Temporal Lesions Research Articles

The Scanpaths of Subjects with Developmental Prosopagnosia during a Face Memory Task.

The scanpaths of healthy subjects show biases towards the upper face, the eyes and the center of the face, which suggests that their fixations are guided by a feature hierarchy towards the regions most informative for face identification. However, subjects with developmental prosopagnosia have a lifelong impairment in face processing. Whether this is reflected in the loss of normal face-scanning strategies is not known. The goal of this study was to determine if subjects with developmental prosopagnosia showed anomalous scanning biases as they processed the identity of faces. We recorded the fixations of 10 subjects with developmental prosopagnosia as they performed a face memorization and recognition task, for comparison with 8 subjects with acquired prosopagnosia (four with anterior temporal lesions and four with occipitotemporal lesions) and 20 control subjects. The scanning of healthy subjects confirmed a bias to fixate the upper over the lower face, the eyes over the mouth, and the central over the peripheral face. Subjects with acquired prosopagnosia from occipitotemporal lesions had more dispersed fixations and a trend to fixate less informative facial regions. Subjects with developmental prosopagnosia did not differ from the controls. At a single-subject level, some developmental subjects performed abnormally, but none consistently across all metrics. Scanning distributions were not related to scores on perceptual or memory tests for faces. We conclude that despite lifelong difficulty with faces, subjects with developmental prosopagnosia still have an internal facial schema that guides their scanning behavior.

Differential roles of gestures on spatial language in neurotypical elderly adults and individuals with focal brain injury

ABSTRACTGestures might serve communicative functions by supplementing spoken expressions or restorative functions by facilitating speech production. Also, speakers with speech deficits use gestures to compensate for their speech impairments. In this study, we examined gesture use in speakers with and without speech impairments and how spoken spatial expressions changed when gestures were restrained. Six patients with speech problems and with left frontal and/or temporal lesions and 20 neurotypical controls described motion events in 3 different conditions (spontaneous gesture, only speech, and only gesture). In addition to the group analyses, we ran case analyses. Results showed that patients used more gestures compared to controls. Gestures served both communicative and restorative functions for patients whereas controls only used gestures for communicative purposes. Case analyses revealed that there were differential patterns among patients. Overall, gesture production is multifunctional and gestures serve different functions for different populations as well as within a population.

An unusual diagnosis of a dural based intracranial lesion

A 19-year old man was referred to the Haematology clinic of a large tertiary hospital in Melbourne, Australia, with an 8-month history of cervical lymphadenopathy, non-drenching night sweats, and unintentional weight loss of 30 kg. His past medical history includes depression and regular marijuana use. He had been recently diagnosed with epilepsy, after presenting to hospital with a first seizure 3 months prior to this presentation. He did not undergo any intracranial imaging at that time. Clinical examination revealed obvious palpable non-tender asymmetric cervical and parotid lymphadenopathy. Neurological examination was unremarkable. Gadolinium-enhanced MRI Brain demonstrated a 44 × 26 × 41 mm left temporal extra-axial lesion (see Fig. 1). What is the most likely diagnosis?A.LymphomaB.Rosai-Dorfman diseaseC.MeningiomaD.HaemangiopericytomaE.SarcoidosisF.ChondrosarcomaG.Epidural abscess Answer on page 285. The authors have no conflicts of interest or sources of support to declare. An unusual diagnosis of a dural based intracranial lesionJournal of Clinical NeuroscienceVol. 66PreviewRosai-Dorfman disease, or sinus histiocytosis with massive lymphadenopathy, is a rare illness that classically manifests with massive, widespread, painless cervical lymphadenopathy [1]. It has a prevalence of 1:200 000 and approximately 100 new cases are diagnosed each year in the United States [2]. It is frequently diagnosed in children and young adults (mean age 20.6 years) [3], predominantly in males (M:F ratio of 1.8:1) [4]. Extranodal disease is a feature of 43% of cases, with central nervous system (CNS) involvement in <5% of cases, and over 300 cases of CNS involvement reported in the literature [5]. Full-Text PDF

68Ga-DOTATOC PET/CT Differentiates Meningioma From Dural Metastases

A 77-year-old woman with history of breast cancer presented with 2 unclear dural contrast-enhancing lesions on MRI; differential diagnoses were breast cancer metastases and meningiomas. On Ga-DOTATOC PET/CT, the temporal lesion showed high uptake and was classified as meningioma, whereas the lesion at the falx showed barely any Ga-DOTATOC uptake uncharacteristic for meningioma and suggestive for a brain metastasis. After resection, histological specimens from the temporal lesion showed meningioma tissue with distinct SSTR2A expression, whereas the falx lesion revealed a breast cancer metastasis without significant SSTR2A expression. Therefore, Ga-DOTATOC PET represents a powerful imaging modality for the evaluation of unclear dural lesions.

The CADASIL Scale-J, A Modified Scale to Prioritize Access to Genetic Testing for Japanese CADASIL-Suspected Patients

Background: Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is definitely diagnosed by genetic testing. Such testing involves the analysis of exons 2-24 of NOTCH3, which encode the epidermal growth factor-like repeat domain, where CADASIL mutations are localized. We previously reported clinical diagnostic criteria for screening CADASIL-suspected Japanese patients prior to genetic testing. Because of its high sensitivity but low specificity, most patients need to undergo genetic testing. In this study, we aimed to develop the CADASIL scale-J, a modified scale to prioritize access to genetic testing for CADASIL-suspected Japanese patients. Methods: We modified the CADASIL scale reported by Pescini et al based on clinical features of 126 CADASIL patients and 53 NOTCH3-negative CADASIL-like patients diagnosed up until March 2016 (Phase 1). For validation, we recruited 69 consecutive patients for genetic testing of NOTCH3 from April 2016 to March 2017 (Phase 2). Results: We developed the CADASIL scale-J with a score ranging from 0 to 25 and the cut-off value of 16, using 8 items: hypertension, diabetes, young onset (≤50 years old), pseudobulbar palsy, stroke/TIA, family history, subcortical infarction, and temporal pole lesion. The sensitivity and specificity of the CADASIL scale-J were 78.9% and 85.7%, respectively. In Phase 2, we obtained a positive predictive value of 70.0% and a negative predictive value of 89.2%. In this study, we identified 54 mutations, 7 of which were novel. Conclusions: The CADASIL scale-J is helpful to prioritize access to genetic testing for CADASIL-suspected Japanese patients.

Detectability of minute temporal bone structures with ultra-high resolution CT

ObjectiveComputed tomography (CT) is the imaging tool of choice in the diagnosis of temporal bone lesions. With the recent progress in imaging technology, CT with higher spatial resolution (Ultra-high resolution CT) has become available in the clinical setting. The purpose of this study is to evaluate the visibility of small temporal bone structures using ultra-high resolution CT. Material and methodsThe visibility of 27 minute temporal bone structures on ultra-high resolution CT images was evaluated. Non-helical axial scans were performed in 18 normal hearing ears without previous otologic diseases. Visibility was scored by an experienced radiologist and otologist. ResultsMinute temporal bone structures including the ossicular chain, the crus of the stapes, the greater superficial petrosal nerve, and the anterior malleolar ligament were clearly visualized on ultra-high resolution CT. The stapedius muscle tendon and the chorda tympani exiting the posterior canaliculus and coursing medial to the malleus could be visualized. ConclusionUltra-high resolution CT provides good visualization of small temporal bone structures in normal subjects.

Preoperative MRI findings and prediction of diagnostic utility of foramen ovale electrodes.

Foramen ovale electrodes (FOEs) are a minimally invasive method to localize mesial temporal seizures in cases in which noninvasive methods are inconclusive. The objective of this study was to identify factors predicting the ability of FOEs to yield a diagnosis in order to determine optimal candidates for this procedure. All cases of diagnostic investigations performed with FOEs at the authors' institution between 2005 and 2017 were reviewed. FOE investigation was defined as diagnostic if it led to a treatment decision. Demographic and clinical variables for diagnostic and nondiagnostic investigations were compared using a Wilcoxon rank-sum test for continuous variables and Fisher's exact test for categorical variables. Ninety-three patients underwent investigations performed with FOEs during the study period and were included in the study. FOE investigation was diagnostic in 75.3% of cases. Of patients who underwent anterior temporal lobectomy following diagnostic FOE evaluation, 75.9% were Engel class I at last follow-up (average 40.1 months). When the diagnostic and nondiagnostic FOE groups were compared, patients who had diagnostic investigations were more likely to be male (57.1% male vs 26.1% in the nondiagnostic group, p = 0.015). They were also more likely to have temporal lesions on preoperative MRI (p = 0.018). FOEs are a useful, minimally invasive diagnostic modality resulting in a treatment decision in 75% of cases. Male patients and patients with temporal lesions on MRI may be most likely to benefit from FOE investigation.

Object recognition in acquired and developmental prosopagnosia

ABSTRACTWhether face and object recognition are dissociated in prosopagnosia continues to be debated: a recent review highlighted deficiencies in prior studies regarding the evidence for such a dissociation. Our goal was to study cohorts with acquired and developmental prosopagnosia with a complementary battery of tests of object recognition that address prior limitations, as well as evaluating for residual effects of object expertise. We studied 15 subjects with acquired and 12 subjects with developmental prosopagnosia on three tests: the Old/New Tests, the Cambridge Bicycle Memory Test, and the Expertise-adjusted Test of Car Recognition. Most subjects with developmental prosopagnosia were normal on the Old/New Tests: for acquired prosopagnosia, subjects with occipitotemporal lesions often showed impairments while those with anterior temporal lesions did not. Ten subjects showed a putative classical dissociation between the Cambridge Face and Bicycle Memory Tests, seven of whom had normal reaction times. Both developmental and acquired groups showed reduced car recognition on the expertise-adjusted test, though residual effects of expertise were still evident. Two subjects with developmental prosopagnosia met criteria for normal object recognition across all tests. We conclude that strong evidence for intact object recognition can be found in a few subjects but the majority show deficits, particularly those with the acquired form. Both acquired and developmental forms show residual but reduced object expertise effects.

Dissociating frontal and temporal correlates of phonological and semantic fluency in a large sample of left hemisphere stroke patients.

Previous lesion studies suggest that semantic and phonological fluency are differentially subserved by distinct brain regions in the left temporal and the left frontal cortex, respectively. However, as of yet, this often implied double dissociation has not been explicitly investigated due to mainly two reasons: (i) the lack of sufficiently large samples of brain-lesioned patients that underwent assessment of the two fluency variants and (ii) the lack of tools to assess interactions in factorial analyses of non-normally distributed behavioral data. In addition, previous studies did not control for task resource artifacts potentially introduced by the generally higher task difficulty of phonological compared to semantic fluency.We addressed these issues by task-difficulty adjusted assessment of semantic and phonological fluency in 85 chronic patients with ischemic stroke of the left middle cerebral artery. For classical region-based lesion-behavior mapping patients were grouped with respect to their primary lesion location. Building on the extension of the non-parametric Brunner-Munzel rank-order test to multi-factorial designs, ANOVA-type analyses revealed a significant two-way interaction for cue type (semantic vs. phonological) by lesion location (left temporal vs. left frontal vs. other as stroke control group). Subsequent contrast analyses further confirmed the proposed double dissociation by demonstrating that (i) compared to stroke controls, left temporal lesions led to significant impairments in semantic but not in phonological fluency, whereas left frontal lesions led to significant impairments in phonological but not in semantic fluency, and that (ii) patients with frontal lesions showed significantly poorer performance in phonological than in semantic fluency, whereas patients with temporal lesions showed significantly poorer performance in semantic than in phonological fluency.The anatomical specificity of these findings was further assessed in voxel-based lesion-behavior mapping analyses using the multi-factorial extension of the Brunner-Munzel test. Voxel-wise ANOVA-type analyses identified circumscribed parts of left inferior frontal gyrus and left superior and middle temporal gyrus that significantly double-dissociated with respect to their differential contribution to phonological and semantic fluency, respectively. Furthermore, a main effect of lesion with significant impairments in both fluency types was found in left inferior frontal regions adjacent to but not overlapping with those showing the differential effect for phonological fluency.The present study hence not only provides first explicit evidence for the anatomical double dissociation in verbal fluency at the group level but also clearly underlines that its formulation constitutes an oversimplification as parts of left frontal cortex appear to contribute to both semantic and phonological fluency.

Kanji (Morphogram) and Kana (Phonogram) Problem in Japanese Alexia and Agraphia.

The kanji and kana (or kanji vs. kana) problem in the Japanese language denotes the dissociation between kanji (morphograms) and kana (phonograms) in reading/comprehension and writing. Since paragraphia of kana in a patient with amyotrophic lateral sclerosis was first reported in 1893, kanji-kana dissociation has been the central topic in Japanese aphasiology. Recent advancements in lesion-to-symptom analyses and functional imaging studies have identified some areas whose damage causes dissociative disturbances of reading or writing between kanji and kana. That is, (1) angular alexia with agraphia causes kanji agraphia; alexia of kana with an angular gyrus lesion is the result of a damage to the middle occipital gyrus; (2) alexia with agraphia for kanji is caused by a posterior inferior temporal cortex (mid-fusiform/inferior temporal gyri; visual word form area) lesion, whereas pure agraphia for kanji is caused by a posterior middle temporal gyrus lesion; and (3) pure alexia, particularly for kanji, results from a mid-fusiform gyrus lesion (Brodmann's Area [BA] 37), whereas pure alexia for kana results from a posterior fusiform/inferior occipital gyri lesion (BA 18/19).

Surgical treatment patients with drug-resistant unilateral MRI-positive temporal forms of epilepsy

To evaluate the results of surgical treatment of patients with unilateral MRI-positive temporal forms of drug-resistant epilepsy. A prospective analysis of 50 patients with unilateral MRI-positive temporal forms of drug-resistant epilepsy, who had undergone resective surgery in the Scientific Research Institute of Emergency Medicine of N.V. Sklifosovsky (Moscow) and in University Clinic of Moscow State University of Medicine and Dentistry between 01.01.14 and 12.12.17, has been performed. MRI-positive temporal symptomatic epilepsy was identified in 79 (55%) patients. MRI results showed unilateral temporal epileptogenic lesions in 50 (67%) patients. These patients were assigned to medial frontal lobectomy. 82% patients become 'seizure free' 12 and 24 months after surgical treatment. In other cases, seizures become less frequent and severe. The results confirm the efficacy and safety of surgical treatment of drug-resistant MRI-positive temporal forms of epilepsy.

Absence of an early hippocampal encoding signal after medial temporal lesions: No consequence for the spacing effect.

Immediately repeated meaningful pictures in a continuous recognition task induce a positive frontal potential at about 200-300 ms, which appears to emanate from the medial temporal lobe (MTL) centered on the hippocampus, as concluded from inverse solutions, coherence measurements, and depth electrode recordings in humans. In this study, we tested patients with unilateral MTL lesions due to stroke to verify the provenance of this signal and its association with the spacing effect (SE)-the improved learning of material encountered in spaced rather than massed presentation. We found that unilateral left or right MTL lesions abolished the early frontal MTL-mediated signal but not the spacing effect. We conclude that the SE does not depend on MTL integrity. We suggest that the early frontal signal at 200-300 ms after immediate picture repetition may serve as a direct biomarker of MTL integrity that may be useful in the early stages of diseases like Alzheimer's.

An unusual biconvex epidural lesion: acutely presenting extraosseous intracranial Ewing\u2019s sarcoma

BackgroundEwing’s sarcoma family of tumors consists of small round cell neoplasms, inclusive of primitive neuroectodermal tumor (PNET), Askin’s tumor, and PNET of the bone. Extraosseous Ewing’s sarcoma occurs commonly at bones of lower extremities and paravertebral region of the spine. It rarely presents as a primary intracranial lesion. When intracranial, it can be misdiagnosed as central PNET (e.g., medulloblastoma, pinealoblastoma, or supratentorial PNET), other intracranial lesions, or even as an epidural hematoma.Case presentationWe report the case of a 20-year-old patient who presented to the emergency department with complaints of drowsiness, headache, and fever for 1 day. On initial computed tomography (CT) scan of the brain, a right temporal biconvex epidural lesion involving squamous-temporal bone with periosteal reaction was noted.The patient underwent urgent craniotomy, and a tumor was found and excised. Biopsy report confirmed Ewing’s sarcoma.ConclusionEwing’s sarcoma is a rare intracranial malignancy with only a few cases reported in literature. In a young patient with a biconvex epidural lesion, in the absence of trauma or ongoing infection, the possibility of Ewing’s sarcoma should be considered as well.

A Rare Case in Early Postpartum Period: Bilatral Facial Paralysis

Introduction: Losing the bilateral muscle functions on one side of the face or both sides is called facial paralysis (FP). FP is observed more frequently in women during pregnancy and in early postpartum period when compared with other women. Bilateral FP, on the other hand, is a very rare situation among other paralyses. The facial nerve paralysis may be observed due to various reasons, such as genetic factors, vascular ischemia and inflammation developed due to viral infection, autoimmune diseases, temporal bone fractures, head-neck tumors, and central nervous system lesions. However, despite these known factors, the majority of FP cases are idiopathic. For this reason, more diseases must be considered to shed some light on the etiology of FP. It is already known that corticosteroids are efficien twhen used early in treatment. A complete blood counts and serologic tests were performed in patients, and the results came back normal. During a 14-day treatment, 1mg/kg methyl prednisolone was applied. After 3 weeks, complete healing took place.Case Report: Written informed consent was obtained from who participated in this study. A 36-year-old female patient worked as a teacher in an educational institution. As of the postpartum 5th day, the patient first experienced sudden pain and then numbness, which were more prominent in the left cheek and ear. After 2 days, the patient reported with a slight pull, first on the left side of the face and then on the right side, disruption in smiling, being unable to close the eyelids adequately, difficulty at chewing, slight swelling in the face and lips.Conclusion: In this case study, we present a clinical follow-up and treatment of a postpartum patient diagnosed with idiopathic bilateral FP, accompanied by literature findings

Postoperative Management of Resected Brain Metastases: When Can Radiotherapy Be Deferred?

The Oncology Grand Rounds series is designed to place original reports published in the Journal into clinical context. A case presentation is followed by a description of diagnostic and management challenges, a review of the relevant literature, and a summary of the authors' suggested management approaches. The goal of this series is to help readers better understand how to apply the results of key studies, including those published in Journal of Clinical Oncology, to patients seen in their own clinical practice. A 67-year-old woman was diagnosed 17 months ago with stage IIIB non-small-cell lung cancer (NSCLC; adenocarcinoma), without a targetable mutation, for which she received chemotherapy and thoracic radiotherapy. She developed new-onset gait ataxia, nausea, morning emesis, and headaches. A brain magnetic resonance imaging (MRI) scan demonstrated a 3.2-cm left cerebellar enhancing metastatic lesion, with surrounding vasogenic edema and mass effect, and three additional enhancing cortical, parenchymal lesions, each < 1.2 cm in maximum diameter, and none with significant mass effect ( Fig 1A ). A restaging positron emission tomography scan revealed no new sites of metastatic disease and no obvious intrathoracic progression. She underwent craniotomy, with piecemeal resection of the cerebellar metastatic lesion that proved to be recurrent lung cancer ( Fig 1B ). Her medical history was significant for mild hypertension and diet-controlled type II diabetes. She had smoked one pack a day for 32 years and had quit 3 years earlier. Postoperatively, her neurologic symptoms resolved, and physical and neurologic examinations were unrevealing; she had an Eastern Cooperative Oncology Group performance status (PS) of 0 and a Mini-Mental State Examination (MMSE) score of 29 of 30. A 3-week postoperative MRI scan confirmed the presence of 1-cm right frontal, 1.2-cm right parietal, and 1.2-cm left temporal enhancing lesions with minimal enhancement and no evidence of mass effect or edema. In addition, there was an ill-defined residual tumor bed, estimated to be approximately 3.7 cm in maximum diameter ( Fig 1C ). The patient was no longer receiving any steroids and was not receiving any anticonvulsants. Because of the residual three brain metastatic lesions, as well as the consideration of a high risk of surgical failure, she was referred for radiotherapy.

Three Skulls Dating from the French Revolutionary Years Diagnosed with Tinea Capitis: A Paleopathologic Approach.

The Musée Dupuytren was a Parisian pathology museum established in 1835. This museum hosted 3 skulls with severe craniofacial lesions initially tagged as aggressive forms of tinea capitis. The aim of this study was to investigate these specimens and discuss the initial diagnosis. Historical investigations were conducted based on the biographic data from the tags of the 3 skulls and entries on the catalog of the museum. Age was determined using dentition and the patency of cranial base synchondroses. The computed tomography scans were performed using standard medical devices. The 3 skulls were from the late 18th to early 19th century. Skull № 1 was a 5-year-old child and presented with microcephaly and extensive vault osteolysis compatible with an aggressive benign lesion, a malignant tumor, or a chronic infection. Skull № 2 was a 12- to 18-year-old teenager and presented with symmetrical porotic hyperostosis compatible with undernutrition and various hematologic conditions causing prolonged anemia, but also with chronic inflammation and/or infection. Skull № 3 was also from a 12- to 18-year-old teenager and presented with focal temporal osteolysis compatible with an aggressive benign or a low-grade malignant temporal soft-tissue lesion or with chronic infection. These skulls contribute to the understanding of the concept of tinea in the 19th century. They are furthermore windows on the sanitary and social conditions in Paris in the years following the French revolution and during the Napoleonian wars.

Surgical strategy for temporal lobe epilepsy with dual pathology and incomplete evidence from EEG and neuroimaging.

Coexistence of hippocampal sclerosis (HS) and a temporal neocortical lesion, including focal cortical dysplasia, vascular malformations or benign primary brain tumors, is defined as dual pathology. In the majority of cases, the complete evidence based on electroencephalogram (EEG) and magnetic resonance imaging (MRI) for each of the dual pathological lesions is difficult to obtain. As a result, patients with dual pathology are poor surgical candidates due to potential incomplete resection of the epileptogenic zone. The current study retrospectively reviewed 24 patients with potential dual pathology and incomplete EEG and MRI evidence, aiming to provide novel surgical strategies. The results revealed a significantly worse seizure-free outcome for patients with incomplete EEG and MRI data compared with patients who received a clear diagnosis of dual pathology based on complete test results (11.1 vs. 60.0%; P<0.05). Notably, satisfying surgical (seizure-free) outcomes were still achieved in 60% of patients with unclear EEGs to locate the onset zone and clear MRI scans identifying the sclerotic hippocampus and nearby neocortical lesions, which could be resected together. In patients with multiple epileptogenic onsets or with widespread epileptic discharges, the hippocampus should be spared from resection due to concern for potential postsurgical mood or memory disorders. In conclusion, patients with resection of the sclerotic hippocampus and neocortical lesion had improved seizure-free outcomes compared with patients who received individual lesion resection. The current study aimed to provide a novel surgical strategy for neurosurgeons treating epileptic patients with dual pathology.

Health-related quality of life, neuropsychiatric symptoms and structural brain changes in clinically isolated syndrome.

BackgroundNeuropsychiatric symptoms and reduced health-related quality of life (HRQoL) are frequent in multiple sclerosis, where are associated with structural brain changes, but have been less studied in clinically isolated syndrome (CIS).ObjectiveTo characterize HRQoL, neuropsychiatric symptoms (depressive symptoms, anxiety, apathy and fatigue), their interrelations and associations with structural brain changes in CIS.MethodsPatients with CIS (n = 67) and demographically matched healthy controls (n = 46) underwent neurological and psychological examinations including assessment of HRQoL, neuropsychiatric symptoms and cognitive functioning, and MRI brain scan with global, regional and lesion load volume measurement.ResultsThe CIS group had more, mostly mild, depressive symptoms and anxiety, and lower HRQoL physical and social subscores (p≤0.037). Neuropsychiatric symptoms were associated with most HRQoL subscores (β≤-0.34, p≤0.005). Cognitive functioning unlike clinical disability was associated with depressive symptoms and lower HRQoL emotional subscores (β≤-0.29, p≤0.019). Depressive symptoms and apathy were associated with right temporal, left insular and right occipital lesion load (ß≥0.29, p≤0.032). Anxiety was associated with lower white matter volume (ß = -0.25, p = 0.045).ConclusionMild depressive symptoms and anxiety with decreased HRQoL are present in patients with CIS. Neuropsychiatric symptoms contributing to decreased HRQoL are the result of structural brain changes and require complex therapeutic approach in patients with CIS.

Episodic memory decline in Parkinson\u2019 s disease: relation with white matter hyperintense lesions and influence of quantification method

The relation of white matter hyperintense lesions to episodic memory impairment in patients with Parkinson’s disease (PD) is still controversial. We aimed at evaluating the relation between white matter hyperintense lesions and episodic memory decline in patients with PD. In this multicentric prospective study, twenty-one normal controls, 15 PD patients without mild cognitive impairment (MCI) and 13 PD patients with MCI were selected to conduct a clinico-radiological correlation analysis. Performance during episodic memory testing, age-related white matter changes score, total manual and automated white matter hyperintense lesions volume and lobar white matter hyperintense lesions volumes were compared between groups using the Kruskal-Wallis and Wilcoxon signed-rank tests, and correlations were assessed using the Spearman test. MCI PD patients had impaired free recall. They also had higher total, left prefrontal and left temporal white matter hyperintense lesions volumes than normal controls. Free recall performance was negatively correlated with the total white matter hyperintense lesions volume, either manually or automatically delineated, but not with the age-related white matter changes score. Using automated segmentation, both the left prefrontal and temporal white matter hyperintense lesions volumes were negatively correlated with the free recall performance. Early episodic memory impairment in MCI PD patients may be related to white matter hyperintense lesions, mainly in the prefrontal and temporal lobes. This relation is influenced by the method used for white matter hyperintense lesions quantification. Automated volumetry allows for detecting those changes.

T160. Magnetoencephalography findings of benign epileptiform transients of sleep on scalp EEG in three patients with temporal lobe epilepsy

Introduction Benign epileptiform transients of sleep (BETS) is a finding on electroencephalography, defined as monophasic or diphasic transients with low amplitude ( μ V) and short duration ( Methods Patient 1, a 37-year-old right-handed male, was diagnosed with left TLE. Complex partial seizures started from age 15 years. Video-EEG (VEEG) showed interictal left anterior and posterior temporal sharp waves, and left temporal seizure onset was suggested. Magnetic resonance (MR) imaging revealed a mass lesion in the left lateral temporal lobe, suspected to be dysembryoplastic neuroepithelial tumor. Patient 2, a 38-year-old right-handed male, was diagnosed with left TLE. Complex partial seizures started from age 20 years. VEEG showed interictal bilateral independent temporal spikes, and left temporal seizure onset was suggested. MR imaging showed no abnormalities. Patient 3, a 33-year-old right-handed female, was diagnosed with right TLE. Complex partial seizures with oral automatism started from age 20 years. VEEG showed interictal right anterior temporal spikes, and right temporal seizure onset was suggested. MR imaging showed no abnormalities. All three patients underwent simultaneous EEG-MEG recording. EEG electrode placement used the 10–10 system with additional anterior temporal electrodes. MEG used a 200 channel whole-head system (MEGvision PQA160C, Ricoh Company, Ltd., Tokyo, Japan). The study investigated MEG activities correlated with EEG findings concordant with BETS. Results In Patient 1, MEG spikes correlated with BETS in the left temporal lobe had epileptic form, with high amplitude spike activity followed by slow wave activity. The source as evaluated with equivalent current dipoles was estimated around the left temporal lesion. In Patient 2, MEG spikes correlated with BETS in the right temporal lobe had epileptic form, with high amplitude spike activity followed by slow wave activity. No activity fulfilling the definition of BETS was detected in the left hemisphere. In Patient 3, no apparent MEG activity correlated with BETS was seen in the right temporal lobe. Conclusion The present study demonstrated variations in MEG findings correlated with EEG BETS in patients with TLE. These results may indicate heterogeneous background of BETS, so that only some BETS have an epileptic mechanism.