Left Supraorbital Region Research Articles

Do Progressive Intensities of Transcranial Direct Current Stimulation with and Without 40 Hz Binaural Beats Change Pre-Frontal Cortex Hemodynamics? A Randomized Controlled Trial

Transcranial direct current stimulation (tDCS) is often reported to have positive effects on brain hemodynamics as well as cognitive performance. Binaural beats (BBs) have also shown the potential to improve cognitive performance. However, we could not find any studies assessing prefrontal hemodynamics using a combination of these techniques or assessing the effects on hemodynamic response at different intensity levels of tDCS (two and three mA). This study aimed to compare the immediate hemodynamic responses to tDCS at different intensities (two and three mA) with and without 40 Hz BBs. Sixty-eight healthy young individuals of both sexes were split into four groups: the tDCS 2 mA group; tDCS 3 mA group; tDCS 2 mA + BB group; and tDCS 3 mA + BB group. All groups received 20 min tDCS (F3-Fp2) alone or combined with BBs. The hemodynamic effect was assessed using a functional near-infrared intracranial spectroscope (fNIRS) positioned on the left supraorbital region (Fp1). The mean values of rates of oxygen saturation (SatO2) were recorded at baseline, during the intervention period, and post-stimulation. The oxygenated hemoglobin rates (HbO) were also extracted. No between-group differences were observed. The within-group analysis did not show significant differences in terms of the time×groups factor. However, the time factor showed significant within-group differences. No differences were found for the HbO rates. The present findings showed that two and three mA tDCS had effects on pre-frontal cortex SatO2; however, the use of additional BBs did not change the SatO2 levels compared to the use of tDCS alone.

Identifying the engagement of a brain network during a targeted tDCS-fMRI experiment using a machine learning approach.

Transcranial direct current stimulation (tDCS) can noninvasively modulate behavior, cognition, and physiologic brain functions depending on polarity and dose of stimulation as well as montage of electrodes. Concurrent tDCS-fMRI presents a novel way to explore the parameter space of non-invasive brain stimulation and to inform the experimenter as well as the participant if a targeted brain region or a network of spatially separate brain regions has been engaged and modulated. We compared a multi-electrode (ME) with a single electrode (SE) montage and both active conditions with a no-stimulation (NS) control condition to assess the engagement of a brain network and the ability of different electrode montages to modulate network activity. The multi-electrode montage targeted nodal regions of the right Arcuate Fasciculus Network (AFN) with anodal electrodes placed over the skull position of the posterior superior temporal/middle temporal gyrus (STG/MTG), supramarginal gyrus (SMG), posterior inferior frontal gyrus (IFG) and a return cathodal electrode over the left supraorbital region. In comparison, the single electrode montage used only one anodal electrode over a nodal brain region of the AFN, but varied the location between STG/MTG, SMG, and posterior IFG for different participants. Whole-brain rs-fMRI was obtained approximately every three seconds. The tDCS-stimulator was turned on at 3 minutes after the scanning started. A 4D rs-fMRI data set was converted to dynamic functional connectivity (DFC) matrices using a set of ROI pairs belonging to the AFN as well as other unrelated brain networks. In this study, we evaluated the performance of five algorithms to classify the DFC matrices from the three conditions (ME, SE, NS) into three different categories. The highest accuracy of 0.92 was obtained for the classification of the ME condition using the K Nearest Neighbor (KNN) algorithm. In other words, applying the classification algorithm allowed us to identify the engagement of the AFN and the ME condition was the best montage to achieve such an engagement. The top 5 ROI pairs that made a major contribution to the classification of participant's rs-fMRI data were identified using model performance parameters; ROI pairs were mainly located within the right AFN. This proof-of-concept study using a classification algorithm approach can be expanded to create a near real-time feedback system at a participant level to detect the engagement and modulation of a brain network that spans multiple brain lobes.

Effects of tDCS dose and electrode montage on regional cerebral blood flow and motor behavior

We used three dose levels (Sham, 2 mA, and 4 mA) and two different electrode montages (unihemispheric and bihemispheric) to examine DOSE and MONTAGE effects on regional cerebral blood flow (rCBF) as a surrogate marker of neural activity, and on a finger sequence task, as a surrogate behavioral measure drawing on brain regions targeted by transcranial direct current stimulation (tDCS). We placed the anodal electrode over the right motor region (C4) while the cathodal or return electrode was placed either over a left supraorbital region (unihemispheric montage) or over the left motor region (C3 in the bihemispheric montage). Performance changes in the finger sequence task for both hands (left hand: p = 0.0026, and right hand: p = 0.0002) showed a linear tDCS dose response but no montage effect. rCBF in the right hemispheric perirolandic area increased with dose under the anodal electrode (p = 0.027). In contrast, in the perirolandic ROI in the left hemisphere, rCBF showed a trend to increase with dose (p = 0.053) and a significant effect of montage (p = 0.00004). The bihemispheric montage showed additional rCBF increases in frontomesial regions in the 4mA condition but not in the 2 mA condition. Furthermore, we found strong correlations between simulated current density in the left and right perirolandic region and improvements in the finger sequence task performance (FSP) for the contralateral hand. Our data support not only a strong direct tDCS dose effect for rCBF and FSP as surrogate measures of targeted brain regions but also indirect effects on rCBF in functionally connected regions (e.g., frontomesial regions), particularly in the higher dose condition and on FSP of the ipsilateral hand (to the anodal electrode). At a higher dose and irrespective of polarity, a wider network of sensorimotor regions is positively affected by tDCS.

Abstract TP163: Electrode Montage and Dose of Non-Invasive Stimulation - Considerations for Stroke Recovery Studies

Transcranial direct current stimulation (tDCS) is increasingly being used as a possible tool to enhance plasticity in brain regions that might undergo remodeling after a stroke. Our aim was to determine whether dose and montage of tDCS leads to differential changes in regional cerebral blood flow (rCBF) and differential effect on a finger sequence motor learning experiment. Methods: A total of 20 right-handed healthy subjects participated in 6 imaging and 6 motor learning sessions. Brain images of non-invasive blood flow (using arterial spin labelling) were obtained before (6min), during (10min), as well as after (8min) tDCS was applied within the MRI scanner. For the motor sequence learning experiment as well as for the imaging studies, we used three different dose levels (Sham, 2mA, and 4mA) and two different electrode montages (unihemispheric or bihemispheric). In both montages, the anodal electrode (excitability increasing) was placed over the right motor region (C4) while the cathodal electrode (excitability decreasing) was placed either over a left supraorbital region (unihemispheric montage) or over the left motor region (C3; bihemispheric montage). Imaging data were processed and analyzed using SPM12. For the finger sequence learning task, subjects were asked to type a randomly chosen sequence of 7 items (using numbers 2-5 on a computer keyboard) with digits 2-5 of each hand several times before and immediately after a 10 min stimulation period. Results: After unihemispheric and bihemispheric stimulation, left hand showed more improvement in finger sequence learning than right hand, although a linear trend as a function of dose was observed in both montage conditions. rCBF increased during the Stimulation condition and showed a clear linear effect of dose in the peri-rolandic region. Bihemispheric stimulation showed similar, but stronger effects and revealed additional activation of frontomesial regions in the 4mA condition. Conclusion: tDCS dose has an effect on regional surrogate markers of neuronal/synaptic. Effects in a finger sequence learning showed a similar dose effect. Montage (unihemispheric versus bihemispheric) shows differential brain effects, but based on our preliminary analysis no clear behavioral effects.

Fronto-ethmoidal Mucocele with Frontal Sinus Destruction

Fronto ethmoidal mucocele is a benign but expansive pseudo cyst due to mucous secreting nature of fronto-ethmoid sinus. A rare presentation of frontoethmoidal mucocele was reported. Our subject a 61 years old female presented with frontoethmoidal mucocele of unusually large size and two in number which developed over 2 years. Two masses one above left supra-orbital region and next on forehead was noted along with diplopia and non-axial proptosis in left eye due to swelling. Similar findings were found on CT scan and diagnosis was confirmed during surgery. Endoscopic marsupialisation of fronto-ethmoid pyocele with incision & drainage of isolated pyocele in the frontal bone was performed under general anaesthesia. A puncture wound in the posterior table of frontal sinus which might have resulted in CSF rhinorrhoea was dealt at the same setting. Keywords: Fronto-ethmoidal mucocele, diplopia, two mucocele, CSF rhinorrhoea

Abstract TMP39: The neural and behavioral basis of Transcranial Direct Current Stimulation

Non-invasive brain-stimulation has been reported to modulate cortical excitability, synaptic plasticity, and interhemispheric interactions of homotop brain regions. All of these processes could play a role in facilitating stroke recovery. Modulation in cortical excitability covaries with changes in regional cerebral blood flow. Our aim was to determine whether varying parameters of transcranially applied direct current stimulation would modulate regional cerebral blood flow and behavioral measures such as motor sequence learning in a differential effect. Twelve right-handed subjects participated in all behavioral and imaging studies. We used three different dose levels (Sham, 2mA and 4mA corresponding current densities: 0mA/cm2, 0.156mA/cm2, and 0.318mA/cm2) and two different electrode montages (unihemispheric or bihemispheric) to examine tDCS effects on a finger sequence learning task and on regional cerebral blood flow (using Arterial Spin Labeling as a Blood Flow MR sequence) using an MR compatible NeuroConn DCMC stimulator. An anodal electrode (diameter of 4 cm) was placed over the right motor region (C4) while the cathodal electrode (diameter of 5 cm) was either placed over the left supraorbital region (unihemispheric montage) or over the left motor region (C3; bihemispheric montage). Each stimulation was of 10 min duration (ON condition) and preceded by 6 minutes of no stimulation and followed by 8 minutes of no stimulation (OFF conditions). A significant difference (p<0.05) in cerebral blood flow between ON and OFF conditions was seen for the group in a region of interest including the perirolandic region on the right (under the anodal electrode) showing an increase in rCBF between sham, 2mA and 4mA. There were trends for stronger bihemispheric blood flow changes for the bihemispheric montage than the unihemispheric montage. In the finger sequence learning task, subjects learned to type a randomly chosen sequence of 7 numbers with digits 2-5 of each hand as accurately and as fast as possible, before and immediately after a 10 minute stimulation phase. Higher numbers of correct finger sequence were seen in the higher current conditions for the unihemispheric condition. Results were more mixed for the bihemispheric montages.

Solitary Plasmacytoma of Frontal Bone: A Case Report.

A 42years old male presenting with complaints of swelling on the left supraorbital region since-5months. Swelling was gradual in onset and progressive in nature. On examination it was a single swelling 5 × 6cm, with diffuse margins, skin over the swelling was red and stretched, swelling is firm in consistency, fixed, tender on touch, non pulsatile with diffuse irregular margin. FNAC. Smears are positive for malignancy. Bone marrow examination was normal. Excision of the mass from the left frontal sinus, orbit and supraorbital region under GA and sent for HPR. Definitive treatment of choice is: radiotherary 45-50Gy/4-5weeks, chemotherapy and surgery. Prognosis is good with local recurrence (< 10%).

MASTOCITOMA CUTÂNEO EM FELINO – RELATO DE CASO

The mast cell tumor is described as the second most common skin neoplasm in cats, but in Brazil we found few reports in this species. The aim of the study is to report a case of cutaneous mast cell tumor in an eight years, male, short hair Brazilian feline attended at the Dermatology Service of the Veterinary Hospital of the University Federal Rural of Rio de Janeiro that had a single nodule, erythematosus, alopecic and ulcerated in the left supraorbital region. Cytological examination revealed the presence of a lot of well-differentiated neoplastic mast cells. The animal was taken to the surgical removal of the nodule. Histopathological examination confirmed the diagnosis of mast cell tumor. It is concluded that cytology is an important tool for the diagnosis of this neoplasm in cats and that surgery is the preferred therapy.

2-P-D-17. Effect of unilateral transcranial direct current stimulation on contralateral cerebral blood flow changes during ipsilateral motor tasks

This study evaluated the cerebral blood flow changes during motor tasks performed before and after transcranial direct current stimulation (tDCS). Seven healthy volunteers (22.8 ± 2.0 years) received tDCS (anodal, cathodal, and sham) applied over the right primary motor cortex at 1 mA for 20 min. The second electrode was placed on the left supraorbital region. Subjects completed a tapping task using the right index finger with maximum effort before and after tDCS. The oxyhemoglobin concentration (O 2 Hb) was collected during the tapping task using 34-channel near-infrared spectroscopy positioned over the left (contralateral side to the tDCS and motor task) sensorimotor area. We calculated the O 2 Hb differences (ΔO 2 Hb) between before and after the tDCS. The finger tapping task induced an increase in O 2 Hb (about 0.01–0.015 mM cm) in the entire left sensorimotor area. However, the ΔO 2 Hb was not significant between the three conditions, as determined using a one-way analysis of variance ( p = 0.556–0.870). These findings suggest that the cerebral blood flow changes induced in the left sensorimotor area by the finger tapping task were not affected by the tDCS applied to the right (ipsilateral to the motor task) primary motor cortex.

Combined Endoscopic Endonasal and Transcranial Approach To a Recurrent Frontal Sinus Mucocele

The frontal mucocele remains a disease difficult to treat even in the era of functional endoscopic sinus surgery (FESS). Indeed, recurrence it is a typical complication of both endoscopic endonasal and transcranial approach or as a consequence of facial fracture. The modern endoscopic endonasal approach to the frontal sinus allows the marsupialization of the pathology in all those cases in which the mucocele is reached via the route of nasal drainage and is optimal when the location of the mucocele is medial. After infection or as a result of their invasion and growth, mucoceles of the frontal sinus can give rise to intracranial and orbital complications. The most versatile and used transcranial approach is considered the Sinus Fat Obliteration (SFO). We describe the case of a 47 years old patient who under went FESS and OFSO for bilateral recurrence of mucocele within a mega-frontal-sinus. The lesion reached the left supra orbital region with erosion of the roof of the ipsilateral orbit. The endoscopic approach, in our experience, it is necessary in the forms of mucocele complicated by orbital medial and superior extension. Instead, in the presence of a mega-frontal-sinus, of a lateral extension of the mucocele as well and the clinical history of relapses of the disease is also indicated the transcranial surgical approach. The Sinus Fat Obliteration (SFO) minimizes the risk of complications with no need for a postoperative neurointensive unit stay compared to the intervention of cranialization. In fact the patient object of this work had a regular postoperative course and was discharged on the sixth day with excellent aesthetic results.

A pilot study of alternative transcranial direct current stimulation electrode montages for the treatment of major depression

BackgroundTypically, transcranial direct current stimulation (tDCS) treatments for depression have used bifrontal montages with anodal (excitatory) stimulation targeting the left dorsolateral prefrontal cortex (DLPFC). There is limited research examining the effects of alternative electrode montages. Objective/hypothesisThis pilot study aimed to examine the feasibility, tolerability and safety of two alternative electrode montages and provide preliminary data on efficacy. The montages, Fronto-Occipital (F-O) and Fronto-Cerebellar (F-C), were designed respectively to target midline brain structures and the cerebellum. MethodsThe anode was placed over the left supraorbital region and the cathode over the occipital and cerebellar region for the F-O and F-C montages respectively. Computational modelling was used to determine the electric fields produced in the brain regions of interest compared to a standard bifrontal montage. The two montages were evaluated in an open label study of depressed participants (N=14). Mood and neuropsychological functioning were assessed at baseline and after four weeks of tDCS. ResultsComputational modelling revealed that the novel montages resulted in greater activation in the anterior cingulate cortices and cerebellum than the bifrontal montage, while activation of the DLPFCs was higher for the bifrontal montage. After four weeks of tDCS, overall mood improvement rates of 43.8% and 15.9% were observed under the F-O and F-C conditions, respectively. No significant neuropsychological changes were found. LimitationsThe clinical pilot was open-label, without a control condition and computational modelling was based on one healthy participant. ConclusionsResults found both montages safe and feasible. The F-O montage showed promising antidepressant potential.

Transcranial direct current stimulation of the prefrontal cortex

Targeting memory processes by noninvasive interventions is a potential gateway to modulate fear memories as shown by animal and human studies in recent years. Modulation of fear memories by noninvasive brain stimulation techniques might be an attractive approach, which, however, has not been examined so far. We investigated the effect of transcranial direct current stimulation (tDCS) applied to the right dorsolateral prefrontal cortex and left supraorbital region on fear memories in humans. Seventy-four young, healthy individuals were assigned randomly to two groups, which underwent fear conditioning with mild electric stimuli paired with a visual stimulus. Twenty-four hours later, both groups were shown a reminder of the conditioned fearful stimulus. Shortly thereafter, they received either tDCS (right prefrontal--anodal, left supraorbital--cathodal) for 20 min at 1 mA current intensity or sham stimulation. A day later, fear responses of both groups were compared by monitoring skin conductance. On day 3, during fear response assessment, the tDCS group had a significantly (P<0.05) higher mean skin conductance in comparison with the sham group. These results suggest that tDCS (right prefrontal--anodal, left supraorbital--cathodal) enhanced fear memories, possibly by influencing the prefrontal cortex-amygdala circuit underlying the memory for fear.

(489) Cranial neuralgia and chronic post-traumatic headache with pulsed radio-frequency ablation of the left supraorbital, auriculotemporal, and greater and lesser occipital nerves: a case report

A 51 y/o Caucasian male who developed post-traumatic headache and neuralgias involving the left supraorbital, auriculotemporal, greater occipital, and lesser occipital nerves after being involved in a motor vehicle accident in 2009. This patient presented in February, 2013 – four years after his initial motor vehicle accident with complaints of chronic left-sided temporo-parietal scalp pain, left supraorbital and retro-orbital pain, and left occiput pain. His physical exam was remarkable for tactile hyperesthesia in the left supraorbital region, left occiput, and left tempo-parietal region.

English

The paranasal sinus mucocele is an epithelized cystic lesion containing fluid and is characterized by non-neoplastic expansion of the paranasal sinuses due to its capacity to erode the overlying bone. Etiology of these lesions is still under debate. In this report, we describe a case of frontal mucocele associated with proptosis and diplopia. A 56 year old male patient was admitted to our hospital in the department of Otorhinolaryngology with chief complaints of left sided nasal obstruction, double vision, swelling in the left eye and headache, all since 3 months. CT scan of the paranasal sinuses revealed a left sided dense hypoechoic mass with destruction of floor of the frontal sinus with intra orbital extension. All other laboratory examinations were within physiological limits. The patient was treated surgically by external approach. An incision was put in the left supra-orbital region and a bone window was created to access the frontal sinus and the mass identified and excised in-toto. Dermal fat graft was harvested the thigh and grafted into the recess. Histopathological examination of the mass revealed the mass to be a mucocele.

Subconjunctival Dirofilaria repens Infestation: A Light and Scanning Electron Microscopy Study

Background: To present a case of subconjunctival infestation with Dirofilaria repens which is very rare in Northern Europe.Methods: A 61-year-old male presented with a swelling and redness of the left supraorbital region migrating to the eyelid and the left eyeball resulting in conjunctival injection, proptosis and diplopia. The patient underwent incisional extraction of a nine cm long worm, which was analysed histologically.Results: The worm was structureless, greyish-white in colour and measuring nine cm in length and 0.5 mm in diameter. Histopathological examination of the worm showed an outer thick, multi-layered cuticle with longitudinal ridges. Beneath the cuticle, a thick muscle layer was observed and internally the intestine and a single reproductive tube containing spermatozoa were noted. Scanning electron microscopy of the worm showed tapered ends, transverse striations and longitudinal ridges at the anterior end. The tail was relatively short with spirally coiled ridges indicating a male Dirofilaria repens.Conclusions: Humans are an uncommon and accidental host of Dirofilaria repens which is rarely seen in Northern Europe but should be considered as a differential diagnosis to other nematode ocular infections. A travel history is helpful in diagnosing the potential involved organisms. No further treatment is necessary beyond surgical removal since this organism fails to mature and thereby does not cause microfilariaemia in humans.

Loss of Recent Memory After Bilateral Hippocampal Lesions

Loss of Recent Memory After Bilateral Hippocampal Lesions

Supraorbitaler Tumor als Manifestation einer fibrösen Dysplasie Jaffe-Lichtenstein

We report on the case of a 16 year old white female who presented at our outpatient clinic with a swelling of the left supraorbital region. Histologically a fibrous dysplasia Jaffe-Lichtenstein was found. Diagnostic procedures, possible complications, adequate therapy and prognosis of this disease are discussed and compared with the relevant literature.

SELF-INFLICTED BULLET WOUND OF FRONTAL LOBES IN A DEPRESSION WITH RECOVERY

A 49-year-old female suffering from a depression complicated by alcoholism had made several unsuccessful suicidal attempts. In 1937 she became acutely depressed and shot a .25 caliber bullet through both frontal lobes. The bullet is still lodged in the left supraorbital region, the patient having a rhinorrhea and pneumoventricle for several months. Neurological findings were uncertain and transitory, with the exception of a series of severe convulsions which occurred two years after the shooting. The patient's alcoholism has persisted but her depression, which cleared up directly after the shooting has remained absent for over three years. Psychological tests indicate childishness, facetiousness and extroversion with no evidence of any organic change in her intellectual status.