Cases reported "Brain Damage, Chronic"

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1/75. Verbal encoding deficits in a patient with a left retrosplenial lesion.

    Over the past decade, memory impairments associated with retrosplenial damage have received increased attention among neuroscientists, although the exact role of the retrosplenial region in memory has not been clearly defined. Evidence from lesion studies and functional neuroimaging has implicated the retrosplenial region in verbal episodic memory, temporal ordering of information, and topographical memory. In addition, recent positron emission tomography studies have shown increased activation of the retrosplenial cortex during tasks involving both the encoding and retrieval of episodic information. The objective of this study was to define more clearly the nature of memory impairments observed in retrosplenial amnesia. A 47-year-old amnesic male with a left retrosplenial arteriovenous malformation was examined on neurocognitive tasks of automatic and directed encoding, temporal ordering of information, and remote memory. Despite normal performance on frontal cognitive tasks, intact memory for remote information, and a superior IQ, this individual exhibited a profound deficit in the encoding of information, evidenced by poor release from proactive interference, poor category clustering on word list recall, poor semantic encoding on a levels of processing task, and mild impairments in temporal ordering. These results imply that the retrosplenial region plays a role in the verbal encoding of information, which contributes to the profound verbal memory impairment reported in previous case studies of patients with retrosplenial damage.
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2/75. names and words without meaning: incidental postmorbid semantic learning in a person with extensive bilateral medial temporal damage.

    The authors describe a densely amnesic man who has acquired explicit semantic knowledge of famous names and vocabulary words that entered popular culture after the onset of his amnesia. This new semantic knowledge was temporally graded and existed over and above the implicit memory he demonstrated in reading speed and accuracy, familiarity ratings, and his ability to make correct guesses on unfamiliar items. However, his postmorbid knowledge was limited to verbal labels denoting famous people and words; he possessed virtually no explicit knowledge of the meaning of these words or the identities of these individuals, although there was some evidence that some of this information had been acquired at an implicit level. Findings are discussed in the context of a neural network model (J. L. McClelland, B. L. McNaughton, & R. C. O'Reilly, 1995) of semantic acquisition.
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3/75. The minimally conscious state in children.

    The minimally conscious state (MCS) is a condition of severely altered consciousness in which minimal but definite behavioral evidence of self- or environmental awareness is shown. Diagnostic criteria recently have been proposed for entry into and emergence from the MCS. We present clinical and neuroimaging data on 5 children diagnosed with MCS and discuss the limited information available concerning its epidemiology, etiology, pathology, and prognosis. Issues related to the evaluation and care of children suspected of having MCS are also reviewed as well as current ethical and legal controversies.
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4/75. Ethical issues in clinical practice: cases and analyses.

    Given the severity and complexity of the neurologic disorders that can affect infants and children, pediatric neurologists frequently encounter complex and challenging ethical issues. This discussion uses five cases to illustrate common ethical issues and dilemmas that are confronted by pediatric neurologists. These cases involve the provision of artificial nutrition and hydration to patients in vegetative or minimally conscious states, the use of mechanical ventilation for patients with spinal muscular atrophy, controversial therapies for autistic spectrum disorders, the use of medical information obtained over the internet, and genetic testing in children with suspected Huntington's disease. The ethical concepts discussed in these cases include autonomy, confidentiality, futility, surrogate decision-making, the best-interest principle, and the withholding and withdrawal of treatment.
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5/75. Butane abuse associated Encephalopathy.

    Butane contained in household products is easily available for abuse and is not subject to legal prosecution in germany. The toxicological properties of butane mainly affect the heart and the CNS. A serious pathophysiological mechanism is asphyxia due to the replacement of oxygen by butane. We report an abusive butane inhalation in a 15-year old girl, resulting in cardiopulmonary resuscitation and subsequent development of severe brain damage. After reviewing the medical literature and questioning German toxicological information centres it became obvious, that abuse of butane is an increasing problem. We give an survey about the complications associated with butane intoxication.
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6/75. Pure topographical disorientation--the anatomical basis of landmark agnosia.

    We used MRI studies of four patients to investigate the lesions responsible for landmark agnosia. A detailed investigation of the relationship between the symptoms and the lesions suggests that the right posterior part of the parahippocampal gyrus is critical for the acquisition of novel information about buildings and landscapes, and that the same region plus the anterior half of the lingual gyrus and the adjacent fusiform gyrus play an important role in the identification of familiar buildings and landscapes. Furthermore, the lesion responsible for prosopagnosia, which frequently occurs with landmark agnosia, seems to involve the posterior half of the lingual and fusiform gyri. This suggests that the lesions responsible for landmark agnosia and prosopagnosia are close to each other, but distinct.
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7/75. The relationship between independent neuropsychological and neurological detection and localization of cerebral impairment.

    Seventy-eight patients referred to the neurology Service of St. Louis veterans Administration Hospital were independently diagnosed by a neurologist and a psychologist. The latter utilized the Halstead Neuropsychological Test Battery, a series of tests known to be a sensitive indicator of the presence and localization of cerebral impairment. The following diagnostic categories were used: no brain damage, localized left hemisphere impairment, localized right hemisphere impairment, diffuse, diffuse with greater left hemisphere impairment, and diffuse with greater right impairment. Diagnostic agreement was present in all but five cases. Statistical analyses of data from the Halstead Battery supported the clinical analyses in terms of indicating both the presence and, to a lesser degree, the location of organic impairment. Advantages of describing the consequences of organic impairment in objectively measured, quantifiable behavioral terms were discussed and an illustrative case history was presented. It was concluded that psychological test data are a clinically useful supplement to neurological diagnostic information.
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8/75. "It ain't necessarily so".

    Preconceived ideas of the effects of brain damage on mental function may lead to erroneous advice, as illustrated by a case in whom severe traumatic damage of the frontal lobe necessitated a significant professional and social change, but did not result in the absolute behavioral incompetence that would have been predicted by current notions of frontal lobe function. Which mental functions are impaired is a question that cannot be answered by referral to the anatomical pathology, however precise the latter information may be.
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9/75. Geographic information has to be spatialized to be neglected: a representational neglect case.

    A patient with unilateral neglect had to evoke mentally the map of france in two different conditions. In the first condition, he was asked to build an iconic representation of the map of france and to list all the towns that he could 'see' on this mental image within two minutes. In the second condition, he had to remember and name as many French towns as possible within two minutes, without being instructed to form a mental image. Left representational neglect was observed in the first condition only, i.e., when an iconic representation was required. These findings, which were replicated four months later, suggest a dual mode of coding, retrieval, or both, of geographic information and show that, although topographic, geographic data has to be spatialized to be neglected.
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10/75. Right hemisphere reading mechanisms in a global alexic patient.

    We investigated the implicit, or covert, reading ability of a global alexic patient (EA) to help determine the contribution of the right hemisphere to reading. Previous studies of alexic patients with left hemisphere damage have suggested that the ability to derive meaning from printed words that cannot be read out loud may reflect right hemisphere reading mechanisms. Other investigators have argued that residual left hemisphere abilities are sufficient to account for implicit reading and moreover do not require the postulation of a right hemisphere system that has no role in normal reading processes. However, few studies have assessed covert reading in patients with lesions as extensive as the one in EA, which affected left medial, inferior temporal-occipital cortex, hippocampus, splenium, and dorsal white matter. EA was presented with lexical decision, semantic categorization, phonemic categorization, and letter matching tasks. Although EA was unable to access phonology and could not overtly name words or letters, she was nevertheless capable of making lexical and semantic decisions at above chance levels, with an advantage for concrete versus abstract words. Her oral and written spelling were relatively intact, suggesting that orthographic knowledge is retained, although inaccessible through the visual modality. Based on her ability to access lexical and semantic information without contacting phonological representations, we propose that EA's implicit reading emerges from, and is supported, by the right hemisphere. Finally, we conclude that her spelling and writing abilities are supported by left hemisphere mechanisms.
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