Left Fornix Research Articles

A disproportionate role for the fornix and mammillary bodies in recall versus recognition memory

Uncovering the functional relationship between temporal lobe amnesia and diencephalic amnesia depends on determining the role of the fornix, the major interlinking fiber tract. In this study relating fornix volume with memory, we made magnetic resonance imaging-based volume estimates of 13 brain structures in 38 individuals with surgically removed colloid cysts. Fornix status was assessed directly by overall volume and indirectly by mammillary body volume (which atrophies after fornix damage). Mammillary body volume significantly correlated with 13 out of 14 tests of episodic memory recall, but correlated poorly with recognition memory. Furthermore, as the volumes of the left fornix and the left mammillary bodies decreased, the difference between recall and recognition scores increased. No other structure was consistently associated with memory. These findings support models of diencephalic memory mechanisms that require hippocampal inputs for recall, but not for key elements of recognition.

Disrupted integrity of the fornix is associated with impaired memory organization in schizophrenia

BackgroundThe fornix is a major projection of the hippocampus to and from other brain regions. A previous diffusion tensor imaging (DTI) study has reported disrupted integrity of the fornix in patients with schizophrenia. However, functional significance of the DTI abnormalities of the fornix in schizophrenia has not been fully studied yet. We investigated an association between DTI abnormalities of the fornix and impairment of memory organization in schizophrenia. MethodsThirty-one patients with schizophrenia and 65 age- and gender-matched healthy controls underwent DTI, and fractional anisotropy (FA) and mean diffusivity (MD) were measured in cross-sections of fornix tractography. In addition, all of the patients and 32 controls performed a verbal learning task specialized for evaluating memory organization, the verbal memory subscale of the Wechsler Memory Scale-Revised, the category- and letter fluency tests, and the Japanese version of National Adult Reading Test. ResultsStatistically significant reduction of FA and increase of MD were found in the fornix of patients with schizophrenia compared with controls with no significant lateralization. A significant patients-specific correlation was found between increased MD in the left fornix and lower scores on utilization of semantic organization in the verbal learning task. In addition, increased MD in the right fornix showed a patients-specific association with poorer performance on the category fluency test, which indexes organization of long-term semantic memory. These patients-specific correlations, however, were not statistically lateralized to either hemisphere. ConclusionsThese results indicate that disrupted integrity of the fornix contributes to impaired memory organization in schizophrenia.

Recovery From Amnesic Confabulatory Syndrome After Right Fornix Lesion

Background. Reports of amnesia due to bilateral fornix lesions are rare. A unilateral right fornix lesion is not known to cause an amnestic confabulatory syndrome. Objective. To investigate the role of right fornix lesion in amnesia, the association of confabulation with executive disorders, and to evaluate the long-term recovery of memory and executive functions after surgical removal of a pilocytic astrocytoma in the right orbitofrontal region extending to the right fornix. Methods. Neuropsychological testing was performed 3 and 17 months after surgery. Results. Severe anterograde global amnesia, mild retrograde amnesia, momentary and spontaneous confabulation, and mild executive deficits were found initially and mostly recovered by 17 months. Conclusions. The authors hypothesize that the lesion of the right fornix was sufficient to cause amnesia by disconnecting the hippocampal formations from the anterior thalamic nuclei and mammillary bodies and interrupting the cholinergic efferents to the hippocampus from the medial septum, according to the extended hippocampal system framework. Sparing of the left fornix may be sufficient to ensure a good recovery of memory. Confabulation is strongly associated with the improvement of executive functions, specifically the ability to suppress irrelevant memory traces.

Wooden orbital foreign body in a Weimaraner

A 2-year-old, male Weimaraner presented with acute-onset nonaxial exophthalmos with dorsal deviation of the left globe. Periorbital swelling, pain and a profuse purulent ocular discharge were present on the left side. A draining sinus tract was present in the left ventral conjunctival fornix and another in the left pterygopalatine fossa. The right eye was normal on complete ophthalmic examination. Orbital ultrasonography revealed large, double, linear, parallel echogenic bands with shadowing present in the ventrolateral aspect of the left orbit suggestive of a foreign body. Deformation of the posterior segment was also present. Removal of the orbital foreign body was attempted under ultrasound guidance via the discharging sinuses in the ventral conjunctival fornix and the pterygopalatine fossa. Neither approach was successful; however, a small amount of organic material was retrieved confirming the diagnosis of orbital foreign body. Magnetic resonance imaging (MRI) revealed a linear foreign body of 8 x 1.5 x 0.8 cm extending from the orbit to the level of the oropharynx. A modified lateral orbitotomy with zygomatic arch resection on the left side allowed removal of the wooden foreign body.

Fertility-sparing radical abdominal trachelectomy for clear cell adenocarcinoma of the upper vagina: A case report

Background. Clear cell adenocarcinoma (CCA) of the vagina is traditionally treated with radical surgical resection with tailored postoperative radiation when indicated. Due to a bimodal distribution, women of reproductive age are frequently affected and could benefit from radical trachelectomy to preserve fertility. Case. A 22 year old female was diagnosed with clinical stage I vaginal clear cell adenocarcinoma in the left fornix abutting the cervix. The patient desired future fertility; therefore, she underwent radical abdominal trachelectomy and upper vaginectomy. Twenty-eight months after initial surgery, she has no evidence of recurrence with regular menstrual cycles. Conclusion. For patients with CCA of the upper vagina, where removal of the cervix is necessary, a radical trachelectomy with upper vaginectomy should be considered to conserve fertility.

Beidseitige ausgeprägte konjunktivale Tumoren als Primärmanifestation einer Sarkoidose - erfolgreiche Therapie mit Steroid-Depot-Injektionen

Ocular manifestations of sarcoidosis vary enormously. They include the conjunctiva, lacrimal gland, orbita, intraocular structures and eye-lid, either isolated or combined. We describe a female patient who presented with unusually large, bilateral conjunctival tumours as a primary manifestation of sarcoidosis. A 79-year-old white woman was referred to us for further management of a persisting "conjunctivitis", which had been refractory to treatment with multiple medications. Initial examination disclosed swollen eye-lids and bilateral large hard tumours of the inferior fornix. The obtained brush smear, which was cytopathologically evaluated, revealed epitheloid cells and multinucleate giant cells. After 4 weeks she developed three reddish-brown maculopapular lesions on her face. The subsequent biopsy from the left inferior fornix and the skin showed histopathologically a granulomatous epitheloid cell inflammation without central necrosis and without acid-proof bacilli. Therefore a sarcoidosis was included into the differential diagnosis. The systemic evaluation revealed no other manifestation. At first we tried to reduce the chronically inflammatory tumours with different immunomodulating local treatment forms. Only the repeated intralesional injection of a steroid depot showed a complete disappearance of all conjunctival and skin tumours. An isolated bilateral primary manifestation of sarcoidosis with large massive conjunctival tumours is very rare and clinically not typical. The non-invasive, cytopathological examination by means of brush smears offers a new perspective in the fast diagnosis of conjunctival manifestation of sarcoidosis. The tumours respond excellently to the intralesional injection of steroid depots.

Diffusion-Tensor Fiber Tractography: Intraindividual Comparison of 3.0-T and 1.5-T MR Imaging

To prospectively evaluate the depiction of brain fiber tracts at 3.0- versus 1.5-T diffusion-tensor (DT) fiber tractography performed with parallel imaging. Institutional review board approval was obtained, and each subject provided written informed consent. Subjects were 30 healthy volunteers (15 men, 15 women; mean age, 28 years; age range, 21-46 years). Single-shot spin-echo echo-planar magnetic resonance (MR) sequences with parallel imaging were applied. Four fiber tracts were reconstructed: corticospinal tract (CST), superior longitudinal fasciculus (SLF), corpus callosum (CC), and fornix. Two neuroradiologists compared 3.0- and 1.5-T tractography in terms of fiber tract depiction by using five depiction scores (scores 0-4) and numbers of reconstructed tract fibers and in terms of lateral asymmetry in the CST by using numbers of reconstructed fibers. The Wilcoxon signed rank test was applied for statistical analysis. Visual scores for both CST hemispheres (P < .001), the right SLF (P = .005), the CC (P = .01), and the right fornix (P = .04) were higher at 3.0-T DT tractography. Larger numbers of CST (right, P = .008; left, P < .001), SLF (right, P = .001; left, P = .02), and fornix (bilaterally, P = .02) tract fibers were depicted at 3.0 T. The asymmetry index for the CST was lower (P < .001) at 3.0 T. Visual scores for the left SLF and the left fornix and numbers of CC tract fibers were not significantly different. Depiction of most fiber tracts was improved at 3.0-T DT tractography compared with depiction at 1.5-T tractography.

Mélanome nodulaire sur mélanose acquise primitive de la conjonctive: À propos d’une observation anatomo-clinique

A 74-year-old woman consulted for bloody tears. The etiology was a large conjunctival nodular melanoma hidden in the left superior fornix that had developed quietly on an unknown primary acquired melanosis. In this report the clinical and histological features as well as the treatment are presented. A decisional tree summarizes the treatment for conjunctival melanosis.

The role of biopsy in vaginal microbicide development

The technique of vaginal biopsy has been used to provide an objective assessment of inflammation in phase I vaginal microbicide studies conducted at Imperial College, London, since 1995. Biopsies are taken from the cervical aspect of the right fornix before product exposure at baseline, and from the cervical aspect of the left fornix at follow-up. We have found biopsy to be a simple, safe, and effective means of assessing genital inflammation in selected populations. Using this technique, inflammatory infiltrates can be characterized and agents with different modes of action can be compared. Vaginal biopsy is most useful in early phase I studies in sexually abstinent populations.

URETEROUTERINE AND VESICOURETEROVAGINAL FISTULAS AS A COMPLICATION OF CESAREAN SECTION

Vesicouterine fistulas are complications of gynecological and obstetric surgery, occurring most commonly after cesarean section.1 Ureterouterine fistulas were first reported approximately 25 years ago as a complication of cesarean section, and fewer than 30 cases have been described.2 Ureterouterine fistula after cesarean section is associated with extending a low transverse uterine incision laterally, causing subsequent damage to the ureter. To our knowledge we report the first case of ureterouterine and vesicoureterovaginal fistulas after cesarean section. CASE REPORT A 32-year-old woman presented with copious leakage of blood tinged vaginal fluid. She had undergone an emergency low transverse cesarean section 1 month earlier at 37 weeks of gestation due to fetal distress. The patient had a bladder injury at that time, which was repaired primarily. She was completely soaking 8 to 10 pads per day and 3 pads per night at presentation. The patient had no history of urological abnormalities. Excretory urography (IVP) demonstrated a vesicovaginal fistula with no ureteral fistula or obstruction (fig. 1). Preoperative cystoscopy revealed scarring on the left side of the bladder in the area of the trigone, and the left ureteral orifice was unidentifiable. An abdominal approach was planned because a left ureteral reimplant was believed to be likely. An internal-external stent was placed through the kidney and down through the ureter, and was thought to be in the bladder as demonstrated on a film of the kidneys, ureters and bladder. Intraoperative cystoscopy was carried out and showed no obvious fistula site, and the internal-external stent was not identified in the bladder. On vaginal examination the stent was seen entering the vagina through the cervical os. The left ureter, which had fistulized to the uterus, was mobilized and transected through a midline abdominal incision. Methylene blue was instilled in the bladder and the vagina was packed with gauze. Blue dye was noted on the gauze lateral to the cervix and a fistula was identified in the left vaginal fornix. The fistulous tract was then catheterized using a 0.38 guidewire. The guidewire entered the bladder through the left ureteral orifice that previously had been unidentifiable (fig. 2). The fistula tract traveling from the left ureteral orifice to the vagina was excised via an intravesical approach, the left

A Neuropsychological Outcome Study of a Child’s Left Pericallosal Arteriovenous Malformation with Occult Fornix Lesion

Pericallosal arteriovenous malformations are rarely reported, particularly in children. Moreover, few arteriovenous malformation studies report through neuropsychological outcome data for assessing post-surgical functioning. This case report provides a longitudinal study of a boy who initially presented for neuropsychological testing at the age of 8 years and 1 month, following polyvinyl alcohol embolization, two craniotomies and resections and stereotactic radiosurgery for a pericallosal arteriovenous malformation involving nearly all of the corpus cailosum. Follow-up magnetic resonance imaging also indicated absence of the left fornix. Functioning has been assessed over 7 years. Neuropsychological measures identified a consistent pattern of verbally mediated cognitive and memory deficits, with relatively spared visual perceptual and visual motor functioning. No evidence of a split-brain syndrome was found. The findings are consistent with insult to dominant hemisphere language and memory systems, provide an interesting example of neurodevelopmental compensation for significant early brain insult, and may provide insight into functions subserved by the fornix.

Basal membrane-depleted scar in lesioned CNS: characteristics and relationships with regenerating axons

The lesion scar formed after CNS injury is an impediment to axonal regeneration and leads to growth arrest or misrouting of sprouting axons. Our previous study showed that pharmacological reduction of basal membrane formation within the scar can overcome this scar impermeability [Stichel C. C. et al. (1999) Eur. J. Neurosci. 11, 632–646]. The aim of the present study was to characterize the basal membrane-depleted scar and to analyse its relationships with penetrating axons. The experiments comprised two groups of animals in which the left postcommissural fornix was transected; in addition, one group received a local immediate injection of the collagen IV-reducing agent dipyridyl, while the other group received an injection of phosphate-buffered saline. Immunohistochemical methods were used to characterize scar formation and scar–axon relationships. Animals receiving dipyridyl showed reduction of collagen IV-immunopositive basal membrane in the lesion center, which was accompanied by: (i) a decrease in laminin, as well as chondroitin and heparan sulfate proteoglycan, deposition in the lesion center; (ii) an increase in chondroitin and keratan sulfate proteoglycan expression in the perilesional area; (iii) a typical activation pattern of astrocytes and microglia/macrophages; (iv) axons regenerating through this modified scar were closely associated with various glial cell types and crossed a prominent chondroitin/keratan sulfate proteoglycan matrix. Our results suggest that neither the formation of a reactive astroglial network nor the accumulation of microglia/macrophages or the deposition of chondroitin and keratan sulfate proteoglycans in the perilesional area represent a barrier to regrowing axons. The present approach demonstrates that the lesion-induced basal membrane itself is the primary determinant of scar impermeability.

The healing effect of all-trans retinoic acid on epithelial corneal abrasions in rabbits.

The aim of the study was to investigate the possible healing effect of the vitamin A analogue all-trans retinoic acid 0.05% (RA) in vaseline on epithelial corneal abrasions in 13 ocularly healthy Copenhagen white rabbits. A corneal abrasion with a diameter of 6 mm was created centrally in both eyes with a trephine and subsequent rubbing off of the corneal epithelium with an n-heptanol soaked swab The corneal abrasions were treated twice daily with topical applications (50 microl); RA was placed in the right inferior fornix and its vaseline vehicle in the left inferior fornix. Photographic documentation of fluorescein stained, non-healed areas, was performed at time points 0, 12, 24, 36, 48 and 72 h. The rabbits were sacrificed by an overdose of pentobarbital and enucleated. Planimetry was performed from corneal photographs. Healed epithelial mean area at time point 36 h was significantly higher after RA compared to vehicle (p=0.036, paired t-test). Median time to 75% and 85% healing was significantly shorter for RA compared to vehicle (p= 0.03 and 0.02, log rank-test). No morphological difference, evaluated by light microscopy (hematoxylin-eosin) or scanning electron microscopy, was noted between the two treatments. It is concluded that RA 0.05% applied twice daily increases the healing rate compared to vaseline vehicle.

Severe amnesia: An unusual late complication after temporal lobectomy

A patient developed the severe amnesic syndrome 8 years after temporal lobe surgery for epilepsy. He underwent left temporal lobectomy (6 cm, 43.5 g; hippocampal sclerosis) aged 19, and remained seizure free for 8 years until a convulsion followed a head injury. He became severely amnesic after a fourth convulsion 16 months later. He was right-handed, pre-operative IQ was average, verbal memory poor and non-verbal memory normal. Post-operatively, these were unchanged. After the first post-operative seizure he began professional training. After onset of amnesia IQ was unchanged, anterograde memory severely impaired and retrograde amnesia dense for at least 16 months. He died 2 years later. Magnetic resonance imaging before amnesia showed absence of anterior left temporal lobe, atrophy of left fornix and mamillary body, and normal right temporal lobe. Four months after onset of amnesia, right hippocampal volume had reduced by 36%. Autopsy showed: previous left temporal lobectomy with absence of left amygdala and hippocampus, atrophy of fornix and mamillary body; neuronal loss in the right hippocampus, severe in CA1 and CA4; intact right amygdala and parahippocampal gyrus; recent diffuse damage associated with cause of death. A convulsion can cause severe hippocampal damage in adult life. Hippocampal zones CA1 and/or CA4 are critical for maintaining memory and the amygdala and parahippocampal gyrus cortex alone cannot support acquisition of new memories.

Synthetic Fiber Granuloma

We read with great interest the report of Ferry1on a synthetic fiber granuloma, having recently encountered a patient with an identical problem. Our experience and previous reports suggest that prompt and accurate diagnosis may allow removal of these lesions without the need for general anesthesia. Report of a Case. A 4-year-old girl was seen for an evaluation of a left inferior conjunctival fornix lesion that her mother had noticed 1 month earlier. On examination, a 1×2-mm white lesion was found in the left inferior fornix, with hairs appearing to arise from within the lesion (Figure 1). The appearance was strikingly similar to that of the patient of Ferry. The lesion was thought to be an atypical dermolipoma or pyogenic granuloma. At surgery, the lesion was examined using anesthesia. It was pedunculated, and the hairs on the lesion were easily removed with a cotton-tip swab. The surrounding conjunctiva was

Correlation of fornix damage with memory impairment in six cases of colloid cyst removal.

We studied six patients in whom colloid cysts had been removed surgically from the third ventricle. The patients were selected simply by availability for the study, not on grounds of clinically diagnosed amnesia or its absence. The outcomes of operation ranged from one patient who had postoperatively resumed a normal life without complaint of memory disorder at any stage, through four who complained of memory disorder since operation, to one who was so severely amnesic as to require constant supervision. Each patient was given psychometric tests of memory, and was also scanned by magnetic-resonance imaging. One of us examined the six scans and assessed the extent of damage to the fornix, and any other brain damage, in ignorance of the outcomes of the psychometric tests. The fornix in the right hemisphere had been destroyed in all six cases, and all showed evidence of moderate or severe impairment in nonverbal memory. The fornix in the left hemisphere was intact in only one patient; this was the patient who had resumed a normal life without complaint of memory disorder. The left fornix was damaged with some sparing in one further patient, and the remaining four patients showed destruction of the fornix in the left as well as in the right hemisphere. The severity of impairment in verbal memory in these six cases was related to the severity of the damage to the left fornix. No other evidence of brain damage appeared to be systematically related to memory ability. These results add to the evidence that bilateral fornix damage produces amnesia, and that sparing of the left fornix alone is sufficient to ensure a more favourable outcome.

Congenital Hydrocephalus Associated with Anomalies of Midline Telencephalic Structures: A Case Report

Hydrocephalus is classified into communicating, if cerebrospinal fluid (CSF) can flow freely from the ventricle to the subarachnoid space, and into non-communicating, if it cannot. The cause of hydrocephalus is diverse, either congenital or acquired conditions causing obstruction to the flow of CSF. The location of the lesion is more important than the size or nature of the lesion. We describe an unusual case of congenital communicating hydrocephalus associated with multiple malformations of midline telencephalic structures. This was a premature male baby of 30 weeks gestational age. The pregnancy was terminated after revealing a hydrocephalus by ultrasonography. The cerebral hemispheres showed marked thinning of parenchyme with dilated lateral ventricles, communication of lateral and third ventricles with dilated foramina of Monro, absence of the septum pellucidum, and hypoplasia or focal agenesis of posterior portion of corpus callosum with dorsal dilation of the third ventricle. The right fornix appeared as a single thick midline cord in its approximately normal position and the hippocampi were poorly developed, especially in the left side. The left fornix was rudimentary.

Unfavorable outcome of adrenal medullary transplant for Parkinson's disease

A 45-year-old woman with moderately severe parkinsonism underwent adrenal medullary autograft to the brain. The operation was performed in Mexico City. There were multiple post-operative complications, including worsening of the parkinsonism with almost complete loss of ability to communicate. Death from bronchopneumonia occurred 13 months after surgery. At autopsy the surgical tract was found to extend through the corpus callosum and into the thalamus on the opposite side. Residual necrotic adrenal tissue was found as a small round well-defined mass in the ventricle loosely attached to the left fornix. This case emphasizes the obvious risks of this still experimental procedure and the difficulties in obtaining a surviving and functional adrenal medullary graft.

Memory Dysfunction Following Unilateral Transection of the Fornix: A Hippocampal Disconnection Syndrome

This study presents a case with a discrete nondischarging lesion of the left fornix that resulted in a marked anterograde memory deficit that was defined by the same material, modality and methodologically specific features characteristic of unilateral lesions of the hippocampus. Since the fornix is the major efferent pathway of the hippocampus to the mamillary bodies, septal nuclei and anterior thalamic nuclei, this patient could be considered to have a hippocampal disconnection syndrome.

Successful use of transabdominal isthmic cerclage in the management of cervical incompetence

In August 1984 a 27-yr-old para 1 + 2 in the 8th wk of pregnancy was seen at the antenatal clinic in Bellshill Maternity Hospital. The patient’s first pregnancy had been in 1980. She went into spontaneous labour at T + 10 days. After 12 h in labour acute fetal distress developed during the second stage. Vaginal examination showed the cervix to be fully dilated: the vertex was right occipito-posterior at zero -2 cm. The patient was delivered by emergency caesarean section under general anaesthesia. At operation there was difficulty in disimpacting the vertex from the pelvis and a tear was sustained at the left angle of the lower segment incision extending to the cervix. This tear was repaired in 2 layers and the operation was completed with a blood loss of 1200 ml. In her second pregnancy a year later she was admitted at 19 wk gestation with spontaneous rupture of the membranes and aborted 24 h later. At the follow up visit 6 wk later a cervical laceration on the left side extending to the vault was noted. In view of this and the unsuccessful pregnancy trachelorrhaphy was performed 2 months later. In February 1982 the patient was seen at 12 wk gestation in her third pregnancy. The cervix was very short and scarred at the left fornix. In view of these findings cervical cerclage was performed 1 wk later when a McDonald suture of 2 layers of black silk was inserted. The patient was allowed home 5 days after operation, but was re-admitted at 20 wk gestation with spontaneous rupture of the membranes. Speculum examination confirmed the presence of liquor in the vagina. The cervix was closed and the suture in place. The patient continued to drain liquor for 5 wk when uterine activity commenced and following removal of the suture she aborted 3 h later. E. coli was grown from a high vaginal swab, although there was no evidence of intra-uterine infection on histological examination of the placenta and membranes. After this pregnancy a further attempt at vaginal repair of the cervical laceration was made in February 1983. Thereafter Cervical Resistance Studies were performed in August 1983, using the technique of Anthony et al. [l]. The cervix was noted to be lacerated on the left side and the laceration extended to the vaginal vault with