 (pseudobulbar affect). Other: MRI with and without infusion: normal.ConclusionTransient tonic-clonic movements of one limb have been described with focal epilepsy associated with diabetic non-ketotic hyperglycemia (Grant, 1985). A metabolic abnormality such as transient hypoglycemia or hyperkalemia can cause a focal dystonia (Soysal, 2012), which theoretically could manifest with monoballismus. This could be a somatic manifestation of underlying conflict, conversion disorder, or as a result of a physical manifestation of panic attack with hyperventilation and tetany (Mihai, 2008). This may be the first manifestation of a generalized cerebral disorder associated with chorea or ballismus such as Wilson’s disease, or Huntington’s Chorea (Mihai, 2008). It is possible that this is a variant of Alien Hand Syndrome with parietal lobe involvement (Shrestha, 2015). But this is unlikely given the absence of hemineglect or hemiagnosia. It is possible that amphetamines may have induced a monochorea. Chronic amphetamine use has been demonstrated to cause chorea (Klawans, 1974) and it theoretically could have caused ballismus movements in this case. In patients who present with short duration monoballismus, evaluation for subthalamic nuclei function, seizure disorders and other origins of ballismus are warranted.Funding AcknowledgementsSmell &amp; Taste Treatment and Research Foundation

Skull and Spinal Ewing's Sarcoma in Children: An Institutional Study.

Background:Ewing’s sarcoma is a disease of children and young adults and occurs most often in bone and soft tissues. The intracranial and spinal manifestation of the disease is rare and reported incidence is 1%–6%.Aims and Objectives:We conducted this study to determine the surgical outcome of children with skull and spine Ewing’s sarcoma (SSES).Methods:This is a prospective analysis of 13 patients of SSES who reported to the Department of Neurosurgery, Nizam’s Institute of Medical Sciences, Hyderabad, Telangana, India, between 2014 and 2016. All cases after detailed examination, magnetic resonance imaging, and computed tomography scan were subjected to surgery followed by adjuvant therapy comprising chemotherapy and radiotherapy. Outcome was analyzed at 6 months as well at latest follow-up. Neurological function, local recurrence, primary or secondary nature of the disease, distant relapse, and treatment-related complications were analyzed in this study.Results:There were eight female and five male patients with a mean age of 12 years (ranging from 4 to 8 years). Pain was the common presenting feature in all cases. Focal neurological deficits corresponding to the anatomical location was seen in six patients. These 13 cases were distributed anatomically as four cases involving the cloves, two cases with occipital bone and lobe involvement, one case of parietal bone and lobe involvement, and six cases of spinal involvement. Surgery was performed in all cases where gross total excision (Ozge C, Calikoglu M, Cinel L, Apaydin FD, Ozgür ES. Massive pleural effusion in an 18-year-old girl with Ewing sarcoma. Can Respir J 2004;11:363-5), near-total excision, and subtotal excision was achieved in these 13 cases (Steinbok P, Flodmark O, Norman MG, Chan KW, Fryer CJ. Primary Ewing’s sarcoma of the base of the skull. Neurosurgery 1986;19:104-7). Subsequently all cases underwent multiagent chemoradiotherapy. Postsurgery pain subsided in 12 (92%) of patients. Ten patients maintained or improved motor function. In seven cranial cases and in six spinal cases, four cases showed improvement whereas three (23%) had deterioration of motor function.Conclusions:Surgical outcome of SSES in short-term follow-up is good with current recommended management regimen of maximum excision followed by chemo and radiotherapy. However, metastasis is not uncommon.

Relationship between tumour location and preoperative seizure incidence in patients with gliomas: a systematic review and meta-analysis.

The aim of this meta-analysis was to assess the relationship between tumour location and preoperative seizure incidence in patients with gliomas. Systematic computerised searches of PubMed and the Web of Knowledge were performed. The meta-analysis of pooled odds ratio (OR) and 95% confidence interval (CI) for preoperative seizure risk, stratified by tumour location, were calculated. Eleven studies with 2,047 patients were included for meta-analysis. For gliomas with or without frontal lobe involvement, the preoperative seizure incidence ranged from 31.7% (19/60) to 85.7% (156/182) and 19.7% (12/61) to 85.7% (12/14), respectively; the pooled OR was 1.560 (95% CI: 1.266-1.923; Z: 4.17; p=0.000). For gliomas with or without temporal lobe involvement, seizure incidence was 22.6% (7/31) to 91.7% (11/12) and 26.7% (24/90) to 78.7% (174/221), respectively; the pooled OR was 1.070 (95% CI: 0.794-1.443; Z: 0.45; p=0.656). For gliomas with or without parietal lobe involvement, seizure incidence was 18.1% (3/16) to 100.0% (3/3) and 26.7% (28/105) to 80.4% (226/281), respectively; the pooled OR was 0.770 (95% CI: 0.570-1.040; Z: 1.71; p=0.088). For gliomas with or without occipital lobe involvement, seizure incidence was 0.0% (0/2) to 100.0% (2/2) and 26.8% (30/112) to 75.7% (56/74), respectively; the pooled OR was 0.336 (95% CI: 0.164-0.686; Z: 2.99; p=0.003). For gliomas with or without insula lobe involvement, seizure incidence was 34.8% (8/23) to 72.0% (77/107) and 34.3% (60/175) to 81.3% (247/304), respectively; the pooled OR was 1.058 (95% CI: 0.765-1.463; Z: 0.34; p=0.732). No significant publication bias was found. Our meta-analysis indicates that frontal lobe gliomas are related to a higher preoperative seizure incidence, while occipital lobe gliomas are related to a lower incidence.

Inferior parietal and right frontal contributions to trial-by-trial adaptations of attention to memory

The attention to memory theory (AtoM) proposes that the same brain regions might be involved in selective processing of perceived stimuli (selective attention) and memory representations (selective retrieval). Although this idea is compelling, given consistently found neural overlap between perceiving and remembering stimuli, recent comparisons brought evidence for overlap as well as considerable differences. Here, we present a paradigm that enables the investigation of the AtoM hypothesis from a novel perspective to gain further insight into the neural resources involved in AtoM. Selective attention in perception is often investigated as a control process that shows lingering effects on immediately following trials. Here, we employed a paradigm capable of modulating selective retrieval in a similarly dynamic manner as in such selective-attention paradigms by inducing trial-to-trial shifts between relevant and irrelevant memory representations as well as changes of the width of the internal focus on memory. We found evidence for an involvement of bilateral inferior parietal lobe and right inferior frontal gyrus in reorienting the attentional focus on previously accessed memory representations. Moreover, we could dissociate the right inferior from the parietal activation in separate contrasts, suggesting that the right inferior frontal gyrus plays a role in facilitating attentional reorienting to memory representations when competing representations have been activated in the preceding trial, potentially by resolving this competition. Our results support the AtoM theory, i.e. that ventral frontal and parietal regions are involved in automatic attentional reorienting in memory, and highlight the importance of further investigations of the overlap and differences between regions involved in internal (memory) and external (perceptual) attentional selection.