Cases reported "Brain Damage, Chronic"

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1/22. From what to where: neuropsychological evidence for implicit interactions between object- and space- based attention.

    Three experiments examined nonspatial extinction in G.K., a patient with bilateral parietal damage. Experiment 1 demonstrated nonspatial extinction (poor detection of a weak relative to a stronger perceptual group), even when the stronger group was less complex than the weaker group. Experiment 2 showed improved report of a letter falling at the location of the stronger group, but explicit judgments of the location of the letter were at chance. Experiment 3 replicated the object-cuing benefit, though G.K. could not discriminate whether a letter fell at the same location as the stronger perceptual group. The data indicate coupling between object- and space-based attention, so that spatial attention is drawn to the location occupied by the winner of object-based competition for selection. In this case, what cues where. This coupling operates implicitly, even when explicit location judgments are impaired.
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2/22. Spatiomotor cueing in unilateral left neglect: three case studies of its therapeutic effects.

    Limb activation contralateral to a cerebral lesion seems to reduce visual neglect, though whether this is due to perceptual cueing or hemispheric activation is controversial. Three case studies are presented which attempt to use this experimental finding therapeutically in the rehabilitation of unilateral left neglect. The first study used a combination of perceptual anchoring training with left arm activation procedures and produced improvements. The second used the same method, but stimulated left arm activation using an avoidance conditioning procedure, again with positive results. The third case treatment focused on cueing for left arm activation without explicit instructions for perceptual anchoring, with positive results.
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3/22. A case of treatment-related leukoencephalopathy: sequential MRI, CT and PET findings.

    A case of treatment-related leukoencephalopathy is presented. A patient with medulloblastoma was postoperatively treated with craniospinal axis irradiation. One month after irradiation, weekly intrathecal administration of methotrexate was performed 4 times to treat cerebrospinal fluid dissemination of the tumor. Two months after the initiation of intrathecal chemotherapy, the patient became somnolent and developed decerebrate posturing. magnetic resonance imaging showed diffuse leukoencephalopathy. Positron emission tomography revealed a diffuse decrease in glucose uptake in the deep white matter. Auditory evoked potential also showed diffuse abnormalities, not only in the cerebrum, but also in the brain stem. High dose intravenous leucovorin rescue was attempted without any neurologic improvement.
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4/22. Effects of emotional face cueing on line bisection in neglect: a single case study.

    One patient with left neglect (FM) and four right brain-damaged controls were tested on a line bisection task with pictures of neutral and emotional faces as unilateral cues. We thus manipulated the attentional salience of the cues (higher for emotional and lower for neutral faces) while keeping constant their physical dimensions. Our findings showed that left emotional faces were more effective than left neutral faces in reducing bisection errors only in FM. These data indicate that in the neglected hemispace cues bias attention rather than simply altering the perceptual point of balance of the line in the horizontal plane.
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5/22. Sequential ordering of morphed faces and facial expressions following temporal lobe damage.

    A card ordering task was developed to evaluate the role of the temporal lobe in perceiving subtle featural displacements of faces that contribute to judgments of facial expression and identity. Individuals with varying degrees of temporal lobe damage and healthy controls were required to manually sort cards depicting morphs of facial expressions or facial identities so that the cards were sequentially ordered from one morph endpoint to another. Four morph progressions were used--three emotion morphs (neutral-to-anger, neutral-to-fear, and fear-to-anger) and an identity morph. Five exemplars were given per morph type. Debriefing verified that participants were using feature-level cues to sort the cards. A patient with bilateral amygdala damage due to epilepsy did not differ in her sorting abilities from unilateral temporal lobectomy patients or controls. In contrast, a post-encephalitic patient with widespread left temporal lobe damage showed impairments that were most marked on the fear-to-anger and identity sorts. These results show that amygdala-damaged individuals can use information contained in facial expressions to solve tasks that rely on feature-level analysis, which recruits processing in other temporal lobe regions involved in making fine featural distinctions.
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6/22. Gaze but not arrows: a dissociative impairment after right superior temporal gyrus damage.

    Superior temporal sulcus (STS) activation has consistently been demonstrated in the normal brain when viewing eyes, and thus this area is implicated as a gaze processing region in humans. In a recent report, we have presented a case, M.J., with a well-circumscribed lesion to the right superior temporal gyrus (STG), who demonstrated impaired discrimination of gaze direction. In the aim to make distinct whether this impairment is unique to gaze, we have applied a spatial cueing paradigm established by Kingstone and colleagues. In our experiment, pictorial gaze and symmetrical arrows were centrally presented as non-predictive, spatial cues in detecting peripheral targets. Fifteen normal subjects and M.J. participated in the experiment. In concordance with previous reports, controls demonstrated a significant facilitation of reaction times in detecting targets cued by congruent gaze/arrows, compared with incongruent cues. In striking contrast, M.J. showed no such congruency advantage for gaze, in the face of a normal congruency advantage for arrows. We have demonstrated that a circumscribed lesion to the right STG impairs the ability to utilize biological directional information such as gaze, but leaves the non-biological counterpart (arrows) intact. This dissociation implies that indeed, the STS specializes in processing gaze.
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7/22. Crossed anomic aphasia: mild naming deficits following right brain damage in a dextral patient.

    A detailed case study is reported of crossed aphasia (CA) in a dextral patient, bearing upon such controversial issues as intrahemispheric localisation of language function and hemispheric reversal of nonverbal function. DA, a man aged 37, developed a mild naming problem due to right temporal lobe haematoma. Apart from a mild acquired stutter, his continuous speech was fluent and had a normal proportion of open to closed class lexical items. His naming deficit appears to originate in the 'blocking' or 'disconnection' of the phonological lexicon: he could usually give a functional definition of un-named items and retrieve them with the help of a phonemic cue. Lexical retrieval appears his only language deficit, as he had no comprehension or phonological discrimination deficits. DA showed no visuo-spatial or auditory-nonverbal deficits, suggesting the complete reversal of hemispheric specialisation.
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8/22. Hemispheric activation vs spatio-motor cueing in visual neglect: a case study.

    We report a case of mild visuo-spatial neglect consequent upon right-hemisphere stroke. At the time of testing, the patient had a complete left visual field deficit but only a very slight left hemiparesis. Under conventional testing conditions, line bisection performed with the right hand showed more severe left neglect than when performed with the left hand. This pattern of performance could, however, be modified, both quantitatively and qualitatively, by changing the starting position of the patient's hand when bisecting horizontal lines. The results suggest that spatio-motor cueing has a more profound effect upon task performance than does differential hemispheric activation per se. We also provide a demonstration that, in a normal subject, the starting position of the hand is likewise a crucial determinant of task performance. In this case, however, there is also an interaction between the hand (and hence hemisphere) deployed and the position of that hand in space.
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9/22. Relationship between neuropsychological data and response to behavioral treatment in a case of carbon monoxide toxicity and dementia.

    The ability of learning measures to predict a behavioral treatment response was of interest in this study. A severely impaired and behaviorally disturbed female neuropsychiatric patient was unable to demonstrate any learning on "direct" tests involving multiple free recall trials or cued paired associate recall. However, she performed normally on an "indirect" test involving implicit learning of new associations. To assess whether direct or indirect measures tapped the kind of learning required by a positive reinforcement-based treatment approach, a token program was carried out. There was a 72.5% reduction in maladaptive behavior relative to baseline, indicating a positive treatment response. The results are discussed in terms of the potential treatment utility and predictive validity of indirect measures of learning and memory and the relation of neuropsychological data to intervention issues in general.
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10/22. Impaired shifting of attention in Balint's syndrome.

    We assessed the efficiency of attentional shifts across the horizontal and vertical axes of the visual field in a patient with Balint's syndrome caused by bilateral parieto-occipital infarctions. This was performed using an adaptation of Posner's peripheral cueing paradigm. In contrast to normal controls and patients with unilateral parietal lesions previously reported, this patient did not benefit from cues directing attention to the left or right visual field. She appeared to benefit only when the cues directed attention to the upper visual field. This suggests a defect in shifting attention that may occur following bilateral parietal lesions. We discuss the implications of these findings for the role of the parietal lobes in attentional processes and for our understanding of the behavioral abnormalities observed in Balint's syndrome.
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