Left Frontal Lobe Research Articles

Combining ADC values in DWI with rCBF values in arterial spin labeling (ASL) for the diagnosis of mild cognitive impairment (MCI).

We aimed to investigate the role of combined apparent diffusion coefficient (ADC) values and relative cerebral blood flow (rCBF) values in the diagnosis of mild cognitive impairment (MCI) patients. The present prospective research enrolled 156 MCI patients and 58 healthy elderly people who came to our hospital from January 2021 to February 2023. T1W, T2W, diffusion-weighted imaging, and arterial spin labeling sequences were performed on all subjects, and ADC values and rCBF values were measured at the workstation. Clinical and demographic data of all patients were collected while mini-mental state examination (MMSE) and Montreal cognitive assessment (MoCA) scores were used to assess patients' cognitive abilities. The MCI group had significantly lower rCBF values in the left frontal lobe, left occipital lobe, right frontal lobe, and right occipital lobe than the HC group. The ADC values in the left frontal lobe as well as the right frontal lobe were remarkably elevated in the MCI group than in the HC group. MoCA and MMSE scores were positively correlated with rCBF values in the left frontal, right frontal, left occipital, and right occipital lobes and negatively correlated with ADC values in the left and right frontal lobes. Combined ADC values and rCBF values from the left frontal lobe for the diagnosis of MCI had a higher sensitivity and specificity with the AUC was 0.877, sensitivity 81.0%, specificity 82.7%. Additionally, pressure fasting plasma glucose, ADC of the left frontal lobe, right frontal lobe, rCBF of left frontal lobe and rCBF of left frontal lobe were the risk factors of patients with MCI. In summary, our results indicated that the ADC values and rCBF values were changed in MCI group compared to HC group and correlated with MMSE and MoCA scores.

Intracranial dissemination in a primary small cell carcinoma of the brain: a case report and literature review.

Primary intracranial small cell carcinoma (SCC) is extremely rare with only 8 previously reported cases. We describe a case of primary intracranial SCC with intracranial metastasis. A 46-year-old man presented with decreased vision and a red and swollen left eye. Brain magnetic resonance imaging (MRI) revealed a heterogeneously enhanced tumor on the left frontal lobe. Preoperative systemic computed tomography (CT), MRI, and positron emission tomography (PET)-CT revealed no extracranial tumors. The tumor on the left frontal lobe was excised. Immunohistochemical staining on the excision showed positivity for CD56, synaptophysin (Syn), cytokeratin (CK), and Ki-67 (30%), and negativity for thyroid transcriptional factor-1 (TTF-1), glial fibrillary acidic protein (GFAP), B-cell lymphoma 6 (Bcl-6), multiple myeloma oncogene 1 (MUM-1), C-Myc, Vimentin, P40, P53, CK7, CD3, CD5, CD20, CD79a, CD10, and CD23. The pathological examination strongly suggested that the tumor was a primary intracranial SCC. One year after the surgery, the patient was readmitted with slurred speech and slow movements. Three well-defined tumors were found in the left upper frontal lobe by brain MRI. Tumor resection was then performed. Further immunohistochemical examination of the excised tissue displayed the same pattern as previously, indicating the recurrence of intracranial SCC in the left frontal lobe. The patient received adjuvant chemotherapy and radiotherapy after the tumor resection. At the 2-year follow-up, he remained asymptomatic.

Long-term survival from progressive multifocal leukoencephalopathy in living-donor liver transplant recipient with preformed donor-specific antibody

Intensive immunosuppression has enabled liver transplantation even in recipients with preformed donor-specific antibodies (DSA), an independent risk factor for graft rejection. However, these recipients may also be at high risk of progressive multifocal encephalopathy (PML) due to the comorbid immunosuppressed status. A 58-year-old woman presented with self-limited focal-to-bilateral tonic-clonic seizures 9 months after liver transplantation. She was desensitized using rituximab and plasma exchange before transplantation and was subsequently treated with steroids, tacrolimus, and everolimus after transplantation for her preformed DSA. Neurological examination revealed mild acalculia and agraphia. Cranial MRI showed asymmetric, cortex-sparing white matter lesions that increased over a week in the left frontal, left parietal, and right parieto-occipital lobes. Polymerase chain reaction (PCR) of the cerebrospinal fluid for the JC supported the diagnosis of PML. Immune reconstitution by reducing the immunosuppressant dose stopped lesion expansion, and PCR of the cerebrospinal fluid for the JC virus became negative. Graft rejection occurred 2 months after immune reconstitution, requiring readjustment of immunosuppressants. Forty-eight months after PML onset, the patient lived at home without disabling deficits. Intensive immunosuppression may predispose recipients to PML after liver transplantation with preformed DSA. Early immune reconstitution and careful monitoring of graft rejection may help improve outcomes.

Is There a Genetic Relationship between Acute Lymphoblastic Leukemia and Meningioma? A Case Report of the Analyses of Three Genes

AbstractMeningiomas are the most common tumors of the central nervous system, and they are generally slow growing and benign. Acute lymphoblastic leukemia (ALL) is a life-threatening ltype of cancer that involves the accumulation of peripheral blood vessels and immature cells in the bone marrow. Genetic mutations play an important role in the etiology of both diseases. Therefore, in the case herein presented, we investigated the meningioma 1 (MN1), nucleophosmin 1 (NPM1), and Wilms tumor 1 (WT1) genes for possible genetic mutations. A 27-year-old female with a chief complaint of headache and history of lllALL presented with a mass in the left frontal lobe. The pathological analysis revealed a fibroblastic meningioma. However, the three genes were found to be normal in the analysis. In light of these findings, we did not encounter any evidence of a genetic relationship between meningioma and ALL in the present study.

Epithelioid Glioblastoma in A 15-Year-Old Boy: A Rare Case Report

Epithelioid glioblastoma (E-GBM), one of the rarest intrusive forms of Glioblastoma multiforme (GBM), was consigned in the World Health Organization (WHO) categorization of the Central nervous system (CNS) in the year 2016. The current article reports a rare epithelioid glioblastoma described for its histomorphological character and clinical finding for its medical rarity. The present case deals with a 15-year-old boy complaining of headaches and multiple episodes of vomiting. The investigatory procedures revealed hypo-intense multiple lesions in the left medial frontal lobe extending to a Sylvian fissure. The case is being discussed to distinguish the development of secondary glioblastomas, which usually occur due to pre-existing lesions, which were not present in our discussed case. The patient had come from a rural background with no previous investigations, ophthalmological examination revealed the presence of bilateral papilledema, and the hematological reports were within normal range. The patient was managed with magnetic resonance imaging (MRI) and computed tomography (CT), which depicted a multifocal tumor. Further left fronto temporal craniotomy and ablation of the lesion were done. The surgical procedure upshot divulged that the patient was conscious with improved right side weakness but a remnant motor aphasia, but within a short span, he could walk with support. The incidence of E-GBM that too in adolescent children is minuscule, and due to its poor prognosis, it's very crucial to acknowledge the attributable features of epithelioid glioblastoma, inclusive of functional outset, neuro-imaging, and the hazards of surgical measures.

COMPARISON OF BRAIN ACTIVATION PATTERNS IN STRESS-INDUCED AND POST-STRESS RESTING STATES: NORMAL SUBJECTS

Stress is a pervasive phenomenon with significant implications for individual well-being. Understanding the neural processes underlying stress responses and recovery is crucial for developing effective interventions. This study employed functional magnetic resonance imaging (fMRI) to investigate the brain activation patterns during stress induction and recovery in healthy adults. The Montreal Imaging Stress Task (MIST) was utilized to elicit acute stress in participants. The results revealed that during the stress task phase, the right hemisphere showed activation in the Inferior Parietal Lobule, Postcentral Gyrus, and Precuneus, while the left hemisphere demonstrated activation in the Inferior Parietal Lobule, Postcentral Gyrus, Middle Frontal Gyrus, and Superior Frontal Gyrus. Following the stress task, during the recovery phase, the right hemisphere exhibited activation in the Precuneus, Middle Occipital Gyrus, Superior Occipital Gyrus, Angular Gyrus, Medial Frontal Gyrus, Middle Frontal Gyrus, and Posterior Cingulate, whereas the left hemisphere displayed activation primarily in the Cuneus. Comparing the two phases, the left frontal lobe and occipital lobe exhibited increased activation during the rest period after stress. In contrast, the parietal lobe showed decreased activation during the recovery phase. These findings contribute to our understanding of the neural mechanisms associated with stress responses and recovery, providing insights into potential interventions for stress management and promoting well-being.

Bradycardia symptomatic causes headache associated with frontal diffuse astrocytoma: a case report

Background: Headache is the most common symptom in patients with brain tumors, whereas a developing brain tumor generally increases intracranial pressure and brain edema. Brain tumors have symptoms including nausea, vomiting, seizures, neurological deficits, and mental status or consciousness changes. Heart rhythm disturbances can occur, including bradycardia (heart rate below 60x/minute), a common symptom in brain tumor patients. Case Presentation: In this case report, a young adult male patient was found with headache symptoms, a previous history of syncope, and sinus bradycardia on the EKG examination, but on physical examination, there were no symptoms of neurological deficits. Head CT scan with contrast found a tumor in the left frontal lobe associated with high intracranial pressure and brain edema that explained the symptoms. Conclusion: The relationship between headache and bradycardia, accompanied by a history of syncope, is close and can be regarded as an early sign of a brain tumor. In this case, a brain tumor found based on pathological examination is diffuse astrocytoma.

Evaluation of Brain Perfusion with Radionuclide Imaging in Dementia Patients

Objective: This study aims to evaluate the perfusion in the affected brain lobes with radionuclide imaging in patients with dementia and to contribute to the literature by determining the relationship between the degree of dementia. Methods: In this retrospective study, 44 adult patients were included. The mean age of the patients was 73 (57-87). Twenty-three (52.3%) of these were female. All patients underwent mini-mental state test, neurological examinations and radionuclide brain perfusion imaging. The areas of interest of the frontal, parietal, temporal, and occipital lobes and the cerebellum were drawn, respectively, and the cerebellum ratios of the relevant lobes were compared. In this way, brain perfusion index values of lobes were obtained. Results: Brain perfusion in group 1 was higher than in other groups. Groups were also compared in pairs. There was no significant difference in perfusion values in the occipital lobe. There was a significant difference in perfusion between groups 1 and 2 in lobes other than the occipital lobe. This was also the case for Groups 1 and 3. When group 2 with early dementia symptoms, and group 3 with moderate dementia were compared, there was a significant difference between the perfusion values of only the right and left frontal lobes. Conclusion: Early diagnosis is very important in progressive dementia. Clinical tests are successfully applied to categorize patients. Evaluation of brain perfusion and metabolism with functional radionuclide imaging is significant in guiding the treatment and evaluating the success of the treatment.

Lateralization difference in functional activity during Stroop tasks: a functional near-infrared spectroscopy and EEG simultaneous study.

Conflict monitoring and processing is an important part of the human cognitive system, it plays a key role in many studies of cognitive disorders. Based on a Chinese word-color match Stroop task, which included incongruent and neutral stimuli, the Electroencephalogram (EEG) and functional Near-infrared Spectroscopy (fNIRS) signals were recorded simultaneously. The Pearson correlation coefficient matrix was calculated to analyze brain connectivity based on EEG signals. Granger Causality (GC) method was employed to analyze the effective connectivity of bilateral frontal lobes. Wavelet Transform Coherence (WTC) was used to analyze the functional connectivity of the bilateral hemisphere and ipsilateral hemisphere. Results indicated that brain connectivity analysis on EEG signals did not show any significant lateralization, while fNIRS analysis results showed the frontal lobes especially the left frontal lobe play the leading role in dealing with conflict tasks. The human brain shows leftward lateralization while processing the more complicated incongruent stimuli. This is demonstrated by the higher functional connectivity in the left frontal lobe and the information flow from the left frontal lobe to the right frontal lobe. Our findings in brain connectivity during cognitive conflict processing demonstrated that the dual modality method combining EEG and fNIRS is a valuable tool to excavate more information through cognitive and physiological studies.

A Case of Methotrexate-induced Subacute Encephalopathy that Showed no Abnormalities on Magnetic Resonance Imaging Soon After Symptom Appearance.

A 21-year-old woman was diagnosed with acute lymphoblastic leukemia. After the administration of intrathecal methotrexate (MTX), the patient experienced dysarthria and paralysis for one hour. Magnetic resonance imaging (MRI) performed one hour from the onset and just before symptoms disappeared revealed no abnormalities. The next day, the symptoms appeared again, and diffusion-weighed MRI revealed a high-intensity area in the left frontal lobe. The patient was diagnosed with MTX-induced encephalopathy. This case suggested that MRI performed as soon as symptoms appear might show normal findings in MTX-induced encephalopathy.

Case Series: Gamma Knife Radiosurgery in Brain Arteriovenous, Is It Good Enough?

Highlight: Brain AVMs are a special concern due to their inherent high risk of bleeding. Gamma Knife radiosurgery (GKRS), as one of the modality treatments, is intended to induce progressive occlusion of an AVM by using high-dose targeted radiation The result of Gamma Knife radiosurgery (GKRS) can be full obliteration, with complications because adverse radiation effects. ABSTRACT Introduction: Brain arteriovenous malformations (AVMs) are relatively uncommon. Gamma Knife radiosurgery (GKRS) is one of the AVM’s therapeutic interventions, with both advantages and disadvantages. Here, we report the results of two cases of brain AVM after GKRS. Cases: Case 1: Non-contrast head MRI imaging of a 45-year-old man with persistent left-sided headaches revealed a 1.4 x 2.5 x 2.28 cm AVM nidus in the left parasagittal frontal lobe. After a single GKRS with a 25-Gy marginal dose, the MRI contrast showed complete obliteration, with persistent perifocal edema and headache. Case 2: A 25-year-old woman with a history of generalized seizures. The angiograms revealed an AVM nidus with a diameter of 32.58 mm on her right posterior frontal lobe. After a single GKRS with a 22-Gy marginal dose, the MRI contrast showed full obliteration with large edema. The patient had presented with hemiparesis. Conclusion: In these cases, the results after GKRS were full obliteration with complications of edema, headache, and hemiparesis. We also found that complications appear to be associated with adverse radiation effects.

Stroke analysis and recognition in functional near-infrared spectroscopy signals using machine learning methods.

Stroke is a high-incidence disease with high disability and mortality rates. It is a serious public health problem worldwide. Shortened onset-to-image time is very important for the diagnosis and treatment of stroke. Functional near-infrared spectroscopy (fNIRS) is a noninvasive monitoring tool with real-time, noninvasive, and convenient features. In this study, we propose an automatic classification framework based on cerebral oxygen saturation signals to identify patients with hemorrhagic stroke, patients with ischemic stroke, and normal subjects. The reflected fNIRS signals were used to detect the cerebral oxygen saturation and the relative value of oxygen and deoxyhemoglobin concentrations of the left and right frontal lobes. The wavelet time-frequency analysis-based features from these signals were extracted. Such features were used to analyze the differences in cerebral oxygen saturation signals among different types of stroke patients and healthy humans and were selected to train the machine learning models. Furthermore, an important analysis of the features was performed. The accuracy of the models trained was greater than 85%, and the accuracy of the models after data augmentation was greater than 90%, which is of great significance in distinguishing patients with hemorrhagic stroke or ischemic stroke. This framework has the potential to shorten the onset-to-diagnosis time of stroke.

White matter microstructural disruption in minimal hepatic encephalopathy: a neurite orientation dispersion and density imaging (NODDI) study.

To evaluate the ability of neurite orientation dispersion and density imaging (NODDI) for detecting white matter (WM) microstructural abnormalities in minimal hepatic encephalopathy (MHE). Diffusion-weighted images, enabling the estimation of NODDI and diffusion tensor imaging (DTI) parameters, were acquired from 20 healthy controls (HC), 22 cirrhotic patients without MHE (NHE), and 15 cirrhotic patients with MHE. Tract-based spatial statistics were used to determine differences in DTI (including fractional anisotropy [FA] and mean/axial/radial diffusivity [MD/AD/RD]) and NODDI parameters (including neurite density index [NDI], orientation dispersion index [ODI], and isotropic volume fraction [ISO]). Voxel-wise analyses of correlations between diffusion parameters and neurocognitive performance determined by Psychometric Hepatic Encephalopathy Score (PHES) were completed. MHE patients had extensive NDI reduction and rare ODI reduction, primarily involving the genu and body of corpus callosum and the bilateral frontal lobe, corona radiata, external capsule, anterior limb of internal capsule, temporal lobe, posterior thalamic radiation, and brainstem. The extent of NDI and ODI reduction expanded from NHE to MHE. In both MHE and NHE groups, the extent of NDI change was quite larger than that of FA change. No significant intergroup difference in ISO/MD/AD/RD was observed. Tissue specificity afforded by NODDI revealed the underpinning of FA reduction in MHE. The NDI in left frontal lobe was significantly correlated with PHES. MHE is characterized by diffuse WM microstructural impairment (especially neurite density reduction). NODDI can improve the detection of WM microstructural impairments in MHE and provides more precise information about MHE-related pathology than DTI.

Frequency-specific directed interactions between whole-brain regions during sentence processing using multimodal stimulus

Neural oscillations subserve a broad range of speech processing and language comprehension functions. Using an electroencephalogram (EEG), we investigated the frequency-specific directed interactions between whole-brain regions while the participants processed Chinese sentences using different modality stimuli (i.e., auditory, visual, and audio-visual). The results indicate that low-frequency responses correspond to the process of information flow aggregation in primary sensory cortices in different modalities. Information flow dominated by high-frequency responses exhibited characteristics of bottom-up flow from left posterior temporal to left frontal regions. The network pattern of top-down information flowing out of the left frontal lobe was presented by the joint dominance of low- and high-frequency rhythms. Overall, our results suggest that the brain may be modality-independent when processing higher-order language information.

Anaplastic oligodendroglioma WHO grade 3: Rare brain tumor

The anaplastic oligodendrogliomas are uncommon gliomas. It is clinically significant to know this entity as they have unique clinical, histopathological and molecular features. We present a 43 year female having complaint of headache, tingling numbness, giddiness. Which was of 2 year duration, off and on, and was increased in last 15 days. MRI brain (plain + contrast) showed a large heterogenously enhancing cortical based solid-cystic lesion with surrounding edema in left frontal lobe with mass effects and midline shift. On radiological features impression was suggestive of high grade glial neoplasm and advised biopsy. In our case on histopathology reported as anaplastic oligodendrogliomas WHO CNS grade 3 of left frontal lobe. Patient was treated with surgery, and chemotherapy. We are presenting this rare case of anaplastic oligodendrogliomas for it’s clinical, Histopathological and radiological findings.

Pearls & Oy-sters: Cognitive and Affective Dysfunction Caused by a Small Cerebellar Hemangioblastoma.

The primary function of the cerebellum is the coordination and regulation of movement; therefore, cerebellar tumors usually present with ataxia, dysarthria, and vertigo. Large tumors also cause elevated intracranial pressure that may lead to a disturbance of consciousness. Furthermore, it has become increasingly evident that the cerebellum plays a substantial role in cognitive and affective processing. A 44-year-old female patient presented with one-month history of depression and flat affect. She had no cerebellar symptoms including no coordination dysfunction or dysarthria. Cognitive function tests revealed impairments in attention, execution, and processing speed. Hamilton Depression Scale and Hospital Anxiety Depression Scale indicated moderate-to-severe depression. Magnetic resonance (MR) imaging revealed a 7-mm enhancing lesion in the culmen of the cerebellar vermis with surrounding edema. Technetium-99m ethyl cysteinate dimer single-photon emission tomography (SPECT) showed hypoperfusion in the left frontal lobe. Although she was initially treated with corticosteroids for presumed sero-negative autoimmune encephalitis, her symptoms persisted. She then underwent cerebellar lesion resection. The histological diagnosis was hemangioblastoma. The patient's symptoms dramatically improved within 1 week of resection, including improved batteries for cognitive function and depression. Complete regression of cerebellar edema and left frontal lobe hypoperfusion were observed on MR and SPECT images, respectively. This case reiterates the crucial influence of the cerebellum on cognitive and affective function. Moreover, cognitive dysfunction may be masked in cases with focal cerebellar symptoms or elevated intracranial pressure, and consequently, not adequately evaluated.

Meningioma and glioma as the first collision brain tumour reported in small animals

We describe the clinical and pathological features of a brain collision tumour consisting of a fibrous meningioma and an anaplastic oligoastrocytoma in a 14-year-old male neutered French Bulldog. Computed tomography of the brain revealed a poorly defined, intra-axial lesion affecting the left frontal lobe. Following euthanasia, histological examination showed an anaplastic oligoastrocytoma invading the brain parenchyma and an adjacent fibrous meningioma. As synchronous intracranial tumours are rare in animals, the aims of this report are to describe the clinical, imaging and histopathological features of an intracranial collision tumour in a dog and highlight the importance of a complete histopathological study despite the imaging findings.

Hemorrhagic Stroke and Blindness after Hyaluronic Acid/Polylactic Acid Filler Injection

The number of people receiving facial filler injections is increasing as it is relatively safe than the other cosmetic procedures. However, complications of facial filler injection range from mild redness and inflammation to cerebral infarction. We report the case of a patient who was diagnosed with cerebral infarction and intracranial hemorrhage after facial filler injection. A 61-year-old male presented to the emergency department with ocular pain and visual loss in the left eye after filler injection into the glabella. Neurological examination revealed monocular blindness. Initial brain magnetic resonance imaging (MRI) revealed small, acute multifocal infarctions in the left frontal, parietal, and temporal lobes. Follow-up MRI revealed subarachnoid hemorrhages in the left frontal and parietal lobe. Follow-up brain computed tomography showed small intracerebral hemorrhage in the left frontal lobe. Clinicians must be aware that not only cerebral infarction, but intracranial hemorrhage could also be a potential adverse effect of the cosmetic filler injection in the face.

Neurobiological factors of aggressive behavior in patients with multi-infarction dementia

Introduction. In the modern literature, the problem of the influence of multifocal brain damage in vascular dementia on the development of aggressive behavior in patients is only partially covered.The purpose of this work is to study the influence of neurobiological factors (number, localization of lesions) on the development of aggressive behavior in multi-infarct dementia.Materials and methods. The study involved 98 subjects diagnosed in multi-infarct dementia (F 01.1), established according to the ICD-10 criteria (1992), in which 52 were men (53.1 %) and 46 women (46.9 %), aged 60 to 90 years, the average age was 74.5 [67; 81] years. Patients are divided into a main group – with aggressive behavior (n = 49), and a control group − without aggressive behavior (n = 49). The study used clinical-anamnestic, clinical-psychopathological, psychometric and neuroimaging methods.Results. The study showed that patients with aggressive behavior compared to patients without aggressive behavior have a greater number of lesions (p < 0.0001). The localization of which is statistically significantly more often determined in the left frontal lobe, subcortical nuclei on the left and in the left ventricular region (p = 0.0002, 0.0212, 0.0036), and patients without aggressive behavior often do not have frontal lobe lesions.Discussion. Patients who show aggression in general, or in isolation physical, verbal aggression, or irritability, have a statistically significantly greater number of lesions than patients without these symptoms (p < 0,0001). Each additional lesion increases the likelihood of developing aggression and its severity. In patients with irritability, lesions localized in the left frontal lobe and left ventricle.Conclusion The study suggests that the number of lesions from four or more, as well as their predominant localization in the left hemisphere of the brain, leads to the development of various types of aggressive behavior.

Fahr disease presenting with multiple cerebral calcifications

Fahr disease, also known as idiopathic basal ganglion calcification, is a rare and genetically heterogeneous neurological disorder. Herein, we report a rare case of Fahr disease presenting with multiple cerebral calcifications. A 63-year-old woman presented with dizziness to a local clinic. Brain computed tomography performed on admission revealed multiple high-intensity lesions in both basal ganglia, both cerebellar hemispheres, and the left frontal lobe. In contrast, brain magnetic resonance imaging (MRI) showed no prominent lesions on T2- and T1-weighted images, and there was no contrast enhancement after gadolinium injection. However, multiple dark signals were detected on gradient echo MRI. The location and radiological appearance of the lesion resembled those of a physiological intracranial calcification, except for asymmetric calcification in both cerebellar hemispheres and the left frontal subcortical white matter. The patient was diagnosed with basal ganglion calcification with multiple cerebral cavernous malformations or, less likely, brain tumors. Through a careful radiological and clinical review, the calcifications were diagnosed as Fahr disease. Follow-up was planned. It is important to consider the presence of multiple intracranial calcifications in the basal ganglia, cerebellum, or deep subcortical white matter as a warning sign for Fahr disease.