Left Frontotemporal Region Research Articles

He can tell which master craftsman blew a Venetian vase, but he can not name the Pope: a patient with a selective difficulty in naming faces

A patient with damage to the left fronto-temporal region could not name faces, although his recognition and semantic knowledge of people were found to be intact. At variance with described anomics for persons’ names, this patient was able to retrieve on definition names of people whose faces he could not name. When, instead, objects were to be named with a person's name, as in the case of manufacturers of Murano glass, the patient, a Murano glass master, was perfect. That is, he could tell which master craftsman in the famous Venini glass-works in Venice had blown a vase, but he could not identify the Pope from a picture. Naming faces is therefore shown to be independent of naming objects.

He can tell which master craftsman blew a Venetian vase, but he can not name the Pope: a patient with a selective difficulty in naming faces

A patient with damage to the left fronto-temporal region could not name faces, although his recognition and semantic knowledge of people were found to be intact. At variance with described anomics for persons’ names, this patient was able to retrieve on definition names of people whose faces he could not name. When, instead, objects were to be named with a person's name, as in the case of manufacturers of Murano glass, the patient, a Murano glass master, was perfect. That is, he could tell which master craftsman in the famous Venini glass-works in Venice had blown a vase, but he could not identify the Pope from a picture. Naming faces is therefore shown to be independent of naming objects.

Descargas epileptiformes lateralizadas y periódicas como forma de presentación de neurosífilis

Neurosyphilis is a recognised cause of epileptic seizures, but its association with periodic lateralised epileptiform discharges (PLED) has been described only rarely, in spite of the fact that it gives rise to acute vascular lesions.We report the case of a male patient who was diagnosed as having meningovascular syphilis after the onset of tonic clonic epileptic seizures and PLED in the left frontotemporal region. The initial neurological exploration revealed a syndrome of confusion and mild mixed, but predominantly motor, dysphasia. In complementary tests, the most noteworthy features were positive luetic serology in the blood and in cerebrospinal fluid (CSF), which was confirmed by means of treponemic assays. The patient was treated with penicillin for two weeks. The study was completed with a magnetic resonance (MR) brain scan that showed a small left temporal infarction, which was the origin of the clinical and electrical convulsive activity. The patient s evolution was satisfactory, with an improvement in the language disorder, and the seizures were controlled after the administration of phenytoin. The control electroencephalogram (EEG) that was performed later only showed a slowing in the known injured area.PLED are an infrequent electroencephalographic pattern whose appearance has been linked with acute brain lesions, mainly with strokes, tumours and meningoencephalitis. When, exceptionally, they appear as a consequence of an ischemia secondary to meningovascular syphilis their significance, clinical features and prognosis do not differ from other causes of a cerebrovascular disease.

Extensive metabolic and neuropsychological abnormalities associated with discrete infarction of the genu of the internal capsule

OBJECTIVEThe clinical presentation of capsular genu infarct varies. Prominent faciolingual weakness and subcortical dementia are the rule, but symptoms depend on the precise location and extension of the lesion beyond...

EEG Patterns in Persons Exposed to Ionizing Radiation as a Result of the Chernobyl Accident: Part 1: Conventional EEG Analysis

Prospective conventional EEG study was carried out 3–5 and 10–13 years after the Chernobyl accident (1986) in patients who had acute radiation sickness and in emergency workers in 1986 (“liquidators”). Control groups comprised healthy volunteers; veterans of the Afghanistan war with posttraumatic stress disorder; veterans with mild traumatic brain injury; and patients with dyscirculatory encephalopathy. In 3–5 years after irradiation, there were irritated EEG changes with paroxysmal activity shifted to the left frontotemporal region (cortical-limbic overactivation) that were transformed 10–13 years after irradiation toward a low-voltage EEG pattern with excess of fast (beta) and slow (delta) activity together with depression of alpha and theta activity (organic brain damage with inhibition of the cortical-limbic system). Quantitative EEG is likely to be very informative for investigation of dose–effect relationships.

EEG patterns in persons exposed to ionizing radiation as a result of the Chernobyl accident: part 1: conventional EEG analysis.

Prospective conventional EEG study was carried out 3-5 and 10-13 years after the Chernobyl accident (1986) in patients who had acute radiation sickness and in emergency workers in 1986 ("liquidators"). Control groups comprised healthy volunteers; veterans of the Afghanistan war with posttraumatic stress disorder; veterans with mild traumatic brain injury; and patients with dyscirculatory encephalopathy. In 3-5 years after irradiation, there were irritated EEG changes with paroxysmal activity shifted to the left frontotemporal region (cortical-limbic overactivation) that were transformed 10-13 years after irradiation toward a low-voltage EEG pattern with excess of fast (beta) and slow (delta) activity together with depression of alpha and theta activity (organic brain damage with inhibition of the cortical-limbic system). Quantitative EEG is likely to be very informative for investigation of dose-effect relationships.

EEG, cognitive and psychopathological abnormalities in children irradiated in utero

Computerised EEG, a clinical neuropsychiatric examination, and IQ tests were examined in 50 randomly selected prenatally irradiated 9–10-year-old children and compared with 50 randomly selected non-exposed control children of the same age. In the prenatally irradiated children a disorganised EEG-pattern with slow and paroxysmal activity (acute and high-voltage δ-waves, sometimes: spike-waves) in the left fronto-temporal region was disclosed. There was also a significant predominance of δ- and β (dominant frequency: 20 Hz)-power in the frontal lobe, particularly, in the left fronto-temporal region, together with depressed spectral θ-power. The more disorganised EEG-patterns were observed in those children exposed at 8–15 weeks of prenatal development, while left-hemisphere abnormalities were more typical for those exposed later at 16–25 weeks of gestation. There was also a significant increase of borderline and low range (70–90) IQ scores and a significant decrease of high verbal (>110) IQ scores. Disorders of psychological development, particularly specific developmental disorders of speech, language, and scholastic skills were more common and correlated with left-sided slow- and fast-wave activity. Behavioural and emotional disorders (social estrangement, exhaustion, emotional lability, tearfulness, apathy) were also more common and associated with a L>R imbalance in arousal. We hypothesise that the cerebral basis of mental disorders in the prenatally irradiated children is the malfunction of the left hemisphere limbic-reticular structures, particularly in those exposed at the most critical period of cerebrogenesis (16–25 weeks of gestation). We propose that the left hemisphere is more vulnerable to prenatal irradiation than the right.

Focal retrograde amnesia associated with vascular headache

We report the case of a 42-year-old man with repeated attacks of headache associated with retrograde amnesia. Neuropsychological tests before and after the major episode of amnesia showed mild neuropsychological deficits but with spared anterograde memory and learning functions. The amnesia was dense for a period of 15–20 years and included people and events (public and private). There was also a suggestion of amnesia for learned skills. Neurologically he had mild clinical signs and focal EEG-abnormalities in the left fronto-temporal region, but CT, MRI, and SPECT showed no abnormality. Five years after the onset of amnesia there was no recovery of the retrograde memory deficit, but a PET (glucose) scan was normal and neuropsychological testing showed no deficits. An association with migraine has been reported for some non-classical amnesias, but this is the first case of selective retrograde amnesia in a patient with headache as a primary neurological diagnosis.

A case of long-lasting but reversible isolated amnesia of unknown aetiology

We report the case of a 64-year-old man with an acute isolated and prolonged transient amnesic state. The underlying aetiology remained obscure. Brain magnetic resonance examination demonstrated only non-specific slight and transitory signal intensity abnormalities within the left hippocampus on T2-weighted images. Electroencephalographic studies showed repetitive periodical and prolonged bursts of rhythmic theta activity, originating from the left fronto-temporal region, but no typical epileptiform discharges. As an epileptic origin could not be excluded, anti-epileptic treatment was administered. Subsequently, electroencephalographic abnormalities disappeared completely after a few days. On follow-up, repetitive clinical and neuropsychological comprehensive evaluations showed that the mnesic capacities improved slowly and gradually. The gradual improvement concerned time and place orientation first of all and was followed thereafter by improvement of explicit memory and the capacity to learn new information. Clinically, at this stage, the patient appeared appropriately orientated, according to the medical staff and his family, although memory tests remained abnormal. The memory deficit lasted -3 months but was followed by complete recovery. In our discussion, we consider possible aetiologies for transient amnesia with emphasis on an epileptic as opposed to a vascular aetiology by focal hippocampal ischaemia.

Right-hemisphere preponderance of responses to painful CO 2 stimulation of the human nasal mucosa

We recorded whole-scalp cerebral magnetic fields from healthy adults to painful CO 2 pulses (duration 200 ms, concentration 65–90%), led to the left or right nostril once every 20 or 30 s. The stimuli were embedded in a continuous airflow (140 ml/s, 36.5°C, relative humidity 80%) to prevent alterations in the mechanical and thermal conditions of the nasal mucosa. The recording passband was 0.03–90 Hz and 16 single responses were averaged per run. Five out of the 9 subjects showed replicable and artefact-free responses 280–400 ms after stimulus onset. The main responses originated close to the second somatosensory cortex (SII), most frequently in the right hemisphere, and also in the rolandic areas, mostly on the left. The signals were considerably stronger over the right than the left frontotemporal region, with a right-to-left ratio of 2.3 for areal mean signal amplitudes calculated across 16 channels, for both left and right nostril stimuli. Air puffs delivered to the nasal mucosa resulted in a trend for right-hemisphere dominant responses, but responses to air puff stimulation of the lip and the forehead were symmetric. The right-hemisphere dominance of the SII responses may be associated with the painful, and thus unpleasant, nature of the CO 2 stimulus, thereby suggesting involvement of the right hemisphere in emotional/motivational aspects of trigeminal pain, in agreement with the role of the trigeminal pathways as a general warning system.

Impulsive Homicide Associated With an Arachnoid Cyst and Unilateral Frontotemporal Cerebral Dysfunction.

A 65-year-old man with no past history of violent or criminal behavior abruptly strangled his wife after she scratched his face during a domestic argument. He appeared emotionally blunted and lacked insight into the motivations for his violent actions. The presence of left-sided cerebral dysfunction was initially suggested by subtly decreased dexterity of his dominant right hand. A magnetic resonance image (MRI) revealed a large arachnoid cyst centered in his left Sylvian fissure that effaced ventral frontal, anterior temporal and insular cortical gyri. The left middle cerebral artery was displaced relative to an earlier study, providing indirect evidence that the cyst had enlarged during his adult life. Neuropsychological testing indicated generally intact cognitive abilities except for mild impairment on tests of prospective memory and executive functions. He was found to have intermittently decreased EEG amplitude in the left fronto-temporal region. Positron emission tomography (PET) revealed significantly reduced resting glucose metabolism in the left frontal and temporal lobes. He was also found to have pathological diminution of autonomic responses to affectively charged visual stimuli, a phenomenon previously reported in patients with ventromedial frontal lobe injury and acquired disturbances of social conduct. In light of these findings, we suggest that his violent behavior represents stimulus-bound aggression, triggered by a novel physical threat and unchecked by learned social restraints owing to the presence of ventral prefrontal dysfunction.

Heritable features of the auditory oddball event-related potential: peaks, latencies, morphology and topography

Baseline auditory ERP data from a larger study of the genetic determinants of the response to alcohol were collected from 59 monozygotic (MZ) twin pairs and from 39 same-sex dizygotic (DZ) twin pairs who drank socially. Three methods for measuring genetic influence on the ERPs were applied. First, based on maximum-likelihood estimates, the heritability of conventional peak amplitude and latency of N1 and P3 components was computed for each of 16 lead locations using tests of the significance of heritability based on intraclass correlations. P3 amplitude provided the strongest results, distributed symmetrically over caudal leads, and implied gene dominance as the mode of genetic transmission for the P3 component. A substantial genetic influence on N1 latency suggested a mixture of additive and dominance effects in the left fronto-temporal region. N1 amplitude measures trended towards significant heritability, but none was observed for P3 latency. The second method used the maximum of the cross-correlation function to compare wave form shape in a lead-by-lead analysis of data from cotwins. Genetic influence was apparent in both target and non-target ERP responses, with a fronto-central topography of significant results. The third method reduced all spatial and temporal ERP differences from a pair of twins to a single scalar number for each response. Distributions of this global measure revealed significant genetic influence on both non-target and target ERPs. A post hoc analysis of the effect of gender on the heritability of N1 or P3 peaks and latencies revealed no statistically significant observations in this sample of young adult twins.

Parkinsonismo associado a tumor cerebral relato de caso

Descreve-se o caso de paciente com síndrome parkinsoniana à direita, associada a disfunções cognitivas e síndrome de hipertensão intracraniana. A tomografia de crânio e o estudo angiográfico de vasos intracranianos demonstraram a presença de volumoso processo expansivo fronto-temporal esquerdo. A eletromiografia revelou tremor de repouso com frequência de 4 a 6 ciclos por segundo. A paciente foi submetida a ressecção cirúrgica da massa tumoral, cujo exame histológico revelou tratar-se de meningioma. A evolução pós-operatória foi excelente e após dois meses todas as anormalidades neurológicas haviam desaparecido. Um ano após a remoção do tumor a paciente permanecia assintomática sem uso de qualquer medicação. São discutidos aspectos fisiopatológicos do parkinsonismo por processo expansivo e as particularidades do presente caso são analisadas em confronto a dados da literatura.

Intraosseous Meningioma

An 82-year-old female was admitted with slowly progressive aphasia and right hemiparesis, accompanied by a hard, 5 x 5 cm subcutaneous swelling in the left frontotemporal region. Plain X-ray film showed a well-circumscribed round radiolucency in the left pterional region. Computed tomography (CT) scans showed an intraosseous mass lesion, homogeneously enhanced postcontrast, extending to the intracranial cavity. Bone CT demonstrated a concave appearance and partial destruction of the inner table, strongly suggesting an intradiploic origin of the tumor. Left carotid angiography revealed the mass supplied by the middle meningeal artery. Left frontotemporal craniectomy demonstrated that the inner surface of the skull was destroyed, and the dura was compressed but not invaded. Histological examination found meningotheliomatous meningioma with many psammoma bodies.

Vacuolated (Microcystic) Meningioma

Two patients with extensively vacuolated meningiomas are described. The first, a 51-year-old female who had had several convulsive seizures within a 3-month period, was found on a plain computed tomography (CT) to have a diffuse, hypodense lesion in the frontoparietotemporal region. Contrast enhancement was slight. Neuroradiological examination suggested an extra-axial mass lesion. Histopathological examination of the surgical specimen showed extensive vacuolation and meningothelial cell nests, and a diagnosis of meningioma was established. No lipids were demonstrated in the vacuolated component. Electron microscopy of a formalin-fixed specimen showed interdigitations of cytoplasmic processes and desmosomes. Cytoplasmic processes also delimitated intercellular spaces of variable size. The second patient, a 68-year-old female, had had several right facial spasms within 6 months before admission. Plain CT revealed a hypodense lesion in the left frontotemporal region. Enhanced CT showed a well defined mass lesion. Light microscopy of the tumor specimen showed an area of mixed vacuolated and angiomatous components. It is important to note that the CT appearance of such hypodense meningiomas may mimic that of intra-axial tumors, such as filial tumors. The low density is considered to be due to extensive, diffuse vacuolation. Electron microscopic findings suggest that one of the causes of vacuolation in vacuolated meningioma is recapitulation of the subarachnoid structure.

Anterior temporal focal abnormalities in EEG in normal aged subjects; correlations with psychopathological and CT brain scan findings

Normal aged subjects (65–83 years) were examined by EEG and CT brain scan; also a Geriatric Mental Scale (GMS) and Neuropsychologic Assessment Battery were administered. Based on the EEG findings 2 subgroups could be distinguished: one with focal abnormalities in the left fronto-temporal region and one without these focal abnormalities. The focal delta subgroup proved to perform poorly on the Fluency Test, a simple quick bedside, but very sensitive, test for word association productivity. Also this subgroup showed more ventricular dilatation than the non-focal group. Therefore slight left-sided antero-temporal abnormalities in normal aged subjects are not irrelevant but an early (subclinical) sign of temporal lobe pathology as expressed in deterioration of language function.

Complementary values of static and dynamic scintigraphy, computerized tomography and angiography in the diagnosis of a partially thrombosed giant intracranial aneurysm

The case history is presented of a 17 year-old male admitted with right hemiplegia and motor aphasia. Static and dynamic scintigraphy allowed prediction of a giant aneurysm in the deep left frontotemporal region, and this supposition was confirmed by CT and carotid angiography. CT also revealed the aneurysm to extend farther medially than the other two examinations had indicated, the medial portion of the aneurysm being thrombosed. Evaluation of the diagnostic information obtained from the three procedures, combined with the clinical data, makes possible a reconstruction of the probable course of events. The presenting signs were probably caused by a newly formed thrombus within the aneurysm. Death, which occurred after five days, was apparently due to subarachnoid hemorrhage.

Transvestism, impotence and temporal lobe dysfunction

A 38-year-old right-handed transvestite was referred for psychiatric treatment because of depression and lifelong impotence. Specific questioning revealed marked global déjà vu experiences and vivid dreaming. Neurological investigation (EEG) showed a focal disturbance in the left fronto-temporal region, and this was supported by results of psychological testing. Treatment with small doses of phenytoin sodium and supportive psychotherapy resulted in rapid amelioration. Nine months later he married, and twenty months later remains well off medication. Even in the absence of spontaneous complaints referable to temporal lobe epilepsy, specific enquiry may as in this patient bring to light other evidence of temporal lobe dysfunction. The link between the patient's temporal lobe disturbance and transvestism is seen in his déjà vu experiences, part of what Hughlings Jackson called “dreamy states” or “reminiscence”. It seems that such sexual disturbances marked by repetitiveness of ritual and characterised by episodicity and “paroxysmalness”, to use another of Jackson's terms, may now be accepted as possible expressions of temporal lobe dysfunction and should be fully investigated accordingly.

SUPRACHIASMAL AND INTRAVENTRICULAR MENINGIOMA IN A FOUR-YEAR-OLD CHILD.

History. In January 1960, when the patient was years old, a large meningioma, weighing 250 gin. (Fig. 1) was removed from the suprachiasmal area. The tumor was located on the dorsal surface of the optic chiasma. The flattened optic nerves, chiasm and optic tracts were markedly stretched downward and bowing, resembling a small concave hammock in which the giant neoplasm nested. The meningioma was not attached to the basi]ar dura mater, the tuberculum sellae, the olfactory grooves, or the falx. Its blood supply was derived from the ethmoidal arteries. ~ The postoperative course was uneventful. He made a satisfactory recovery. Aside from a bilateral anosmia, all neurological findings were essentially normal including fundi and vision. Course. Sixteen months later seizures occurred, each attack lasting 2 to 5 minutes. During these seizures the child was stuporous but not unconscious, with eyes fixed, pupils dilated, pale, at times perspiring and hyperventilating without tonic or clonic phase. The seizures were largely controlled by Dilantin and 1Vfysoline. Since the operation the child was noted to be restless and hyperactive. He seemed to be everywhere at once, running and hopping, shifting from one activity to another, but short of concentration. He was constantly exploring and manipulating objects in the environment, not remaining with any one thing for any great length of time but moving about from one thing to another as if driven from within. Fits of anger were easily provoked. In tantrum, he rolled on the floor. At meals he was running in and out for a mouthful at a time. For this hyperkinetic behavior he was treated with Dexedrine 5 mg. t.i.d. The hyperactivity was reduced considerably. Repeated electroencephalography showed diffuse bilateral delta activity, especially prominent in the left frontotemporal region. Spike potentials often were intermixed with the slow activity. In December 1961, examination disclosed a bilateral weakness of the 6th cranial nerve, more marked on the left. There was no papiUedema. His fundiand vision were normal. Measurement of the head was normal for his age. All other neurological findings were essentially negative. A radiograph of the skull showed the cranial sutures to be normal. A globular shadow of calcification was visualized extending from the midline to the left (Fig. 2). Radiograms taken in 1960 before the first operation

Vascular malformation of the left thalamus: report of a case of successful treatment, with a note on occulsion of the left internal cerebral vein.

The pat ient , t a 41-year-old right-handed school-teacher and housewife, had had a subarachnoid hemorrhage without localizing signs at the age of 16 years. She was well until 5 days before her admission, at which time, while a t home, she suddenly experienced severe headache, nausea and vomiting, and became comatose. Lumbar puncture revealed bloody spinal fluid. She was then hospitalized at a local hospital. Neurological examination disclosed a right hemiparesis and some difficulty with speech. She continued to improve until 4 days later when there was an increase in the severity of the symptoms and of the blood in the spinal fluid. She was then transferred to the Mount Sinai Hospital. Examination. She was a noncommunicative, aphasic patient with right-sided weakness, including the face. Right hyperreflexia and Babinski's sign were present. The fundi were normal. There was vertical nystagmus, with paralysis of upward gaze. An electroencephalogram showed severe diffuse slowing, accentuated in the left frontotemporal region. Her state of alertness improved but tile signs persisted. I t was now possible to ascertain that there was no apparent sensory disturbance within the limits of testing and tha t visual fields were full to confrontation. Thirteen days after admission, a left carotid angiogram was carried out. I t showed, in the anteroposterior projection (Fig. 1), a small vascular malformation lying lateral and slightly dorsal to the internal cerebral vein, to which it shunted. The lat ter structure was not shifted across the midline. The malformation seemed to derive most of its blood supply from ganglionic vessels arising inferiorly. The lateral angiogram (Figs. i and 3) also showed the malformation and its shunt to the dilated internal cerebral vein. The lat ter structure was dislocated upwards, indicating a mass in the thalamic region. The anomaly could be seen to project superiorly to the striatothalamic vein and it was judged that a t least part of it might be in proximity to the left lateral ventricle. For this reason a pneumoencephalogram was carried out. The anteroposterior erect films disclosed marked elevation of the thalamic shadow (Fig. 4), with some irregularity of its roof, possibly indicative of the malformation. The lateral view (Fig. 5) showed a marked general increase of the left thalamic outline with local accentuation anterodorsally, in the area under suspicion. There was no filling of the posterior part of the third ventricle. The impression was that this was an arteriovenous anomaly of the left thalamus which was superficial and had ruptured into the thalamus and the left lateral ventricle. I t was felt that the lesion might be safely approached through the hydrocephalic ventricle, and removed, because of its small size. Operation, Under hypothermia and hypotension, 6 weeks after admission, the left su-