Organic Brain Lesions Research Articles

Medical Treatment in Childhood Epilepsies

Summary The majority of epileptic seizures are controlled with antiepileptic drugs (AEDs). Whether or not to start treatment following an initial unprovoked seizure should be decided on an individualized basis; and, the risk of seizure recurrence versus possible side-effects and social conse quences of chronic AED treatment should be evaluated. Main risk factors for seizure recurrence can be summarized as the presence of focal seizure types, organic brain lesion, focal neurologic abnormality, previous neurodevelopmental retardation, specific EEG abnormality and positive family history of epilepsy. The AED chosen for initial therapy should be one that is highly effective for a particular seizure type and epilepsy syndrome, as also, that is safe and well tolerated. Monotherapy is the goal in epilepsy treatment. If the first two monotherapies fail, combinations of AEDs should be tried. Withdrawal of AED therapy should be considered in most children after two years without seizures. AEDs should be tapered slowly rather than halted abruptly.

Isolated Aphasic Status Epilepticus as Initial Presentation of Nonketotic Hyperglycemia

Diagnosis of aphasic status epilepticus is sometimes not easy because of its rarity and electroclinical dissociation. Although most cases are associated with organic brain lesions, nonketotic hyperglycemia (NKH)-related aphasic status epilepticus is rare, especially if it is isolated (without other clinical seizure activity). On the other hand, unlike other metabolic disorders, or hypoglycemia-related generalized seizures, focal motor seizure and epilepsia partialis continua can occur in 25% of NKH, with seizures being the initial manifestation in up to 50% of patients. However, the presentation of epileptic aphasia is rare in NKH patients. We report a rare case of NKH presenting initially as persistent and isolated aphasic status epilepticus. Brain magnetic resonance imaging did not reveal any focal lesion, but ictal electroencephalography (EEG) disclosed left frontotemporal continuous theta to delta waves, intermingled with epileptiform discharges. Correcting the hyperglycemia failed to improve the language disorder, and the seizure was controlled only by the addition of carbamazepine. Patients with NKH may initially present with isolated aphasic status epilepticus. Unlike stroke-related aphasia, accurate diagnosis is difficult if based solely on neurologic examination and brain neuroimaging. Use of EEG and blood sugar determination should be helpful in this special condition.

Right frontal lobe glioma presenting as anorexia nervosa: Further evidence implicating dorsal anterior cingulate as an area of dysfunction

The association of anorexia nervosa (AN) with organic brain lesions may offer insight into underlying illness neuropathology. A systematic review reported an association between AN and lesions located in the right frontal lobe. To date, no studies have studied such a case longitudinally. A case of a male presenting with AN and a frontal lobe glioma is described. The clinical symptoms and subsequent medical and neuropsychological investigations before and after surgery are reviewed. The remission of ED symptoms is observed at 2 year post-surgery follow up. The features of this case are set into the context of recent conceptualizations of AN and the clinical implications for identifying individuals with underlying organic causes.

Treatment of recurrent epileptic seizures in patients with neurological disorders

This study aimed to investigate the clinical characteristics and the treatment principles and methods of recurrent epileptic seizures in patients with neurological disorders. A retrospective analysis was performed of the clinical data, treatment methods and results in 13 patients with recurrent epileptic seizures attending the neurosurgery department. Of the 13 patients, 10 had a history of epilepsy, 9 had organic frontal lobe brain lesions and 11 exhibited frontal lobe epilepsy. The causes of the epileptic seizure aggravation included drug withdrawal, dose reduction and dressing change (5 cases). The epileptic seizure types included partial and secondary full seizures and the seizure frequency ranged from 1 seizure/3 min to 1 seizure/several h. Following combined therapy with multiple anti-epileptic drugs (AEDs), including oral administration and injection, the epilepsy was controlled. The addition of orally administered levetiracetam improved the treatment efficiency. In cases of recurrent epileptic seizures in patients with neurological disorders, the combined administration of AEDs should be conducted with doses higher than the conventional initial dose to control the epileptic seizures as rapidly as possible.

Cryptogenic West syndrome and subsequent mesial temporal lobe epilepsy

We report on a male patient who experienced a previously unreported sequence of cryptogenic West syndrome in infancy and subsequent mesial temporal lobe epilepsy. His complex partial seizures were consistently characterised by motionless staring with brief right eye blinking. Scalp electroencephalography (EEG) showed bilateral temporal spikes which were dominant on the right side. Magnetic resonance imaging (MRI) revealed no organic brain lesion. Invasive EEG recording captured seizures with right hippocampal onset. The patient became seizure-free following right temporal lobectomy at 27 years, 8 months of age. Pathological examination of the resected specimen revealed corpora amylacea and gliosis in the temporal cortex but no clear findings of hippocampal sclerosis. It is suggested that an epileptogenic lesion causing MRI-negative mesial temporal lobe epilepsy may give rise to apparent cryptogenic West syndrome in infancy.

An uncommon case of random fire-setting behavior associated with Todd paralysis: A case report

BackgroundThe association between fire-setting behavior and psychiatric or medical disorders remains poorly understood. Although a link between fire-setting behavior and various organic brain disorders has been established, associations between fire setting and focal brain lesions have not yet been reported. Here, we describe the case of a 24-year-old first time arsonist who suffered Todd’s paralysis prior to the onset of a bizarre and random fire-setting behavior.Case presentationA case of a 24-year-old man with a sudden onset of a bizarre and random fire-setting behavior is reported. The man, who had been arrested on felony arson charges, complained of difficulties concentrating and of recent memory disturbances with leg weakness. A video-EEG recording demonstrated a close relationship between the focal motor impairment and a clear-cut epileptic ictal discharge involving the bilateral motor cortical areas. The SPECT result was statistically analyzed by comparing with standard SPECT images obtained from our institute (easy Z-score imaging system; eZIS). eZIS revealed hypoperfusion in cingulate cortex, basal ganglia and hyperperfusion in frontal cortex,. A neuropsychological test battery revealed lower than normal scores for executive function, attention, and memory, consistent with frontal lobe dysfunction.ConclusionThe fire-setting behavior and Todd’s paralysis, together with an unremarkable performance on tests measuring executive function fifteen months prior, suggested a causal relationship between this organic brain lesion and the fire-setting behavior. The case describes a rare and as yet unreported association between random, impulse-driven fire-setting behavior and damage to the brain and suggests a disconnection of frontal lobe structures as a possible pathogenic mechanism.

A Case of Precocious Puberty in a Setting with Limited Resources

Precocious puberty is a rare condition characterized by the development of secondary sexual characteristics before the median age for the sex. It is either gonadotropin dependent also called as central or gonadotropin independent also known as peripheral type. Hypothalamamic Hamartoma is a common cause of the central or precocious puberty due to organic brain lesion. Here we present a two year male who presented us with precocious puberty due to a hypothalamic Hamartoma.

Unilateral paralysis associated with profound hypokalemia

Unilateral paralysis is rarely reported to be primary presentation of severe hypokalemia. We describe a 24-year-old woman who presented to the emergency department with sudden onset of right-sided weakness. Neurologic examination revealed diminished muscle strength and tendon reflexes over the right limbs. Computed tomography of the brain showed no organic brain lesion. However, laboratory data showed hypokalemia (K+ 2.0 mmol/L) with metabolic acidosis (HCO3 − 19 mmol/L). She needed a total of 260 mmol K+ to achieve complete recovery of muscle strength at a serum K+ level of 3.2 mmol/L and was proved to have distal renal tubular acidosis. Severe hypokalemia must be kept in mind as a cause of acute unilateral paralysis without organic lesions to avoid unnecessary examination and potentially life-threatening complications.

Pathological and Incidental Findings on Brain MRI in a Single-Center Study of 229 Consecutive Girls with Early or Precocious Puberty

Central precocious puberty may result from organic brain lesions, but is most frequently of idiopathic origin. Clinical or biochemical factors which could predict a pathological brain MRI in girls with CPP have been searched for. With the recent decline in age at pubertal onset among US and European girls, it has been suggested that only girls with CPP below 6 years of age should have brain MRI performed.ObjectiveTo evaluate the outcome of brain MRI in girls referred with early signs of puberty in relation to age at presentation as well as clinical and biochemical parameters.MethodA single-center study of 229 consecutive girls with early or precocious puberty who had brain imaging performed. We evaluated medical history, clinical and biochemical factors, and four groups were defined based on the outcome of their MRI.ResultsThirteen out of 208 (6.3%) girls with precocious puberty, but no other sign of CNS symptoms, had a pathological brain MRI. Importantly, all 13 girls were above 6 years of age, and 6 girls were even 8–9 years old. Twenty girls (9.6%) had incidental findings on brain MRI. Furthermore, 21 girls had known CNS pathology at time of evaluation. Basal LH was significantly higher in girls with newly diagnosed CNS pathology compared to girls with a non-pathological MRI (p = 0.025); no cut of value was found as values overlapped.ConclusionA high frequency of 6–8 year old girls with precocious puberty in our study had a pathological brain MRI, which could not be predicted from any clinical nor biochemical parameters. Thus, we believe that girls with precocious pubertal development of central origin before 8 years of age should continue to be examined by a brain MRI.

A Case of Chlorfenapyr Intoxication with Central Nervous System Involvement

Background: Chlorfenapyr is a widely used insecticide worldwide for farming. However, chlorfenapyr intoxication with organic brain lesion has never been reported. Case report: A 49-year-old man attempted suicide by ingesting 200 ml of Chlorfenapyr. He suffered from severe diaphoresis with a sustained high fever. Ten days after chlorfenapyr poisoning, he developed altered mentality. Brain Magnetic resonance imaging (MRI) showed extensive bilateral involvement of the white matter. Conclusion: We presumed Chlorfenapyr or its metabolite can induced delayed neurotoxicity in the central nervous system. We report herein a case of Chlorfenapyr intoxication with brain MRI findings.

Visual and Auditory Hallucinations During Normal Use of Paroxetine for Treatment of Major Depressive Disorder

Visual and Auditory Hallucinations During Normal Use of Paroxetine for Treatment of Major Depressive Disorder

An unusual case of random fire-setting behavior associated with lacunar stroke

A case of a 47-year-old man with a sudden onset of a bizarre and random fire-setting behavior is reported. The man, who had been arrested on felony arson charges, complained of difficulties concentrating and of recent memory impairment. Axial T1-weighted magnetic resonance imaging showed a low intensity lacunar lesion in the genu and anterior limb of the left internal capsule. A neuropsychological test battery revealed lower than normal scores for executive functions, attention and memory, consistent with frontal lobe dysfunction. The recent onset of fire-setting behavior and the chronic nature of the lacunar lesion, together with an unremarkable performance on tests measuring executive functions two years prior, suggested a causal relationship between this organic brain lesion and the fire-setting behavior. The present case describes a rare and as yet unreported association between random impulse-driven fire-setting behavior and damage to the left internal capsule and suggests a disconnection of frontal lobe structures as a possible pathogenic mechanism.

Pharmacology in Health Foods: Effects of Arachidonic Acid and Docosahexaenoic Acid on the Age-Related Decline in Brain and Cardiovascular System Function

Arachidonic acid (ARA) and docosahexaenoic acid (DHA) are major constituents of cell membranes and play important roles in preserving physiological and psychological function. Recently, data from several studies have indicated that impairments in long-term potentiation (LTP), the process underlying plasticity in synaptic connections, are associated with a decrease in membrane ARA and DHA in aged rats; and treatment of aged rats with either of these polyunsaturated fatty acids (PUFAs) reverses age-related decrease in LTP and the decrease in membrane fatty acid concentration. This review focuses on our recent findings concerning the effects of ARA and DHA on the age-related decline in the function of the brain and cardiovascular system. ARA supplementation decreased P300 latency and increased P300 amplitude of event-related potentials in healthy elderly men. Cognitive impairments in patients with mild cognitive impairment (MCI) and patients with organic brain lesions were significantly improved with ARA and DHA supplementation. ARA and DHA supplementation also increased coronary flow velocity reserve in elderly individuals; this suggests beneficial effects of PUFAs on coronary microcirculation. In conclusion, ARA and DHA may be beneficial in preventing and/or improving age-related declines in brain and cardiovascular system function.

Enhancing memory performance after organic brain disease relies on retrieval processes rather than encoding or consolidation

Neuropsychological rehabilitation of memory performance is still a controversial topic, and rehabilitation studies have not analyzed to which stage of memory processing (encoding, consolidation, or retrieval) enhancement may be attributed. We first examined the efficacy of a computer training program for stroke patients, based on a previous study (Hildebrandt, Clausing, Janssen, & Mödden, 2007a) for memory-impaired patients of a rehabilitation unit and compared it with the standard group treatment. In a second randomized controlled experiment, we trained two groups of 15 patients with mild to moderate memory disorders, caused by organic brain lesions, with the same two treatment approaches. We used several standard tests to analyze improvement of memory functions, focusing on separate parameters for encoding, consolidation, and retrieval. We developed for that purpose a new word-list learning test, which allowed assessment of response to novelty and a systematic comparison of free recall after learning of semantically structured and nonstructured word lists. The first treatment experiment showed significant improvement of verbal learning for patients treated with the computer software program. The second experiment showed that memory improvement was based exclusively on retrieval processes, whereas no specific change was found for encoding and consolidation. However, the two groups of the second experiment showed no significant differences for the treatment, although the absolute scores pointed in the same direction as in the first experiment.

Neuropsychological Improvement in Patients With Cervical Spondylotic Myelopathy After Posterior Decompression Surgery

Patients with cervical spondylotic myelopathy sometimes complain of cognitive dysfunction, which may be coincidence. However, cognitive dysfunction may be related to disorders of the cervical spine and/or spinal cord. This study investigated cognitive dysfunction in patients with cervical spinal disorders. A total of 79 patients with cervical spondylotic myelopathy (40 women and 39 men, mean age 61.2 years) underwent cervical laminoplasty between January 2006 and July 2007. Ten of these 79 patients (7 women and 3 men, mean age 65.2 years) complained of moderate to severe memory disturbances. These 10 patients underwent neuroimaging studies and a battery of neuropsychological tests consisting of the mini-mental state examination, Kohs Block Design Test, Miyake Memory Test, Benton Visual Retention Test (BVRT), and "kana-hiroi" test before and 3 months after surgery. Brain magnetic resonance imaging showed no organic brain lesions in the 10 patients, but single photon emission computed tomography demonstrated reduced regional cerebral blood flow in the posterior cortical areas in eight patients before surgery. Neuropsychological test scores showed statistically significant improvement after surgery in the Kohs Block Design Test and the BVRT, which measure visuospatial perception and reflect the function of the parietal and/or occipital lobes (p < 0.05). The practice effect may have contributed to the neuropsychological improvements, but this study suggests that cervical spinal disorders may affect cognitive functions and that surgical treatment can ameliorate such effects.

Cognitive impairment in non-demented elderly persons with mild emotional disturbances

Background: Emotional disturbances presented in old age frequently are initial signs of organic brain lesion such as cerebral vascular insufficiency or pre-clinical neurodegeneration. We suggest that in this situation, emotional disturbances would be accompanied with cognitive and other neurological symptoms.

Signs of brain organic lesion in patients examined in the acute period of ixodic tick-borne borreliosis

Signs of organic lesion of brain have been studied in 85 patients in the acute period of tick-borne borreliosis. The analysis of results of clinical and clinical-psychopathological studies has revealed signs of brain organic lesion (BOL) in 100% cases. In the studied group, the moderate degree of BOL signs is most often (54%), mild cases are somewhat rarer (41%), and the pronounced degree is confidently rarer (5%). The degree of manifestation of signs of brain organic lesion depends on the age and the somatic-neurological burdened background of patients and influences the course of the acute and remote periods of ixodic tick-borne borreliosis.

Assessment of children with developmental delay: Korean infant and child development test (KICDT) and Korean Bayley scale of infant development-II (K-BSID-II)

Purpose : We aimed to compare the effectiveness of 2 developmental tests-Korean Infant and Child Development Test (KICDT) and Korean Bayley Scale of Infant Development-II (K-BSID-II)-in the assessment of children with developmental delay. Methods : Twenty-eight children with suspected developmental delay, who visited the Department of Pediatrics in Asan Medical Center from February 2007 to June 2008 were enrolled. They were examined using both KICDT and K-BSID-II. The results of the tests were compared on the basis of 2 parameters: age group of the children and detection of organic brain lesion on magnetic resonance imaging (MRI). The correlation between the results of the 2 tests was analyzed using SPSS. Further, intraclass correlation coefficient was calculated using SAS to examine consistency between the results of the 2 tests. Results : The mental developmental index of K-BSID-II showed significant correlation with every KICDT score (P

Relationships between health status, depression and cognitive functions of institutionalized male veterans

The purpose of this study was to explore the relationships among health state, depression, and cognitive functions of institutionalized male veterans. A cross-sectional and correlation research design with a cluster sampling was conducted. A total of 223 veterans who were above 65 years old, with no psychiatric disorders and no organic brain lesions were recruited from two veterans’ institutions in Southern Taiwan. The researcher interviewed them one-on-one using structural questionnaires, including demographic data, health status, Taiwan Geriatric Depression Scale (TGDS) and Mini-Mental State Examination (MMSE). The results of this study were as follows: (1) Veterans who were able to read, were married, had good dietary habits, avoided over-oiled and high-fat food to keep healthy, took exercise at least 30min each time, and had static leisure activities had significant differences in cognitive functions. (2) Cognitive functions were significantly negatively correlated with age and depression, whereas positively correlated with education level, the number of children and perceived health status. (3) Depression, literacy, education level and age were the four predictors of cognitive functions, accounting for 29% of the variance. The findings of this study provide a reference to caregivers and health care professionals for home care, clinical practice and cohort study in the future.

Brain Lesions Manifesting as Psychiatric Disorders:Eight Cases

Sometimes patients with organic brain lesions in neurologically silent brain areas might present only with psychiatric symptoms, such as depression, anxiety disorders, schizophrenia, anorexia nervosa, or cognitive dysfunction. This study presents eight cases of patients with brain lesions (four cases of meningiomas, one case of intracerebral cysts, one case of anaplastic oligodendroglioma, one case of multiform glioblastoma, and one case of occlusive hydrocephalus) who, for a significant period of time, were diagnosed and treated for psychiatric disorders (three cases of Alzheimer's disease, two cases of schizoaffective disorder, one case of schizophrenia, one case of depression, and one case of organic emotional lability disorder). When neurologic symptoms developed, they underwent neuroimaging studies and organic brain lesions were diagnosed. Further treatment required neurosurgical interventions. These cases show that brain tumors can be neurologically silent for a sufficient period of time and manifest as psychiatric disorders. Therefore, neuroimaging studies are needed when atypical changes in mental status or neurologic symptoms and signs develop.