Involvement Of Left Hemisphere Research Articles

33 Pre-Surgical Evaluation of Bilingual Epilepsy Patients; A Case Study Demonstrating the Importance of Bilingual Assessment

Objective:In the US, >20% of individuals aged 5 years and older speak a language other than English at home, with rates of bi- and multilingualism increasing. Providing linguistically- and culturally- competent care to increasingly diverse populations is a necessary task for neuropsychologists. The need for close attention to bilingualism is even more glaring in the context of neurosurgical interventions, such as in intractable epilepsy. Pre-surgical epilepsy evaluations serve as a baseline for post-surgical change, inform lateralization and localization, and help determine cognitive risks associated with surgery. The importance of evaluating bilingual status and assessing cognitive abilities in both languages, if needed, in presurgical epilepsy evaluations is examined. We present the neuropsychological profile of a 10-year-old bilingual male with intractable epilepsy participating in a pre-surgical epilepsy evaluation.Participants and Methods:This right-handed male is a sequential language learner, exposed to Spanish at birth and English when he began kindergarten. His parent reported he was primarily English speaking. Developmental milestones were met within expected timeframes. Seizures began at age 5. He is prescribed Vimpat and Lamictal. vEEG during admission revealed right temporal-onset seizures. Neuropsychological assessment was conducted in English based on parent report; however, expressive language testing revealed significantly higher performance in Spanish (average) compared to English (exceptionally low). Subsequently, a bilingual provider was consulted, and supplemental Spanish verbal reasoning and verbal memory measures were administered.Results:The patient’s neuropsychological profile captured a significant difference between English and Spanish verbal abilities. WISC-V Similarities scaled scores (ss) were 5 and 11 in English and Spanish, respectively. Vocabulary scaled scores were 8 and 15 in English and Spanish, respectively. Regarding verbal memory, list learning was below average in English (ss = 5), but low average in Spanish (ss = 6). Contextual verbal memory was only administered in Spanish; scores were average (ss = 10). Verbal Fluency administered in English was low (phonemic fluency ss = 5, categorical fluency ss = 6). fMRI verbal tasks were performed in English and revealed left-sided language lateralization.Conclusions:In pre-surgical epilepsy evaluations of bilingual children, consideration of language is essential. Assessment of language dominance is a minimum requirement in bilingual families, followed by full bilingual evaluation if necessary. In this case, starkly different conclusions regarding lateralization and localization may have been made if the child had not been evaluated in both languages. In English, a significant split between verbal and non-verbal cognition was apparent, possibly suggesting involvement of the dominant left hemisphere. With Spanish testing, this split disappeared, with high average verbal skills. While a growing proportion of children in the US are bilingual, bilingual assessments are not commonly conducted in pre-surgical epilepsy evaluations. In fact, very little work has been done examining language functioning in bilingual epilepsy patients, particularly in children. With both epilepsy-and language-related factors at play in a developing brain, we encourage closer attention to these issues, particularly in the context of neurosurgical procedures.

Neuroanatomical and cellular degeneration associated with a social disorder characterized by new ritualistic belief systems in a TDP-C patient vs. a Pick patient.

Frontotemporal dementia (FTD) is a spectrum of clinically and pathologically heterogenous neurodegenerative dementias. Clinical and anatomical variants of FTD have been described and associated with underlying frontotemporal lobar degeneration (FTLD) pathology, including tauopathies (FTLD-tau) or TDP-43 proteinopathies (FTLD-TDP). FTD patients with predominant degeneration of anterior temporal cortices often develop a language disorder of semantic knowledge loss and/or a social disorder often characterized by compulsive rituals and belief systems corresponding to predominant left or right hemisphere involvement, respectively. The neural substrates of these complex social disorders remain unclear. Here, we present a comparative imaging and postmortem study of two patients, one with FTLD-TDP (subtype C) and one with FTLD-tau (subtype Pick disease), who both developed new rigid belief systems. The FTLD-TDP patient developed a complex set of values centered on positivity and associated with specific physical and behavioral features of pigs, while the FTLD-tau patient developed compulsive, goal-directed behaviors related to general themes of positivity and spirituality. Neuroimaging showed left-predominant temporal atrophy in the FTLD-TDP patient and right-predominant frontotemporal atrophy in the FTLD-tau patient. Consistent with antemortem cortical atrophy, histopathologic examinations revealed severe loss of neurons and myelin predominantly in the anterior temporal lobes of both patients, but the FTLD-tau patient showed more bilateral, dorsolateral involvement featuring greater pathology and loss of projection neurons and deep white matter. These findings highlight that the regions within and connected to anterior temporal lobes may have differential vulnerability to distinct FTLD proteinopathies and serve important roles in human belief systems.

H - 24 The Role of Bilingual Neuropsychologists in Presurgical Epilepsy Evaluations: La Evaluación Comprensiva en Español.

As neuropsychologists continually work to establish clinical standards of practice for evaluation of linguistically and culturally diverse children with epilepsy (Berrios-Siervo et al., 2023), this case study supports efforts to document complex assessment procedures with an adolescent who recently immigrated from Mexico to the U.S. A 16-year-old, right-handed, primarily Spanish-speaking, Hispanic male with intractable epilepsy (complex partial seizures) was referred for a presurgical neuropsychological evaluation. Medication was initiated in Mexico at age 11years, but increased frequency and severity of seizures prompted immigration to the U.S. at age 14 for further treatment. EEG and brain MRI indicated left hemisphere involvement. Magnetoencephalography results indicated right-hemisphere dominance for receptive language. Functional MRI (fMRI) indicated left-hemisphere dominance. Subsequent Wada and bilateral language mapping results supported left-hemisphere dominance. Personal history was significant for anxiety and depressed mood. Bilingual neuropsychologists completed a presurgical evaluation, fMRI, stereo EEG language mapping, and Wada in Spanish. He was seizure-free 6months post selective left temporal resection. He recently completed his1-year post-op evaluation. Baseline testing indicated average neurocognitive functioning, with select relative weaknesses lacking strong evidence for lateralization/localization. Post-operative consultation/ evaluation at 6 and 12months, respectively, revealed the patient was doing well academically with perceived improvements in attention and memory and minimal language difficulties. Reported improvements in mood were attributed to family reunification and increased social engagement. In addition to pre/post-surgical assessment in Spanish, bilingual neuropsychologists are uniquely positioned to contribute to the establishment of culturally-informed, standardized approaches to essential aspects of the presurgical workup (e.g., language mapping, Wada).

Determinants of cerebral collateral circulation in acute ischemic stroke due to large vessel occlusion.

Cerebral collateral circulation has a central role in ischemic stroke pathophysiology, and it is considered to correlate with infarct size, the success of reperfusion therapies, and clinical outcomes. Our aim was to study the factors influencing the development of collaterals in patients with acute ischemic stroke eligible for endovascular treatment. We enrolled patients with acute ischemic stroke and large vessel occlusion of anterior circulation potentially eligible for endovascular treatment. Included patients performed multiphase CT angiography to assess collaterals that were graded by the Menon Grading Score. We investigated the associations between clinical factors and collaterals and tested independent associations with logistic (good vs. poor collaterals) and ordinal (collateral grade grouped, Menon 0-2, 3, 4-5) regression analysis adjusting for age, sex, stroke severity, and onset to CT time (OCTT). We included 520 patients, the mean age was 75 (±13.6) years, 215 (41%) were men, and the median (IQR) NIHSS was 17 (11-22). Good collaterals were present in 323 (62%) patients and were associated with lower NIHSS (median 16 vs. 18; p < 0.001) and left hemisphere involvement (60% vs. 45%; p < 0.001), whereas previous stroke/TIA was more frequent in patients with poor collaterals (17 vs. 26%; p = 0.014). These results were confirmed in both logistic and ordinal regression analyses where good collaterals were associated with lower NIHSS (OR = 0.94; 95% CI = 0.91-0.96; cOR = 0.95; 95% CI = 0.92-0.97, respectively) and left hemisphere stroke (OR = 2.24; 95% CI = 1.52-3.28; cOR = 2.11; 95% CI = 1.46-3.05, respectively), while previous stroke/TIA was associated with poor collaterals (OR = 0.57; 95% CI = 0.36-0.90; cOR = 0.61; 95% CI = 0.40-0.94, respectively). Vascular risk factors, demographics, and pre-stroke treatments did not influence the collateral score. The results of our study suggest that risk factors and demographics do not influence the development of collateral circles, except for a negative relation with previous ischemic events. We confirm an already reported observation of a possible protective effect of collaterals on tissue damage assuming NIHSS as its surrogate. The association between left hemispheric stroke and better collaterals deserves to be further explored. Further efforts are needed to identify the factors that favor the development of collaterals.

Non-Paretic Arm Motor Deficit and Recovery as a Function of Damage Lateralization after Stroke: Biomechanical Study

The aim was to study the dependence of post stroke motor impairments of the paretic and the intact arm of lesion lateralization and paresis severity. The influence of lateralization of the lesion and the severity of paresis on the recovery of motor functions after rehabilitation using a hand exoskeleton controlled by a brain-computer interface was also studied. The study included 24 patients, 12 with left hemisphere involvement and 12 with right hemisphere involvement. Each group included 6 patients with moderate paresis and 6 patients with severe paresis. As motor tests, isolated movements in the joints of the paretic and intact hands were used before and after the rehabilitation course. Joint torque and motion isolation degree were used to assess motor function. It is shown that the muscle moments of the intact arm are greater in the case of damage to the left hemisphere; the asymmetry of the moments in the joints in this case was more pronounced than in the case of damage to the right hemisphere. This may be due to a greater imbalance in the activity of the hemispheres. The effectiveness of rehabilitation was manifested in: 1) an increase in moments in the joints in both paretic and intact hands; 2) an increase in the symmetry of the biomechanical parameters of the paretic and intact hands, which may indicate the restoration of the balance of the activity of the hemispheres. Biomechanical analysis of isolated movements allows suggests the pronation-supination in the vertical position of the arm as a sensitive indicator of motor function recovery after stroke.

Outcomes of Decompressive Craniectomy in Patients with Supratentorial Ischaemic Stroke: A Longitudinal Study

Introduction: Decompressive Craniectomy (DC) is a surgical procedure that entails removing a section of the skull with the aim of preventing neuronal damage and improving the patient’s prognosis. The goal was to determine if DC is associated with reduced risk of death and improved outcomes. Aim: To study the outcome, morbidity and mortality associated with DC in patients with intracranial ischaemic infarct. Materials and Methods: A longitudinal single-centre study was carried in the Department of Neurosurgery, GR Medical College and JA Group of Hospitals, Gwalior, Madhya Pradesh, India, from January 2019 to June 2020. A total of 25 cases were operated on and subsequently followed-up. Patients who were admitted with life-threatening supratentorial infarction and deemed eligible for DC based on clinical assessment {National Institute of Health Stroke Scale, Glasgow Coma Scale (GCS)} and neuroimaging with computed tomography head or Magnetic Resonance Imaging (MRI) brain were prospectively included in the study. The outcomes of the study were evaluated based on the functional impairment experienced by patients after a stroke. This was assessed using the Modified Rankin Scale (mRS), a seven-point scale that ranges from 0 (no symptoms) to 6 (death). The assessments were conducted at discharge, three months and six months. Paired t-test was used to analyse the functional outcomes of patients at admission, discharge, 3-month, and 6-month follow-up, using the mRS as the tool of evaluation. The relationship between patient characteristics and neurological outcome was analysed using the Chi-square test. Results: In the study, 25 patients were analysed, with 76% being males. The right hemisphere was affected in 13 (52%) patients, while 12 (48%) patients had left hemisphere involvement. At admission, 23 (92%) patients had a mRS score of five and only 2 (8%) patients had an mRS score of 4. During hospitalisation, 8 (32%) patients died. After discharge, 7 (28%) patients had a mRS score of 4 or less, which increased to 9 (36%) patients at three months follow-up and 12 (48%) patients at six months follow-up. Conclusion: The results of the present study revealed that decompressive hemicraniectomy improved neurological outcomes of patients with supratentorial ischaemic infarcts, with patient characteristics playing a significant role.

Evaluation of central neuropathic pain and its relationship with quality of life in patients with stroke: a cross-sectional study

Objectives: In addition to other complications in stroke patients, central post-stroke pain (CPSP) is sometimes overlooked. Considering the morbidities it causes in patients, it turns out to be a very important problem. The aim of this study is to investigate the frequency of CPSP, the factors causing CPSP, and the relationship between the CPSP and the quality of life and ambulation of individuals. Methods: A cross-sectional study was conducted on a group of patients with stroke. One hundred forty stroke patients were included in the study. Pain (The Leeds Assessment of Neuropathic Symptoms and Signs Pain Scale), health-related quality of life (Short Form 36 Questionnaire) and ambulation (Functional Ambulation Classification) were evaluated. In addition, a special evaluation form was created for this study. With this form, demographic characteristics of the patients, stroke type, cerebral location and hemisphere affected in stroke were recorded. These data were collected for the period between May 2016 and January 2018. Patients were divided into two groups. Group 1 included patients with CPSP and Group 2 patients without neuropathic symptoms. Results: CPSP was detected in 23 of 140 patients. In terms of demographic data, only gender differences were found between group 1 and group 2. CPSP was statistically significantly higher in female patients. There was no significant difference between the two groups in terms of the affected cerebral region and stroke type, but CPSP was significantly more common in patients with left hemispheric involvement. Emotional role restriction, body pain, social funtion, general health and mental health subcategories of the SF-36 were found to be significantly lower in group 1 compared to group 2. Also ambulation was worse in patients with CPSP. Conclusions: It was concluded that CPSP is a common problem and negatively affects the quality of life of the patients. Therefore, CPSP should be recognized in the early period after stroke and treatments should be arranged accordingly.

Left Hemisphere Dominance for Negative Facial Expressions: The Influence of Task.

Major theories of hemisphere asymmetries in facial expression processing predict right hemisphere dominance for negative facial expressions of disgust, fear, and sadness, however, some studies observe left hemisphere dominance for one or more of these expressions. Research suggests that tasks requiring the identification of six basic emotional facial expressions (angry, disgusted, fearful, happy, sad, and surprised) are more likely to produce left hemisphere involvement than tasks that do not require expression identification. The present research investigated this possibility in two experiments that presented six basic emotional facial expressions to the right or left hemisphere using a divided-visual field paradigm. In Experiment 1, participants identified emotional expressions by pushing a key corresponding to one of six labels. In Experiment 2, participants detected emotional expressions by pushing a key corresponding to whether an expression was emotional or not. In line with predictions, fearful facial expressions exhibited a left hemisphere advantage during the identification task but not during the detection task. In contrast to predictions, sad expressions exhibited a left hemisphere advantage during both identification and detection tasks. In addition, happy facial expressions exhibited a left hemisphere advantage during the detection task but not during the identification task. Only angry facial expressions exhibited a right hemisphere advantage, and this was only observed when data from both experiments were combined. Together, results highlight the influence of task demands on hemisphere asymmetries in facial expression processing and suggest a greater role for the left hemisphere in negative expressions than predicted by previous theories.

Headache features of cerebellar ischemic strokes: Clinical and radiological-experiences of a single center

The prevalence of headache in stroke has been reported between 8% and 34%. Determining the prevalence, features, and effects on prognosis of cerebellar ischemic strokes that presented with headache solely and/or with other cerebellar signs were the aims of our study.All patients diagnosed with cerebellar ischemia were included. Electronic medical records were reviewed. Patients have been followed up for 6th month. Descriptive statistics were generated. A total of 4763 patients were evaluated retrospectively, 200 patients had cerebellar ischemia and 22 patients of these cerebellar ischemias (11%) had a headache at initial presentation. Ataxia, dysarthria, dysmetria were the most common neurological findings. There was no significant difference whether ischemic lesion single or multiple and whether above or below 1.5 cm diameter. Ischemic lesions generally were in cortical/ juxtacortical layer. According to vascular perfusion areas, 54.5% patients’ ischemia was located in PICA (posterior inferior cerebellar artery) territory. Patients presenting with a headache, predominantly had left hemispheric (vermian > hemispheric > pedincular) involvement. Although these patients generally had high modified Rankin Scale scores at the first evaluation, they had low NIHSS (National Institutes of Health Stroke Scale) scores (0–5), and nearly all patients recovered, with low mRS at the 6-month follow-up.Cerebellar ischemic strokes with headache presentation are significantly prevalent in patients with left hemispheric, cortical/juxtacortical, PICA perfusion territory ischemias and are associated with low morbidity unless there was a conscious disorder. We believe this is one of the first studies that evaluated the clinical and radiological parameters of cerebellar stroke patients with headache.

Tube feeding predictors after ischemic hemispheric stroke during hospitalization

Purpose To verify the factors associated with the need of tube feeding (TF) during patients post-ischemic stroke hospitalization. Method This is a retrospective study with 70 adult post-ischemic hemispheric stroke adult patients hospitalized in the Neurology department at a tertiary public hospital in Santa Catarina, Brazil. We investigated associations between the need of a feeding tube during hospitalization and the variables age, gender, admission and discharge NIHSS and FOIS, length of hospital stay in days, presence of thrombolytic therapy, extensive stroke, hemisphere affected, prior stroke, pneumonia during hospitalization, presence of signs of laryngeal penetration and laryngotracheal aspiration and dysphagia in the first and last swallowing clinical evaluation. Results A total of 33 participants used tube feeding. There was a significant relationship among tube feeding and the following parameters: NIHSS (p value .001), FOIS (p value .001), extensive stroke (p value .034), left hemisphere involvement (p value .035), pneumonia during hospitalization (p value .001), length of hospital stay in days (p value .001), signs of laryngotracheal penetration/aspiration (p value .001) and dysphagia in speech-language assessment (p value .001). Conclusion Tube feeding during patients hospitalization after ischemic hemispheric stroke was predicted by the severity of stroke and signs of airway permeation. Key points Swallowing difficulty is one of the most common post-stroke consequences. There are few studies on the characterization of post-stroke patients with tube feeding. Tube feeding after ischemic stroke predictors were severity of stroke and signs of airway permeation.

Impact of unilateral stroke on right hemisphere superiority in executive control

In our previous study, we have demonstrated a right hemisphere superiority in executive control of attention, with the right hemisphere being more efficient in dealing with conflict for stimuli presented in the left visual field. However, the unique and synergetic contribution of the two hemispheres to this superiority effect is still elusive. Here, using the lateralized attention network test, we compared the flanker conflict effect for stimuli presented in the left and right visual fields in patients with an ischemic stroke in the right or left hemisphere as the unilateral lesion groups and in patients with a transient ischemic attack without an acute infarction as the control group. In contrast to the transient ischemic attack group, which demonstrated a right hemisphere superiority in conflict processing, there was no evidence for such an effect in both unilateral stroke groups. These results can be explained by our model proposing that there is bilateral hemispheric involvement for conflict processing for information received from the left visual field and unilateral hemispheric involvement for conflict processing for information received from the right visual field, resulting in more efficient processing for the left visual field, i.e., the right hemisphere superiority effect. When there is damage to either hemisphere, the responsibility of conflict processing will largely fall on the intact hemisphere, eliminating the right hemisphere superiority effect.

NCMP-07. TREATMENT-INDUCED CEREBRAL NECROSIS IN GLIOMAS: THE OHIO STATE UNIVERSITY COMPREHENSIVE CANCER CENTER (OSUCCC) EXPERIENCE

Abstract INTRODUCTION Treatment-induced cerebral necrosis (TN) is a challenging complication encountered in neuro-oncology. Diagnosis and treatment of TN remains poorly defined. METHODS In this single institution, retrospective study, consecutive patients with gliomas and TN between 01/01/2012 and 04/20/2020 at the OSUCCC were identified. Details of the tumor treatment, molecular markers, radiological and pathological findings of TN, as well as treatment, recurrence rate and management upon recurrence were collected. RESULTS Of the 53 patients analyzed, 37 had glioblastoma, 7 had anaplastic oligodendroglioma and 9 had grade II or III astrocytoma. MGMT promoter hypermethylation was present in 31/50 (59%) and IDH mutation in 17/53 (32%). Diagnosis of TN was based on histology in 43/53 (81%) or clinical/radiographic features in 10/53 (19%). Worsening of focal weakness (36%), seizures (9%) or being (30%) were common presentations at TN diagnosis. Patient with right compared to left hemisphere involvement were more symptomatic at TN diagnosis. (p=0.049). Bevacizumab (BEV) (51%), resection (28%), steroids only (9%) or Laser Interstitial Thermal Therapy (6%) were used to treat TN. Steroids were weaned off in 20/27 (74%) after receiving BEV. Among all treatments, BEV was significantly associated with a better outcome (resolution or partial improvement of enhancement in 84.6%) (p=0.0006, Bonferroni corrected p&amp;lt; 0.005). TN Recurrence occurred in 36%, 70% and 100% of the patients treated with BEV, resection and LITT respectively. The median duration to TN recurrence was 10 weeks (range: 3–70 weeks). Initial treatment used for TN, MGMT methylation and IDH mutation status did not predict TN recurrence. (p=0.074; p=0.819; p=0.607 respectively). CONCLUSIONS BEV appears to be a superior treatment to control TN overall. Recurrence of TN in patients previously treated with BEV was 36%. There was no difference in the risk of developing recurrent TN based on MGMT or IDH status.

EEG frequency-tagging demonstrates increased left hemispheric involvement and crossmodal plasticity for face processing in congenitally deaf signers

In humans, face-processing relies on a network of brain regions predominantly in the right occipito-temporal cortex. We tested congenitally deaf (CD) signers and matched hearing controls (HC) to investigate the experience dependence of the cortical organization of face processing. Specifically, we used EEG frequency-tagging to evaluate: (1) Face-Object Categorization, (2) Emotional Facial-Expression Discrimination and (3) Individual Face Discrimination. The EEG was recorded to visual stimuli presented at a rate of 6 Hz, with oddball stimuli at a rate of 1.2 Hz. In all three experiments and in both groups, significant face discriminative responses were found. Face-Object categorization was associated to a relative increased involvement of the left hemisphere in CD individuals compared to HC individuals. A similar trend was observed for Emotional Facial-Expression discrimination but not for Individual Face Discrimination. Source reconstruction suggested a greater activation of the auditory cortices in the CD group for Individual Face Discrimination. These findings suggest that the experience dependence of the relative contribution of the two hemispheres as well as crossmodal plasticity vary with different aspects of face processing.

Does the right or left hemisphere involvement affect swallowing in patients with hemiplegia?

Stroke is one of the most important causes of swallowing difficulty. It is seen in one of every two patients with stroke. Although the swallowing function is controlled by both hemispheres, it is unknown which hemisphere is more dominant than another for controlling the swallowing function. However, the aspiration and pharyngeal phase dysfunction can be seen in right hemisphere involvement while oral phase dysfunction can be seen in left hemisphere involvement. The aim of this study was to investigate whether water swallowing performance, deep cervical flexor muscle endurance, and maximum phonation time were affected in right handed patients with hemiplegia. The study was designed as a cross-sectional study. Patients with unilateral strokes that damaged the right (Group I: n = 37) and left (Group II: n = 20) hemispheres were included. Swallowing difficulties were evaluated with the Turkish version of the Eating Assessment Tool. The water swallowing performance was measured with the 100 ml water swallow test. The muscle endurance (ME) of deep neck flexors was measured in the chin-tuck position. The laryngeal function was measured indirectly with maximum phonation time (MPT). The mean age of patients was 73.54±7.28 years in Group I and the mean age of patients was 73.15±6.94 years in Group II. There were no differences in maximum phonation time, water swallowing performance (swallow volume, capacity, and speed), and swallowing difficulty (p > 0.05). The neck flexor muscular endurance of patients with unilateral strokes that damaged the left hemisphere was better than the patients with unilateral strokes that damaged the right hemisphere (p < 0.05). There was a relationship between MPT and ME, MPT and swallowing difficulty, ME and swallowing difficulty (r:0.637, p:0.000; r:-0.465, p:0.004; r:-0.473, p:0.003 respectively) in the right hemisphere involvement patients. There was a relationship between swallowing difficulty to swallowing volume and swallowing capacity (respectively, r:-0.402 and p:0.014; r:-0.473 and p:0.003) in the patients with unilateral strokes that damaged the right hemisphere. There was no relationship between other parameters in Group I (p > 0.05). There was no relationship between all parameters in Group II (p > 0.05). This study is the first study to investigate whether water swallowing performance, deep cervical flexor muscle endurance, and maximum phonation time were affected in right handed patients with unilateral strokes that damaged the right or left hemispheres. In light of the findings of the study, it was thought that swallowing should be evaluated in detail especially in hemiplegic patients with right hemisphere involvement. There is a need for studies examining the results of swallowing rehabilitation on right or left hemisphere in hemiplegic individuals.

Discrepancy between post-treatment infarct volume and 90-day outcome in the ESCAPE randomized controlled trial.

Some patients with ischemic stroke have poor outcomes despite small infarcts after endovascular thrombectomy, while others with large infarcts sometimes fare better. We explored factors associated with such discrepancies between post-treatment infarct volume (PIV) and functional outcome. We identified patients with small PIV (volume ≤ 25th percentile) and large PIV (volume ≥ 75th percentile) on 24-48-h CT/MRI in the ESCAPE randomized-controlled trial. Demographics, comorbidities, baseline, and 24-48-h stroke severity (NIHSS), stroke location, treatment type, post-stroke complications, and other outcome scales like Barthel Index, and EQ-5D were compared between "discrepant cases" - those with 90-day modified Rankin Scale(mRS) ≤ 2 despite large PIV or mRS ≥ 3 despite small PIV - and "non-discrepant cases". Multi-variable logistic regression was used to identify pre-treatment and post-treatment factors associated with small-PIV/mRS ≥ 3 and large-PIV/mRS ≤ 2. Sensitivity analyses used different definitions of small/large PIV and good/poor outcome. Among 315 patients, median PIV was 21 mL; 27/79 (34.2%) patients with PIV ≤ 7 mL (25th percentile) had mRS ≥ 3; 12/80 (15.0%) with PIV ≥ 72 mL (75th percentile) had mRS ≤ 2. Discrepant cases did not differ by CT versus MRI-based PIV ascertainment, or right versus left-hemisphere involvement (p = 0.39, p = 0.81, respectively, for PIV ≤ 7 mL/mRS ≥ 3). Pre-treatment factors independently associated with small-PIV/mRS ≥ 3 included older age (p = 0.010), cancer, and vascular risk-factors; post-treatment factors included 48-h NIHSS (p = 0.007) and post-stroke complications (p = 0.026). Absence of vascular risk-factors (p = 0.004), CT-based lentiform nucleus sparing (p = 0.002), lower 24-hour NIHSS (p = 0.001), and absence of complications (p = 0.013) were associated with large-PIV/mRS ≤ 2. Sensitivity analyses yielded similar results. Discrepancies between functional ability and PIV are likely explained by differences in age, comorbidities, and post-stroke complications, emphasizing the need for high-quality post-thrombectomy stroke care. https://clinicaltrials.gov/ct2/show/NCT01778335.

Dual-Task Paradigm Reveals Variation in Left Hemisphere Involvement in Verbal Processing Across the Menstrual Cycle in Normally Cycling Women.

Cognitive performance and cerebral hemispheric function are known to vary with fluctuating levels of estradiol and progesterone across the menstrual cycle in naturally cycling females. However, the literature is mixed with regard to how each hemisphere may be affected by elevated ovarian hormones. To better understand this, the current study employed a dual-task paradigm to examine potential shifts in hemispheric involvement for a verbal problem-solving task across the menstrual cycle in 30 right-handed, normally cycling young adult females (18-21 years old). To our knowledge, no study to date has utilized dual-task procedures to directly investigate the potential shifts in hemispheric function across the menstrual cycle. Specifically, participants were tested during both menses and their estimated midluteal phase where they engaged in repetitive unilateral finger-tapping while concurrently solving anagrams silently or aloud. Analysis of finger-tapping interference during the dual-task conditions revealed that solving anagrams silently was lateralized to the left hemisphere while solving anagrams aloud yielded a pattern of more bilateral hemispheric involvement, both of which were consistent across both menses and midluteal phases. Analysis of cognitive performance, however, revealed that silent anagrams performance while tapping with the right, but not left, hand significantly increased during the midluteal phase. Consistent with a number of other studies using different methodological approaches, the current dual-task findings suggest that when ovarian hormone levels are putatively elevated, there is enhanced recruitment of left hemisphere resources while performing a lateralized verbal task.

Left hemisphere abnormalities in developmental prosopagnosia when looking at faces but not words.

Developmental prosopagnosia is a disorder characterized by profound and lifelong difficulties with face recognition in the absence of sensory or intellectual deficits or known brain injury. While there has been a surge in research on developmental prosopagnosia over the last decade and a half, the cognitive mechanisms behind the disorder and its neural underpinnings remain elusive. Most recently it has been proposed that developmental prosopagnosia may be a manifestation of widespread disturbance in neural migration which affects both face responsive brain regions as well as other category-sensitive visual areas. We present a combined behavioural and functional MRI study of face, object and word processing in a group of developmental prosopagnosics (N = 15). We show that developmental prosopagnosia is associated with reduced activation of core ventral face areas during perception of faces. The reductions were bilateral but tended to be more pronounced in the left hemisphere. As the first study to address category selectivity for word processing in developmental prosopagnosia, we do not, however, find evidence for reduced activation of the visual word form area during perception of orthographic material. We also find no evidence for reduced activation of the lateral occipital complex during perception of objects. These imaging findings correspond well with the behavioural performance of the developmental prosopagnosics, who show severe impairment for faces but normal reading and recognition of line drawings. Our findings suggest that a general deficit in neural migration across ventral occipito-temporal cortex is not a viable explanation for developmental prosopagnosia. The finding of left hemisphere involvement in our group of developmental prosopagnosics was at first surprising. However, a closer look at existing studies shows similar, but hitherto undiscussed, findings. These left hemisphere abnormalities seen in developmental prosopagnosia contrasts with lesion and imaging studies suggesting primarily right hemisphere involvement in acquired prosopagnosia, and this may reflect that the left hemisphere is important for the development of a normal face recognition network.

The clinico-radiological spectrum of Dyke-Davidoff-Masson syndrome in adults.

Dyke-Davidoff-Masson syndrome (DDMS) is characterized by cerebral hemiatrophy, seizure, contralateral hemiplegia/hemiparesis, and mental retardation. In this study, clinical and radiological investigations of seven patients who were diagnosed with DDMS as adult age were evaluated and discussed. Seven patients (four male, three female) were included. The mean age±SD of the patients was 46±21years. Clinical presentation of six patients was epileptic seizure. One patient was presented with head trauma due to a fall. Two patients had complex partial seizures, three patients had generalized tonic-clonic seizures (GTC), and one had GTC and myoclonic seizure. Mental retardation was in five patients. A congenital cause was detected in one patient in the etiologic investigation and acquired causes in two patients. In four patients, the etiology was not identified. We observed left-hemisphere involvement in four patients and right-hemisphere involvement in three patients. Brain imaging was performed by CT only in four patients and by MRI only in three patients. All patients were diagnosed with DDMS at adulthood. Atrophy in basal ganglia was detected in five patients, and atrophy in brain stem in four patients. Calvarial thickening was observed in four patients. Three patients had hyperpneumatization in mastoid cells. Sinus hyperpneumatization, including the paranasal and frontal sinuses, was seen in six patients. DDMS can also be diagnosed in adulthood symptomatically (mild-severe) or asymptomatically in adulthood. As a result, DDMS is a syndrome with wide clinical and radiological spectra that can be variably symptomatic at different stages of life.

Correlation between characteristics of intracranial lesions and level of cognitive function in patients with an initial diagnosis of brain metastases

Objective To investigate the correlation between the characteristics of intracranial lesions and the level of cognitive function in patients with an initial diagnosis of brain metastases. Methods A retrospective analysis was performed in 51 patients with an initial diagnosis of brain metastases who were admitted to The Second Hospital Affiliated to Suzhou University from January 2015 to April 2016.CT and (or) MRI were used to determine the characteristics of intracranial lesions and the Montreal Cognitive Assessment was used to evaluate the cognitive function of patients. Comparison between groups was made by Mann-Whitney U test. The correlation between ranked data was analyzed by Spearman rank correlation test. Results Of the 51 patients with an initial diagnosis of brain metastases, 47(92%) had cognitive impairment, including mild cognitive impairment in 31(61%) and dementia in 16(31%). There was no significant difference in level of cognitive function between the patients with involvement of the left hemisphere alone and those with involvement of the right hemisphere alone (P=0.425). The patients with involvement of both hemispheres had a significantly lower level of cognitive function than those with involvement of the left hemisphere alone (P=0.042). The patients with involvement of three or more brain lobes had a significantly lower level of cognitive function than those with involvement of one or two brain lobes (P=0.015, 0.024). The intracranial lesion volume and edema volume had no significant effect on the overall cognitive function of patients (P=0.077, 0.178). The patients with>3 intracranial lesions had a significantly lower level of cognitive function than those with 1-3 intracranial lesions (P=0.010). Conclusions More than 90% of patients with an initial diagnosis of brain metastases have cognitive impairment. Cognitive impairment is mainly associated with lesion site, involvement of brain lobes, and number of lesions, but not with lesion volume and edema volume. Key words: Neoplasms metastases, brain; Cognitive function; Cognitive assessment

Word and object recognition during reading acquisition: MEG evidence

Studies on adults suggest that reading-induced brain changes might not be limited to linguistic processes. It is still unclear whether these results can be generalized to reading development. The present study shows to which extent neural responses to verbal and nonverbal stimuli are reorganized while children learn to read. MEG data of thirty Basque children (4–8y) were collected while they were presented with written words, spoken words and visual objects. The evoked fields elicited by the experimental stimuli were compared to their scrambled counterparts. Visual words elicited left posterior (200–300ms) and temporal activations (400–800ms). The size of these effects increased as reading performance improved, suggesting a reorganization of children’s visual word responses. Spoken words elicited greater left temporal responses relative to scrambles (300–700ms). No evidence for the influence of reading expertise was observed. Brain responses to objects were greater than to scrambles in bilateral posterior regions (200–500ms). There was a greater left hemisphere involvement as reading errors decreased, suggesting a strengthened verbal decoding of visual configurations with reading acquisition. The present results reveal that learning to read not only influences written word processing, but also affects visual object recognition, suggesting a non-language specific impact of reading on children’s neural mechanisms.