1/72. Crossed apraxia: implications for handedness.Liepmann posited that right hand preference relates to left hemisphere dominance for learned skilled movements. Limb apraxia, impairment of skilled movement, typically occurs in individuals with left hemisphere (LH) lesions. The occurrence of apraxia in right-handed individuals following right-hemisphere lesions appears to refute Liepmann's hypothesis. We studied the apraxia of a right-handed man, RF, following a right frontal lesion to determine whether his apraxia paralleled the apraxia seen following LH lesions. Results of behavioral testing indicated that, like individuals with apraxia following left frontal lesions, RF was better at gesture recognition than gesture production which was significantly impaired across tasks. Kinematic motion analyses of movement linearity, planarity, and the coupling of temporospatial aspects of movements substantiated the parallel impairments in RF and patients with LH apraxia. The impairment seen in our patient with crossed apraxia provides evidence for the fractionation of systems underlying hand preference and skilled movement.- - - - - - - - - - ranking = 1keywords = near (Clic here for more details about this article) |
2/72. Cryptic mucor infection leading to massive cerebral infarction at initiation of antileukemic chemotherapy.A 74-year-old man with newly diagnosed acute myelogenous leukemia unexpectedly suffered a massive cerebral infarct on day 2 of induction chemotherapy. Clinically, the hemorrhagic infarct was thought to be due to leukostasis and thrombocytopenia. Necropsy, however, revealed that Zygomycetes-type hyphae had infiltrated cerebral vessels in and near the infarct. The fungal infection was clinically silent otherwise, although fungal elements were also identified in the lung at autopsy. This case illustrates how closely fungal infection may resemble a leukemia-associated cerebrovascular accident.- - - - - - - - - - ranking = 1keywords = near (Clic here for more details about this article) |
3/72. The smell of burnt toast: a case report.A 71-year-old woman awoke one morning to find that she perceived all aromas, odors, and fragrances as smelling like burnt toast. Over the next three years, numerous studies and therapeutic trials failed to elicit the cause of her dysosmia or to provide relief. Finally, the demonstration of small infarcts as seen on a brain MRI suggested that an infarct near the olfactory pathway was responsible for the sudden onset and the 11 year persistence of her unique paromia.- - - - - - - - - - ranking = 1keywords = near (Clic here for more details about this article) |
4/72. Selective loss of vergence control secondary to bilateral paramedian thalamic infarction.The supranuclear pathways for vergence eye movements are poorly understood. The authors report a 57-year-old patient who presented with selective loss of vergence control and dissociation of light and near reaction. MRI showed a symmetric paramedian thalamic infarction without midbrain lesion. The findings suggest that this syndrome is due to an interruption of supranuclear fibers to midbrain vergence neurons.- - - - - - - - - - ranking = 1keywords = near (Clic here for more details about this article) |
5/72. Heterotopic ossification in childhood and adolescence.Heterotopic ossification, or myositis ossificans, denotes true bone in an abnormal place. The pathogenic mechanism is still unclear. A total of 643 patients (mean age, 9.1 years) admitted for neuropediatric rehabilitation were analyzed retrospectively with respect to the existence of neurogenic heterotopic ossification. The purpose of this study was to obtain information about incidence, etiology, clinical aspect, and consequences for diagnosis and therapy of this condition in childhood and adolescence. Heterotopic ossification was diagnosed in 32 patients (mean age, 14.8 years) with average time of onset of 4 months after traumatic brain injury, near drowning, strangulation, cerebral hemorrhage, hydrocephalus, or spinal cord injury. The sex ratio was not significant. In contrast to what has been found in adult studies, serum alkaline phosphatase was not elevated during heterotopic ossification formation. A persistent vegetative state for longer than 30 days proved to be a significant risk factor for heterotopic ossification. The incidence of neurogenic heterotopic ossification in children seems to be lower than in adults. A genetic predisposition to heterotopic ossification is suspected but not proven. As a prophylactic regimen against heterotopic ossification we use salicylates for those patients in a coma or persistent vegetative state with warm and painful swelling of a joint and consider continuous intrathecal baclofen infusion and botulinum toxin injection for those patients with severe spasticity. We prefer to wait at least 1 year after trauma before excision of heterotopic ossification.- - - - - - - - - - ranking = 1keywords = near (Clic here for more details about this article) |
6/72. Phonological agraphia following a focal anterior insulo-opercular infarction.Following a unique infarction, restricted to the left anterior insula and the adjacent part of the intrasylvian frontal opercular cortex, an 83-year-old right-handed patient acutely developed a severe speech disorder that evolved into mere mutism within a few hours. After rapid recovery from mutism, oral language was characterized by severe apraxia of speech. In-depth language investigations further disclosed an isolated, highly selective disturbance of the spelling system (phonological agraphia) which resolved rapidly. One year after onset of neurological symptoms, the apraxia of speech had almost completely receded. The anatomoclinical findings in this first representative of pure and nearly isolated phonological agraphia complement previous neuroanatomical and neurolinguistic accounts of phonological agraphia. The data not only seem to enrich current insights in the anatomical locus for phonological agraphia, they also seem to contribute to a further delineation of the insular role in phonologically mediated aphasic manifestations.- - - - - - - - - - ranking = 1keywords = near (Clic here for more details about this article) |
7/72. Conflict and integration of spatial attention between disconnected hemispheres.OBJECTIVES: To clarify how the disconnected hemispheres perceive a line and bisect it with successful or unsuccessful integration of spatial attention. methods: eye movements were recorded when a patient with an extensive callosa infarction bisected horizontal lines. The lesion extended into the left cingulate gyrus. RESULTS: When the patient bisected lines with the right hand, the gaze was initially directed rightward and shifted further to the right side with the execution of manual response, which resulted in rightward errors. Shortly after bisection, rapid ocular searches occurred to the left side, whereas the rightward errors did not decrease throughout the trials. When using the left hand, there was no deviation of the gaze before presentation of lines. In the first few trials, the patient bisected the line with a leftward error and then searched rapidly to the right side. The subsequent bisections were almost accurate, as the subjective midpoint was placed near the point of the initial fixation that fell around the true centre. Ocular searching was mostly absent during and after line bisection. CONCLUSIONS: In callosa disconnection, left unilateral spatial neglect may appear when use of the right hand induces a rightward bias in the attentional control of the left hemisphere and damage to its cingulate gyrus inhibits interhemispheric integration of attention. Resultant rightward errors of line bisection often cause interhemispheric conflict of attention, as the right hemisphere perceives the longer extent on the left side. By contrast, the disconnected but intact right hemisphere may bisect a line accurately by integrating attention to the extents perceived in the left and right visual fields.- - - - - - - - - - ranking = 1keywords = near (Clic here for more details about this article) |
8/72. A case of Netherton's syndrome with cerebral infarction.Netherton's syndrome, a rare congenital disease of childhood, is characterized by variable cutaneous erythematous eruptions with different manifestations. A five-year-old boy, who presented with ichthyosis linearis circumflexa, atopic manifestations and pili torti, had spastic hemiparesia due to cerebral infarction. Netherton's syndrome can easily be misdiagnosed as Leiner's disease, generalized psoriasis or nonbullous congenital ichthyosiform erythroderma, especially in the neonatal period, because of its nonspecific clinical and histological features. Pediatricians should consider this syndrome in the differential diagnosis of the generalized erythematous skin disorders of childhood associated with various abnormalities.- - - - - - - - - - ranking = 1keywords = near (Clic here for more details about this article) |
9/72. Treatment of ballism and pseudobulbar affect with sertraline.BACKGROUND: The pathogenesis of ballism is uncertain and may involve more than one mechanism; treatment is not always efficacious. OBJECTIVE: To provide evidence of a nondopaminergic mechanism and the potential for a prompt and nearly complete response to a serotonergic agent. methods: Report of 2 separate trials of sertraline hydrochloride in a single patient. RESULTS: Complete remission of symptoms within 48 hours of each drug trial. CONCLUSION: sertraline may offer an alternative with a better adverse effect profile than dopamine receptor blockers in the treatment of patients with ballism.- - - - - - - - - - ranking = 1keywords = near (Clic here for more details about this article) |
10/72. Bilateral cerebellar infarctions caused by a stenosis of a congenitally unpaired posterior inferior cerebellar artery.Bilateral symmetrical cerebellar infarcts in the territory supplied by the medial posterior inferior cerebellar artery (pica) branches are extremely rare. In the few cases published, it has not been possible to clearly pinpoint the cause of this infarct pattern. The authors present the case history of a 58-year-old man who had acute headaches accompanied by pronounced rotatory vertigo with nausea and vomiting. The neurological examination revealed bilateral cerebellar signs. Cranial magnetic resonance imaging showed bilateral, nearly symmetrical infarcts in the territory of the medial branches of both PICAs. These bilateral pica infarctions were caused by a stenosis of an unpaired pica originating from the left vertebral artery supplying both cerebellar hemispheres.- - - - - - - - - - ranking = 1keywords = near (Clic here for more details about this article) |
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