Organic Brain Lesions Research Articles

Auditory nerve and brain-stem evoked responses in normal, autistic, minimal brain dysfunction and psychomotor retarded children

In several forms of abnormal behavior in infants and children, the cause is either uncertain or an unspecified organic brain lesion is assumed to be present. Evoked averaged auditory nerve and brain-stem responses to click stimuli were recorded from groups of normal, autistic, minimal brain dysfunction (MBD) and psychomotor retarded children in order to search for electrophysiological evidence for a brain lesion. Most of the control children were awake and most of the experimental children were in sedated sleep but records were also made from some children while awake and again in the same children when asleep and no change was seen in the response traces. In several of the autistic children there were no electrophysiological responses (indicating a profound hearing loss). In several of the psychomotor retarded children the responses from the region of the inferior colliculus were absent. In the other children in the experimental group, auditory nerve and brain-stem responses were recorded with normal response thresholds but abnormal in other ways: the latency of the auditory nerve response was longer than in the normal children. Also, brain-stem transmission time, measured as the time interval from the negative peak of the auditory nerve response to the positive trough of the response from the inferior colliculus, was shortest in the control group and longest in the MBD group. These results thus present electrophysiological evidence for the existence of an organic brain lesion in these children, at least in the brain-stem regions concerned with auditory function. Together with evidence from other studies, there is support for the conclusion that most of the abnormal behavior seen in these patients is due to a diffuse brain lesion.

Evidence from auditory nerve and brainstem evoked responses for an organic brain lesion in children with autistic traits

In an attempt to resolve the question as to whether children with autistic traits have an organic nervous system lesion, auditory nerve and brainstem evoked responses were recorded in a group of 15 children with autistic traits. The most obvious results included a longer response latency of the auditory nerve and a longer brainstem transmission time, compared to normal children. Five of the autistic children were found to be profoundly deaf. These results strengthen the theory that an organic lesion of the nervous system can give rise to autistic traits.

Genetic Factors in Childhood Epilepsy with Focal Sharp Waves1– I. Clinical Data and Familial Morbidity for Seizures

203 epileptic children (127 boys, 76 girls), who had demonstrated at least once focal sharp waves in the EEG during the course were investigated regarding clinical and historical data as well as familial morbidity for seizures. Expectedly, the seizure symptomatology was multiform: focal seizures of different type, especially secondarily generalized, grand mal, psychomotor fits, infantile spasms etc. Organic brain lesions play an important role. In 23% of cases a familial seizure affliction can be registered. The morbidity (close family) is significantly lower than in families of patients with spike wave absences (2.5 and 4.4% resp., Doose et al. 1973). Like in spike wave absence epilepsies mothers and mothers' siblings are more often affected than fathers and fathers' siblings. Among the affected relatives grand mal epilepsies predominate. The increase of febrile convulsions and spike wave absences observed in the families of absence epileptics is not present. In probands with onset of epilepsy during early childhood a significantly increased familial affliction can be observed. A more extensive discussion of the results will follow in a second paper deeling with EEG findings in probands and siblings.

The Use of Bromides for Epilepsy

Sir .—Robert J. Joynt made a significant contribution to theJournalin his excellent article that appeared in the September issue (128:362, 1974). His statement that It is also unusual that a drug with this life span is still used is correct, but unfortunately in most centers in this country, bromides, the oldest of the antiepileptic drugs, have been largely outmoded by the organic anticonvulsants. The purpose of this letter is to call attention to the fact that bromides still have a definite place in the treatment of epilepsy in infants and prepubertal children. Bromides should always be given a fair trial in treating major motor epilepsy (grand mal) after maximal tolerated doses of the standard antiepileptic drugs (phenobarbital, diphenylhydantoin, primidone, etc) have failed. Bromides have been found especially useful in the treatment of grand mal seizures associated with organic brain lesions and of some value in the treatment of

Delirium metabolicum und erstarrende Rückbildungsdepression im höheren Lebensalter

A melancholic-schizophrenic mixed psychosis is described in a 64-year-old man. It was diagnosed as a ‘rigid (or catatonic) involutional depression’ (<i>Medow</i>, 1922), showing besides hypochondriacal, nihilistic and micromanic delusions, a transient delusional syndrome of ‘Delirium metabolicum’ (<i>Mendel</i>, 1902), with zo-anthropy. An attempt was made to avoid the differential diagnostic classification of that clinical picture into involutional melancholia (296.0) and paranoid psychosis of involutional age (197.1) which, as in so many psychoses of the older age groups, is quite inadequate. Thus the psychopathological phenomena of the psychosis, which after all are the only reliable data, were attributed on the one hand to the senile deterioration and slight but demonstrable arteriosclerosis of the brain, and on the other hand, to the conspicuous premorbid characteristics which correspond to an anankastic psychopathy with a depressive-inadequate basic mood. It was considered as likely that the Delirium metabolicum represented an exogenous (organic) psychotic syndrome, and that the precipitation of the psychosis as well as its development into an enfeebled endstate was due to an organic brain lesion, while the catatoniformpsychomotor phenomena and the melancholic stupor were crystalisations of traits in the premorbid personality.

MINIMAL CEREBRAL DYSFUNCTION IN CHILDREN WITH CHRONIC THROMBOCYTOPENIA

Chronic cases of idiopathic thrombocytopenic purpura (ITP) follow a relatively benign course in the majority of cases. A conservative attitude is, therefore, generally adopted in dealing with these cases. A disproportionately high incidence of the syndrome of minimal cerebral dysfunction (MCD) has been observed in a series of 20 patients with chronic ITP closely followed over a period of years. Six patients had serious behavior problems and learning difficulties. Psychological testing revealed a visuomotor deficiency and an impaired capacity for abstraction. The clinical and psychological picture was consistent with the diagnosis of MCD. This diagnosis was supported by EEG findings, which showed abnormalities in all six patients. Psychological indicators of MCD and EEG abnormalities were prominent in the group of 20 patients as a whole. These findings could be accounted for by multiple minute capillary bleeding. Considerations of prognosis in chronic ITP should be modified in view of this evidence for an organic brain lesion.

Visually evoked potentials in patients with brain lesions with or without disturbances of consciousness.

A study was made on the behaviour of the visually evoked potentials and rhythmic after activity in 32 patients with brain lesions of various kinds. Sixteen of them were fully conscious and sixteen in a state of coma. Eleven normal subjects served as a control series. Evoked potentials were recorded using scalp electrodes in the occipital regions and averaged with a standard San-ei computer. The background EEG activity was recorded simultaneously. One group consisted of fully conscious patients with organic brain lesions; the other group of patients in severe coma also having organic brain lesions. In both groups either alterations or abolition of evoked responses and rhythmic after activity were found, but no striking differences could be observed between the two groups. Thus the results indicate that the mechanisms underlying changes in visually evoked potentials are not identical with those causing alterations in the level of consciousness. On the other hand, various organic brain lesions may cause alterations in visually evoked potentials without disturbing consciousness.

EEG changes following total cerebral angiography in patients with organic brain lesions

EEG changes following total cerebral angiography in patients with organic brain lesions

Quadro clínico do lobo orbitário com crises cerebelares: Cisticercose racemosa do ângulo ponto-cerebelar

O paciente fôra apresentado duas vêzes em reuniões clínicas, para diagnóstico diferencial entre alterações neuropsíquicas orgânicas e pitiatismo. Da primeira, aos 2 meses de internação, releva notar os seguintes dados: trabalho mental lento, porém sem distúrbios intelectuais intrínsecos; atenção pouco fixável; expressão verbal sem transtornos intrínsecos, mas escassa; carência global de iniciativa; indiferença para com a própria situação; atitudes por vezes teatrais, em aparência pitiáticas; hipertonia muscular variável, aparentemente despertada pelo exame; marcha em pequenos passos, com incerteza variável; queda lenta, em direção inconstante; camptocormia, que se exagera quando desamparado; crises tônicas, de tipo da descerebração; condições somáticas precárias; exame neuro-oftalmológico só possível quanto a fundos oculares, sem anormalidade; exames de líquor incompletos, com alterações discretas; reações negativas para sífilis no líquor e no sangue. Diagnóstico provisório: Psicose por lesão cerebral, com provável comprometimento orgânico da região frontal orbitaria ou da via fronto-ponto-cerebelar. Ao ser apresentado da segunda vez, decorridos três meses, estavam mais acentuados o desligamento para com o ambiente, a carência de iniciativa, a total incapacidade para cuidar de si, com espurcícia; agravou-se a perturbação da marcha com completa astasia-abasia e com ataxia do tronco; tornaram-se mais freqüentes as crises tônicas de tipo cerebelar; repetidos os exames de líquor, ainda incompletos, denotaram alterações do mesmo tipo anterior; o exame de fundos oculares foi novamente negativo; não fôra ainda possível a pneumencefalografia. A evolução dos distúrbios, com alterações de origem orgânica evidente e com outras aparentemente pitiáticas, permitiu precisar o aspecto localizatório: Síndrome frontal orbitaria por alterações cerebelares prováveis. Sòmente cinco meses após a primeira discussão clínica do quadro, quando obtido o exame completo do líquor, o diagnóstico etiológico pôde ser aventado. O exame neuro-oftalmológico foi ainda negativo. A evolução dos sintomas levou o doente à obnubilação e ao embotamento intelectuais, à espurcícia; e, pelo lado neurológico, à impossibilidade de locomoção, à ataxia do tronco, ao relaxamento dos esfincteres. Diagnóstico: quadro neuropsiquiátrico orbitario, como repercussão de alterações ponto-cerebelares; cisticercose provável. O paciente faleceu 11 meses após a internação. A necropsia revelou, quanto ao sistema nervoso central, um cacho de vesículas de cisticerco racemoso ao nível do ângulo ponto-cerebelar direito (fig. 1) e espessamento das leptomeninges na base do encéfalo até a dos lobos temporais. Nenhuma alteração histológica do córtex cerebral ou das vias intra-hemisféricas (Nissl e Weil). Quanto ao aspecto patogênico, o quadro orbitario descrito por Kleist era representado pela falência na manutenção do esfôrço e da atividade em geral (Ausdauer), na regência instintiva dos atos (gesinnungsmässige Handlungen), bem como pelo distúrbio teatral, tipo pitiático, do caráter (Gesin-nung). Os transtornos neurológicos e mesmo neurovegetativos correspondiam, na opinião dos autores, à falência paleocerebelar.

Physiological correlates of intelligence.

An interim report is presented illustrating differences in physiological response to atropine among mental defectives of low and high-grade intelligence. Epileptics, and patients with evidence of organic brain lesions, were excluded from the series. Certain types of response common in schizophrenics occur more frequently among the low-grade defectives, and show increasing intensity over the period of adolescence, while the converse is true of high-grade groups. A concept of ‘inadequate improvement on pre-existing schizophrenic tendencies’ is postulated as a factor in determining the degree of intellectual deficiency in mental defectives of this series. A speculative attempt is made to reconcile this finding with our current knowledge of mental growth in childhood, and is advanced as a possible line of thought for further research.

Bromides in the treatment of epilepsy in children.

BROMIDES were the first effective treatment for epilepsy. Sir Charles Locock 1 reported on their use in epilepsy in 1853, and for many years they were widely used. Today, however, because of the enthusiasm for the newer anticonvulsant drugs, bromides are not used very extensively. Some physicians even consider bromides to be of historical interest only. Several recent reviews on the treatment of epilepsy mentioned the past importance of bromides and then dismissed the drugs as ineffective and possessing many undesirable side reactions. 2 In this clinic bromides are still considered to be a valuable anticonvulsant. Since this appears to be contrary to the prevailing opinion, it seems worth while to report our experience with the use of bromides in the treatment of epilepsy in children. MATERIAL AND METHODS Selection of Patients .—A total of 196 epileptic children with severe organic brain lesions evidenced by mental retardation, hemiplegia, or other

Psychological test performance in patients over sixty. I. Senile psychosis and the affective disorders of old age.

Affective disturbances are a common consequence of organic brain lesions of varying aetiology, and it is to be expected that the differentiation between affective symptoms of “functional” origin and those resulting from organic lesions would become an increasingly difficult problem in an age-range which is particularly susceptible to pathological cerebral changes. In fact the classical accounts of mental disorder in old age convey the impression, by their emphasis on the depressive form of senile psychosis, that an affective disorder appearing in senescence is commonly the manifestation of some cerebral degenerative process. This is one of the sources of the widely prevalent view in contemporary clinical practice that there is a large group of cases in which dementia and a depressive (and less often a manic) symptom-complex are associated. The overlap being large, an ill-defined line of demarcation is held to exist in old age between the organic degenerative diseases and the affective illnesses of a “functional” kind.

Psychological changes in organic brain lesions and ablations.

Psychological changes in organic brain lesions and ablations.

Personality Changes Accompanying Organic Brain Lesions: III. A study of Preadolescent Children

Personality Changes Accompanying Organic Brain Lesions: III. A study of Preadolescent Children

Personality Changes Accompanying Organic Brain Lesions

Personality Changes Accompanying Organic Brain Lesions

THE INSANE PSYCHONEUROTIC

The first point of interest lies in the differentiation of psychoneurotic from psychotic states. In almost all of the cases presented the diagnosis is rather perturbing. Indeed, in some it appears rather clearly to be other than psychoneurosis. Yet in most cases the state seems to be what we call psychogenetic in origin, and there are many symptoms of a psychoneurotic nature. It is very difficult to define simply and accurately the differences between psychoneurosis and psychosis. In both the symptoms may be of the same type—pains, somatic ideas, emotional and ideational difficulties. The great outstanding difference seems to be that the psychoneurotic resist the ideas, where the psychotic accept the ideas, incorporate them into the personality and elaborate them. There are also fatigability, sensitiveness and worrying as symptoms of the psychoneurotic state, which are not usual in the psychoses. It is readily seen that the border line is tenuous and decision often difficult. In such cases the reaction to suggestion and explanation may be very important in determining the true diagnosis. Such suggestion is often only temporarily accepted even by the psychoneurotic, so that this is not an infallible guide to correct diagnosis. Most of these patients are obviously insane in the sense earlier given. Such patients as Case I (suicidal attempt); Case II (successful suicide) ; Case III (dementia præcox type of incorporation of ideas) ; Case IV (depression causing inability to care for self); Case VII (seclusion, suicidal attempts); Case IX (somatic delusions ?, psychosexual disturbance); Case X (attempts at suicide, agitation); are clearly in need of mental hospital care and treatment, for their own protection and in the attempt to alleviate the condition. Such cases are not suitable for out-patient treatment. Yet with the exception of Case III, Case VII and Case X, the symptoms are certainly those of a psychoneurosis. Neurotic persons are especially likely to be thrown off balance under external stress and strain. This was true in Cases II, III (?), IV, V, VI (?), VIII, IX (?). In Case III the cause possibly lay in the distasteful work and the reaction to masturbation. In Case VI the external stress seemed to be related to a cause for depression, usually the death of a loved one—which brought up the vicious circle of ideas regarding her own death. In Case IX the cause is not quite so clear, and here, furthermore, the ideas are more incorporated into the personality. In the other cases the cause seems quite clear. In Cases I, VII and X the external cause is not so apparent. In fact, the exact cause does not always clearly appear. This, of course, is more like the origin of psychosis. Thus, Case I seems possibly associated with alcohol (involution ?); Case VII with hypertension, and some organic brain lesion (type not clear); Case X with constitutional inferiority, hypertension and involution—all of which are factors which usually do not produce states of this sort, at least in our experience. Promptly the question is raised as to the relation between these possible causes and the observed state. But it does not seem that we have progressed far enough in etiological investigation, either psychic or organic, to do more than note the associations in these cases and to await the results of therapy. There is no a priori ground for believing that a particular cause is necessary, providing that the soil be right. We could phrase it thus: Any cause on particular soils, or particular causes on any soil— although this goes somewhat too far, it roughly approximates the truth. Accordingly it appears that differential diagnosis of psychoneurosis versus psychosis is not always easy; that external and internal causes may produce much the same state; that some psychoneuroses (symptomatically) run a manic-depressive course; that psychoneurotic symptoms may occur as the prodromal signs of dementia præcox; that psychoneurotics not infrequently commit suicide; that many are insane; that such causes as alcohol and arteriosclerosis may operate to produce a syndrome not to be distinguished from psychoneurosis.

THE TARSOPHALANGEAL REFLEX.

In 1901 von Bechterew, of St. Petersburg, described a normal reflex, which consists in a dorsal flexion of the second and third or second to fifth toes when the dorsum of the foot in the region of the cuboid or external cuneiform bone is lightly tapped. This reflex is supposed to be due to a direct stimulation of the extensor muscles (longus and brevis) of the toes. Von Bechterew pointed out that in patients suffering from certain organic brain lesions this reaction is absent and in its place is seen a plantar flexion of the same toes. Three years later Mendel, of Berlin, whose name is frequently associated with this reflex, described the same phenomenon and expressed the opinion that the significance of plantar flexion is the same as that of Babinski's sign, that it indicates some central organic lesion of the motor nervous system, and may be utilized to

3. Dutch Retrospect

In the “Nederlandsche Tÿdschrift voor Geneeskunde” for February, 1888, there is to be found an article under the above heading (“A Contribution to the Study of the Treatment of Epilepsy”) which is worthy of some consideration, for it discusses a subject which has received but scant notice at the hands of medical men, viz., the influence of electricity on the epileptic state. The success achieved by Dr. Niermeÿer in the treatment of the cases he cites would be a sufficient inducement for attempting by the method he advocates, if not the permanent cure, at least the amelioration of the condition of such patients in private and hospital practice, and before the consequent psychical change had introduced a new element in to the affection; but it would also be opening up a new field of study if a careful trial could be given, and the results published, of the effect of Niermeÿer's process on a series of favourable epileptic cases resident in asylums, the affection in such being independent of organic brain lesion. The practical importance of the subject justifies a quotation of Niermeÿer's contribution in extenso:—