DOCSLIB.ORG

Psychiatric Aspects of Tumours of the Central Nervous System

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Psychiatric Aspects of Tumours of the Central Nervous System Volume 3, 2018, 18-24 REVIEW ARTICLE Psychiatric aspects of tumours of the central nervous system NUNO MADEIRA* PEDRO OLIVEIRA Psychiatry Department, Centro Hospitalar e Universitário de Coimbra; Faculty of Medicine, University of Coimbra TIAGO Santos Department of Psychiatry and Mental Health, Baixo Vouga Hospital Centre EMíLIA ALBUqUERqUE Psychiatry Unit, Francisco Gentil Portuguese Institute of Oncology, Coimbra Abstract: The incidence of brain tumours has increased in recent years. They represent the second most common cause of death attributable to neurological conditions. Although expansive brain lesions often lead to observation by Neurology or Neurosurgery, it is not uncommon for psychiatric symptoms to be the reason for initial contact with medical care. Brain tumours may present as symptomatology similar to the so-called primary, or functional, psychiatric disorders. However, in contrast to psychiatric disease in other types of cancer, where adjustment disorders predominate, organic syndromes are the most frequent diagnosis in patients with CNS tumours. Anatomic location represents one of several factors that contribute to the nature and severity of psychiatric conditions. Tumours of the frontal lobe are more frequently associated with changes in executive function, amotivational syndrome and personality changes. Temporal tumours can trigger psychotic symptoms such as hallucinations and delusions. The treatment of the symptomatology will essentially involve removal of the lesion whenever possible. Nevertheless, symptomatic treatment of psychiatric manifestations should always take place. Psychopharmacology, psychotherapy and psychoeducation of caregivers are the best modes of treatment. Keywords: Central Nervous System Neoplasms; Psycho-oncology; Psychiatric Symptoms Introduction rior fossa, the most common supratentorial lesions being Psycho-oncology spans the two principal psychiatric and those of the frontal (22%) and temporal lobes (22%); 12% psychological dimensions of cancer: on the one hand, the are located in the parietal lobes, 10% in the sella turcica, experiences of patients and their family members over the and 4% in the occipital cortex 2 . course of the disease, and also the stress felt by care-giv- Cerebral metastases generally manifest as hemiparesis ing professionals; on the other, the psychological, behav- and cognitive dysfunction; unilateral hypoesthesia, atax- ioural and social factors that influence risk, detection and ia and aphasia are less common symptoms 3 . The usual survival of oncological disease 1 . symptomatology of primary brain tumours – solid tu- The incidence of brain tumours has increased in recent years. mours or lymphomas – is cognitive dysfunction, head- They represent the second most common cause of death at- aches, vomiting, seizures and focal deficits 4 . Disease tributable to neurological causes, the first being stroke 2 . progression and the toxic effects of treatment (e.g. radio- Brain tumours can be classified according to their nature therapy) tend to cause cognitive deterioration to worsen (primary or metastatic), histology or location. Gliomas and, at advanced stages, demential syndromes or changes (40-55%) and meningiomas (10-20%) represent the ma- in consciousness. jority of expansive intracerebral lesions. Metastatic le- While expansive brain lesions often lead to observation by sions (15-25%) originate most commonly from lung and Neurology or Neurosurgery, it is not uncommon for initial breast tumours. 30% of tumours are located in the poste- contact with medical care to be prompted by psychiatric symptoms. A study of 530 patients with brain tumours re- * Correspondence to: [email protected] ported that in 18% of cases clinical presentation was psy- Psychiatric aspects of tumours of the central nervous system 19 chiatric 5 . A recent analysis of patients with meningiomas medial syndrome, which manifests above all as apathy, indicated that 21% of the study sample had initially pre- is usually related to tumour lesions of midline structures sented with psychiatric symptoms in the absence of neu- (thalamus, third ventricle, hypothalamus and pituitary), rological signs 6 . and also occurs following bilateral occlusion of the ante- rior cerebral arteries and bilateral thalamic infarcts. Lastly, Clinical Aspects orbitofrontal syndrome, in which changes in behaviour Brain tumours may present in the form of symptoms and pragmatics are to the fore, is associated with tumours similar to primary, or functional, psychiatric disorders. (e.g. inferior frontal meningiomas), as well as post-trau- However, in contrast with what happens with regard to matic lesions, vascular lesions of the anterior cerebral ar- psychiatric illness in other types of cancer, where ad- tery, multiple sclerosis and fronto-temporal dementia 8 . justment disorders predominate, organic syndromes are the most common diagnosis in patients with tumours of Table 1. Frontal syndromes the CNS. DORSOLATERAL syndrome Although some symptoms or syndromes may be associ- Predominant involvement of executive functions. ated with dysfunction of certain parts of the brain (e.g. Poor planning depression and personality changes in frontal tumours and Reduced mental flexibility psychosis in temporal lesions), anatomic location repre- Abstraction deficit sents one of several factors that contribute to the nature Persistence and severity of the psychiatric picture. Fast-growing tu- Apathy Distractibility mours are more frequently associated with agitation and Personal neglect psychosis, and more obvious cognitive dysfunction. Less Behaviours directed at stimuli aggressive lesions are associated with apathy, depression and incomplete personality changes. Multiple tumour sites VENTROMEDIAL syndrome tend to cause more significant behavioural changes. In- Deficit of initiative and motivation. creased intracranial pressure, a non-specific consequence Apathy Abulia of tumours of the CNS, is associated with apathy, depres- Incontinence sion, irritability, agitation and changes of consciousness. Gait changes Silent onset and few symptoms are a feature of the evo- lution of tumours of certain regions of the brain; lesions ORBITOFRONTAL syndrome of the anterior part of the frontal lobes, the corpus callo- Predominance of personality changes. sum, the non-dominant parietal and temporal cortex and Deterioration of social pragmatics the posterior fossa are examples of this 2 . Disinhibition Impulsiveness Moria (foolish euphoria) Frontal Lesions Emotional lability The frontal lobe constitutes the most recently evolved re- Distractibility gion of the brain in phylogenetic terms and the largest in Olfactory changes the central nervous system, representing 1/3 of its total volume. From the anatomo-functional point of view, the This anatomo-functional division is rarely clear in clin- frontal lobe is divided into at least five specialised regions: ical practice: pure presentations of these syndromes are (1) motor cortex, (2) pre-motor cortex, (3) frontal opercu- uncommon. In addition, personality changes, particular- lum, (4) para-olfactory or subcallosal zone and (5) pre- ly associated with frontal lesions (more than 70% of cas- frontal cortex. The pre-frontal cortex is the region of the es), may occur in disorders of diencephalic and temporal frontal lobe most commonly related to metacognitive abil- structures. ities, executive functions and social behaviour in general. Psychotic symptoms may be present in 10% of frontal tu- It can be divided into three distinct zones, which corre- mours. Delusions are usually fragmented and hallucina- spond to the dorsolateral, orbitofrontal and frontomedial tions are rarely auditory and complex, in contrast to what cortex. In general terms, we can organise the nature of the is most characteristic of schizophrenic psychosis 2 . deficits resulting from lesions in accordance with the pro- posed division of the pre-frontal cortex by establishing the Temporal lesions existence of three syndromes – see Table 1. 7 In addition to frequent symptoms of the ictal sphere, tu- Dorsolateral, or disorganised, syndrome, characterised mours of the temporal region have in the past been associ- by impairment of executive functions, is due in the major- ated with psychotic symptoms of a schizophreniform type. ity of cases to tumour lesions, ischaemic lesions, trauma However, more recent reports have described atypical or neurodegenerative disease of the frontal lobe 8 . Ventro- symptoms, not always associated with schizophrenia: vis- 20 Nuno Madeira | Pedro Oliveira | Tiago Santos | Emília Albuquerque ual, olfactory or tactile hallucinations, and mood swings Onset of symptoms is acute or subacute, and the latter are with suicidal behaviours, with conserved affect and social transient and reversible. These chronological characteris- interaction. tics help differentiate it from demential syndrome. In their Behavioural symptoms are common in temporal lesions: early stages, cases of hypoactive delirium may be inter- personality changes have been described in more than preted as depression. In rare situations, delirium may be the 50% of patients. As described in lesions of the frontal initial manifestation of neoplastic lesions in the CNS 15 . lobe, psychiatric symptoms like apathy, irritability and The approach to delirium includes from the start identify- emotional lability occur. Anxiety is also present in more ing and correcting, wherever possible, underlying causes than 30% of cases 2 . (see Table 2). Parietal
Load more

Recommended publications
  • Cognitive Emotional Sequelae Post Stroke
    11/26/2019 The Neuropsychology of Objectives 1. Identify various cognitive sequelae that may result from stroke Stroke: Cognitive & 2. Explain how stroke may impact emotional functioning, both acutely and long-term Emotional Sequelae COX HEALTH STROKE CONFERENCE BRITTANY ALLEN, PHD, ABPP, MBA 12/13/2019 Epidemiology of Stroke Stroke Statistics • > 795,000 people in the United States have a stroke • 5th leading cause of death for Americans • ~610,000 are first or new strokes • Risk of having a first stroke is nearly twice as high for blacks as whites • ~1/4 occur in people with a history of prior stroke • Blacks have the highest rate of death due to stroke • ~140,000 Americans die every year due to stroke • Death rates have declined for all races/ethnicities for decades except that Hispanics have seen • Approximately 87% of all strokes are ischemic an increase in death rates since 2013 • Costs the United States an estimated $34 billion annually • Risk for stroke increases with age, but 34% of people hospitalized for stroke were < 65 years of • Health care services age • Medicines to treat stroke • Women have a lower stroke risk until late in life when the association reverses • Missed days of work • Approximately 15% of strokes are heralded by a TIA • Leading cause of long-term disability • Reduces mobility in > 50% of stroke survivors > 65 years of age Source: Centers for Disease Control Stroke Death Rates Neuropsychological Assessment • Task Engagement • Memory • Language • Visuospatial Functioning • Attention/Concentration • Executive
    [Show full text]
  • Lack of Motivation: Akinetic Mutism After Subarachnoid Haemorrhage
    Netherlands Journal of Critical Care Submitted October 2015; Accepted March 2016 CASE REPORT Lack of motivation: Akinetic mutism after subarachnoid haemorrhage M.W. Herklots1, A. Oldenbeuving2, G.N. Beute3, G. Roks1, G.G. Schoonman1 Departments of 1Neurology, 2Intensive Care Medicine and 3Neurosurgery, St. Elisabeth Hospital, Tilburg, the Netherlands Correspondence M.W. Herklots - [email protected] Keywords - akinetic mutism, abulia, subarachnoid haemorrhage, cingulate cortex Abstract Akinetic mutism is a rare neurological condition characterised by One of the major threats after an aneurysmal SAH is delayed the lack of verbal and motor output in the presence of preserved cerebral ischaemia, caused by cerebral vasospasm. Cerebral alertness. It has been described in a number of neurological infarction on CT scans is seen in about 25 to 35% of patients conditions including trauma, malignancy and cerebral ischaemia. surviving the initial haemorrhage, mostly between days 4 and We present three patients with ruptured aneurysms of the 10 after the SAH. In 77% of the patients the area of cerebral anterior circulation and akinetic mutism. After treatment of the infarction corresponded with the aneurysm location. Delayed aneurysm, the patients lay immobile, mute and were unresponsive cerebral ischaemia is associated with worse functional outcome to commands or questions. However, these patients were awake and higher mortality rate.[6] and their eyes followed the movements of persons around their bed. MRI showed bilateral ischaemia of the medial frontal Cases lobes. Our case series highlights the risk of akinetic mutism in Case 1: Anterior communicating artery aneurysm patients with ruptured aneurysms of the anterior circulation. It A 28-year-old woman with an unremarkable medical history is important to recognise akinetic mutism in a patient and not to presented with a Hunt and Hess grade 3 and Fisher grade mistake it for a minimal consciousness state.
    [Show full text]
  • Prosopagnosia by B
    J. Neurol. Neurosurg. Psychiat., 1959, 22, 124. PROSOPAGNOSIA BY B. BORNSTEIN and D. P. KIDRON From the Department of Neurology, Beilinson Hospital, Petah Tiqva, Israel "And what is the nature of this knowledge or recollection? I mean to ask, Whether a person, who having seen or heard or in any way perceived anything, knows not only that, but has a conception of something else which is the subject, not of the same but of some other kind of knowledge, may not be fairly said to recollect that of which he has the conception?" "And when the recollection is derived from like things, then another consideration is sure to arise, which is, Whether the likeness in any degree falls short or not of that which is recollected?" "The Philosophy of Plato " Phaedo (the Jowett translation). Does visual agnosia exist in a partial or isolated bances in sensation time, in adaptation time, in form, in which certain qualities only are affected, visual acuity, and in brightness discrimination. as opposed to generalized visual agnosia? Many Ettlinger (1956) rejected Bay's contentions. After workers cast doubt on this concept, maintaining analysing 30 cases of head injury, he showed that that partial visual agnosia is no more than a com- some patients had neither field nor perceptual bination of defects in vision, memory, and orienta- defects, others had field but not perceptual defects, tion, appearing together. and only in eight of the 30 patients were field and The clinical elucidation of partial visual agnosia perceptual defects found together. It is true that is likely to be affected by the patient's intellectual visual agnosia is frequently associated with homony- capacity, his mental state at the time of examination, mous hemianopsia, but despite this there are cases and his ability to cooperate without being influenced of hemianopsia without gnostic defects.
    [Show full text]
  • Can We Lose Memories of Faces? Content Specificity and Awareness in a Prosopagnosic
    Can We Lose Memories of Faces? Content Specificity and Awareness in a Prosopagnosic Nancy L. Etcoff Department of Brain and Cognitive Sciences Massachusetts Institute of Technology Neuropsychology Laboratory Massachusetts General Hospital Downloaded from http://mitprc.silverchair.com/jocn/article-pdf/3/1/25/1755723/jocn.1991.3.1.25.pdf by guest on 18 May 2021 Roy Freeman Division of Neurology New England Deaconess Hospital Beth Israel Hospital Harvard Medical School Kyle R. Cave Department of Psychology University of California, San Diego Abstract H Prosopagnosia is a neurological syndrome in which patients nonfacial channels. The only other categories of shapes that he cannot recognize faces. Kecently it has been shown that some has marked trouble recognizing are animals and emotional prosopagnosics give evidence of “covert” recognition: they expressions, though even these impairments were not as severe show greater autonomic responses to familiar faces than to as the one for faces. Three measures (sympathetic skin re- unfamiliar ones, and respond differently to familiar faces in sponse, pupil dilation, and learning correct and incorrect learning and interference tasks. Although some patients do not names of faces) failed to show any signs of covert face recog- show covert recognition, this has usually been attributed to an nition in LH, though the measures were sensitive enough to “apperceptive” deficit that impairs perceptual analysis of the reflect autonomic reactions in LH to stimuli other than faces, input. The implication is that prosopagnosia is a deficit in access and face familiarity in normal controls. Thus prosopagnosia to, or awareness of, memories of faces: the inducing brain cannot always be attributed to a mere absence of awareness injury does not destroy the memories themselves.
    [Show full text]
  • Abadie's Sign Abadie's Sign Is the Absence Or Diminution of Pain Sensation When Exerting Deep Pressure on the Achilles Tendo
    A.qxd 9/29/05 04:02 PM Page 1 A Abadie’s Sign Abadie’s sign is the absence or diminution of pain sensation when exerting deep pressure on the Achilles tendon by squeezing. This is a frequent finding in the tabes dorsalis variant of neurosyphilis (i.e., with dorsal column disease). Cross References Argyll Robertson pupil Abdominal Paradox - see PARADOXICAL BREATHING Abdominal Reflexes Both superficial and deep abdominal reflexes are described, of which the superficial (cutaneous) reflexes are the more commonly tested in clinical practice. A wooden stick or pin is used to scratch the abdomi- nal wall, from the flank to the midline, parallel to the line of the der- matomal strips, in upper (supraumbilical), middle (umbilical), and lower (infraumbilical) areas. The maneuver is best performed at the end of expiration when the abdominal muscles are relaxed, since the reflexes may be lost with muscle tensing; to avoid this, patients should lie supine with their arms by their sides. Superficial abdominal reflexes are lost in a number of circum- stances: normal old age obesity after abdominal surgery after multiple pregnancies in acute abdominal disorders (Rosenbach’s sign). However, absence of all superficial abdominal reflexes may be of localizing value for corticospinal pathway damage (upper motor neu- rone lesions) above T6. Lesions at or below T10 lead to selective loss of the lower reflexes with the upper and middle reflexes intact, in which case Beevor’s sign may also be present. All abdominal reflexes are preserved with lesions below T12. Abdominal reflexes are said to be lost early in multiple sclerosis, but late in motor neurone disease, an observation of possible clinical use, particularly when differentiating the primary lateral sclerosis vari- ant of motor neurone disease from multiple sclerosis.
    [Show full text]
  • THE CLINICAL ASSESSMENT of the PATIENT with EARLY DEMENTIA S Cooper, J D W Greene V15
    J Neurol Neurosurg Psychiatry: first published as 10.1136/jnnp.2005.081133 on 16 November 2005. Downloaded from THE CLINICAL ASSESSMENT OF THE PATIENT WITH EARLY DEMENTIA S Cooper, J D W Greene v15 J Neurol Neurosurg Psychiatry 2005;76(Suppl V):v15–v24. doi: 10.1136/jnnp.2005.081133 ementia is a clinical state characterised by a loss of function in at least two cognitive domains. When making a diagnosis of dementia, features to look for include memory Dimpairment and at least one of the following: aphasia, apraxia, agnosia and/or disturbances in executive functioning. To be significant the impairments should be severe enough to cause problems with social and occupational functioning and the decline must have occurred from a previously higher level. It is important to exclude delirium when considering such a diagnosis. When approaching the patient with a possible dementia, taking a careful history is paramount. Clues to the nature and aetiology of the disorder are often found following careful consultation with the patient and carer. A focused cognitive and physical examination is useful and the presence of specific features may aid in diagnosis. Certain investigations are mandatory and additional tests are recommended if the history and examination indicate particular aetiologies. It is useful when assessing a patient with cognitive impairment in the clinic to consider the following straightforward questions: c Is the patient demented? c If so, does the loss of function conform to a characteristic pattern? c Does the pattern of dementia conform to a particular pattern? c What is the likely disease process responsible for the dementia? An understanding of cognitive function and its anatomical correlates is necessary in order to ascertain which brain areas are affected.
    [Show full text]
  • Prosopagnosia: a Clinical, Psychological, and Anatomical Study of Three Patients
    J Neurol Neurosurg Psychiatry: first published as 10.1136/jnnp.40.4.395 on 1 April 1977. Downloaded from Journal ofNeurology, Neurosurgery, and Psychiatry, 1977, 40, 395-403 Prosopagnosia: a clinical, psychological, and anatomical study of three patients A. M. WHITELEY' AND ELIZABETH K. WARRINGTON From the Department ofNeurology, The London Hospital, and the Department ofPsychology, National Hospital, Queen Square, London SUMMARY Three patients with prosopagnosia are described of whom two had right occipital lesions. An analysis of visual and perceptual functions demonstrated a defect in perceptual classi- fication which appeared to be stimulus-specific. A special mechanism for facial recognition is postu- lated, and the importance of the right sided posterior lesion is stressed. Prosopagnosia is a rare but interesting condition unreliably, as pointers to cerebral lesions, and most in which recognition of faces is impaired. The cases have a left homonymous defect indicating right sufferer is quite unable to identify people purely by hemisphere disease, but not excluding a left sided their facial appearance but can do so without lesion (Meadows, 1974a). There are many cases, Protected by copyright. difficulty by their voice and by visual clues such as however, with bilateral field defects indicating clothing, hair colour, and gait. Recognition of other bilateral lesions, but there are cases with right visual material can be intact, but in some cases highly homonymous defects and cases with no field defects discriminative visual skills, such as species of birds at all. There are several case reports where surgery and types of fruit, are impaired (Bornstein, 1963; to right temporal and occipital lobes is responsible, De Renzi et al., 1968).
    [Show full text]
  • THE SYNDROMES of the ARTERIES of the BRAIN and SPINAL CORD Part 1 by LESLIE G
    65 Postgrad Med J: first published as 10.1136/pgmj.29.328.65 on 1 February 1953. Downloaded from THE SYNDROMES OF THE ARTERIES OF THE BRAIN AND SPINAL CORD Part 1 By LESLIE G. KILOH, M.D., M.R.C.P., D.P.M. First Assistant in the Joint Department of Psychological Medicine, Royal Victoria Infirmary and University of Durham Introduction general circulatory efficiency at the time of the Little interest is shown at present in the syn- catastrophe is of the greatest importance. An dromes of the arteries of the brain and spinal cord, occlusion, producing little effect in the presence of and this perhaps is related to the tendency to a normal blood pressure, may cause widespread minimize the importance of cerebral localization. pathological changes if hypotension co-exists. Yet these syndromes are far from being fully A marked discrepancy has been noted between elucidated and understood. It must be admitted the effects of ligation and of spontaneous throm- that in many cases precise localization is often of bosis of an artery. The former seldom produces little more than academic interest and ill effects whilst the latter frequently determines provides Protected by copyright. nothing but a measure of personal satisfaction to infarction. This is probably due to the tendency the physician. But it is worth recalling that the of a spontaneous thrombus to extend along the detailed study of the distribution of the bronchi affected vessel, sealing its branches and blocking and of the pathological anatomy of congenital its collateral circulation, and to the fact that the abnormalities of the heart, was similarly neglected arterial disease is so often generalized.
    [Show full text]
  • High-Yield Neuroanatomy
    LWBK110-3895G-FM[i-xviii].qxd 8/14/08 5:57 AM Page i Aptara Inc. High-Yield TM Neuroanatomy FOURTH EDITION LWBK110-3895G-FM[i-xviii].qxd 8/14/08 5:57 AM Page ii Aptara Inc. LWBK110-3895G-FM[i-xviii].qxd 8/14/08 5:57 AM Page iii Aptara Inc. High-Yield TM Neuroanatomy FOURTH EDITION James D. Fix, PhD Professor Emeritus of Anatomy Marshall University School of Medicine Huntington, West Virginia With Contributions by Jennifer K. Brueckner, PhD Associate Professor Assistant Dean for Student Affairs Department of Anatomy and Neurobiology University of Kentucky College of Medicine Lexington, Kentucky LWBK110-3895G-FM[i-xviii].qxd 8/14/08 5:57 AM Page iv Aptara Inc. Acquisitions Editor: Crystal Taylor Managing Editor: Kelley Squazzo Marketing Manager: Emilie Moyer Designer: Terry Mallon Compositor: Aptara Fourth Edition Copyright © 2009, 2005, 2000, 1995 Lippincott Williams & Wilkins, a Wolters Kluwer business. 351 West Camden Street 530 Walnut Street Baltimore, MD 21201 Philadelphia, PA 19106 Printed in the United States of America. All rights reserved. This book is protected by copyright. No part of this book may be reproduced or transmitted in any form or by any means, including as photocopies or scanned-in or other electronic copies, or utilized by any information storage and retrieval system without written permission from the copyright owner, except for brief quotations embodied in critical articles and reviews. Materials appearing in this book prepared by individuals as part of their official duties as U.S. government employees are not covered by the above-mentioned copyright. To request permission, please contact Lippincott Williams & Wilkins at 530 Walnut Street, Philadelphia, PA 19106, via email at [email protected], or via website at http://www.lww.com (products and services).
    [Show full text]
  • 26 Aphasia, Memory Loss, Hemispatial Neglect, Frontal Syndromes and Other Cerebral Disorders - - 8/4/17 12:21 PM )
    1 Aphasia, Memory Loss, 26 Hemispatial Neglect, Frontal Syndromes and Other Cerebral Disorders M.-Marsel Mesulam CHAPTER The cerebral cortex of the human brain contains ~20 billion neurons spread over an area of 2.5 m2. The primary sensory and motor areas constitute 10% of the cerebral cortex. The rest is subsumed by modality- 26 selective, heteromodal, paralimbic, and limbic areas collectively known as the association cortex (Fig. 26-1). The association cortex mediates the Aphasia, Memory Hemispatial Neglect, Frontal Syndromes and Other Cerebral Disorders Loss, integrative processes that subserve cognition, emotion, and comport- ment. A systematic testing of these mental functions is necessary for the effective clinical assessment of the association cortex and its dis- eases. According to current thinking, there are no centers for “hearing words,” “perceiving space,” or “storing memories.” Cognitive and behavioral functions (domains) are coordinated by intersecting large-s- cale neural networks that contain interconnected cortical and subcortical components. Five anatomically defined large-scale networks are most relevant to clinical practice: (1) a perisylvian network for language, (2) a parietofrontal network for spatial orientation, (3) an occipitotemporal network for face and object recognition, (4) a limbic network for explicit episodic memory, and (5) a prefrontal network for the executive con- trol of cognition and comportment. Investigations based on functional imaging have also identified a default mode network, which becomes activated when the person is not engaged in a specific task requiring attention to external events. The clinical consequences of damage to this network are not yet fully defined. THE LEFT PERISYLVIAN NETWORK FOR LANGUAGE AND APHASIAS The production and comprehension of words and sentences is depen- FIGURE 26-1 Lateral (top) and medial (bottom) views of the cerebral dent on the integrity of a distributed network located along the peri- hemispheres.
    [Show full text]
  • THE SYNDROMES of the ARTERIES of the BRAIN AND, SPINAL CORD Part II by LESLIE G
    I19 Postgrad Med J: first published as 10.1136/pgmj.29.329.119 on 1 March 1953. Downloaded from - N/ THE SYNDROMES OF THE ARTERIES OF THE BRAIN AND, SPINAL CORD Part II By LESLIE G. KILOH, M.D., M.R.C.P., D.P.M. First Assistant in the Joint Department of Psychological Medicine, Royal Victoria Infirmary and University of Durham The Vertebral Artery (See also Cabot, I937; Pines and Gilensky, Each vertebral artery enters the foramen 1930.) magnum in front of the roots of the hypoglossal nerve, inclines forwards and medially to the The Posterior Inferior Cerebellar Artery anterior aspect of the medulla oblongata and unites The posterior inferior cerebellar artery arises with its fellow at the lower border of the pons to from the vertebral artery at the level of the lower form the basilar artery. border of the inferior olive and winds round the The posterior inferior cerebellar and the medulla oblongata between the roots of the hypo- Protected by copyright. anterior spinal arteries are its principal branches glossal nerve. It passes rostrally behind the root- and it sometimes gives off the posterior spinal lets of the vagus and glossopharyngeal nerves to artery. A few small branches are supplied directly the lower border of the pons, bends backwards and to the medulla oblongata. These are in line below caudally along the inferolateral boundary of the with similar branches of the anterior spinal artery fourth ventricle and finally turns laterally into the and above with the paramedian branches of the vallecula. basilar artery. Branches: From the trunk of the artery, In some cases of apparently typical throm- twigs enter the lateral aspect of the medulla bosis of the posterior inferior cerebellar artery, oblongata and supply the region bounded ventrally post-mortem examination has demonstrated oc- by the inferior olive and medially by the hypo- clusion of the entire vertebral artery (e.g., Diggle glossal nucleus-including the nucleus ambiguus, and Stcpford, 1935).
    [Show full text]
  • Balin Bhatia Gadolinium Deposition Basal Ganglia
    T1 weighted basal ganglia hyperintensities due to gadolinium deposition – a cautionary note Bettina Balint, MD1,2 and Kailash P. Bhatia, MD, FRCP1 1 Sobell Department of Motor Neuroscience and Movement Disorders UCL Institute of Neurology, Queen Square, London WC1N 3BG, United Kingdom 2 Department of Neurology, University Hospital Heidelberg, Heidelberg, Germany Corresponding author: Prof Kailash P. Bhatia Sobell Department of Motor Neuroscience and Movement Disorders UCL Institute of Neurology Queen Square WC1G 3BG London U.K. Tel: +44 02034488723 Email: [email protected] Correspondence Word count: 585; Character count title: 91; number of references: 5; number of figures: 0; Supplemental Data: 0 Disclosures: Dr Balint reports no conflict of interest. Prof Bhatia reports no conflict of interest. Full disclosures for the past 12 months unrelated to the present manuscript: K.P.B. receives royalties from Oxford University Press and a stipend for MDCP editorship, holds grants from NIHR RfPB, MRC Welcome Strategic grant (WT089698), PD UK (Ref. no.: G-1009) and Horizon 2020 EC grant Propag- Aging. He has received honoraria/financial support to speak/attend meetings or serve on advisory boards from Ipsen, Merz, Allergan, Teva Lundbeck pharmaceutical companies. Gadolinium-based contrast agents (GBCAs) have been widely used in clinical MR imaging since the late 1980ies. Overall, they were considered safe, apart from the well-known risk of nephrogenic systemic fibrosis, which could be counteracted by limitation of their use in patients with renal insufficiency. Now however, there have been a number of publications describing the dose-dependent deposition of Gadolinium in the brain, manifesting as high signal intensities on non-enhanced T1-weighted images particularly in the dentate nucleus and globus pallidus, but also in the thalamus and the pons.1-3 Gadolinium is a rare-earth metal.
    [Show full text]