David B. FitzGerald

Language dominance determined by whole brain functional MRI in patients with brain lesions

Background: Functional MRI (fMRI) is of potential value in determining hemisphere dominance for language in epileptic patients. Objective: To develop and validate an fMRI-based method of determining language dominance for patients with a wide range of potentially operable brain lesions in addition to epilepsy. Methods: Initially, a within-subjects design was used with 19 healthy volunteers (11 strongly right-handed, 8 left-handed) to determine the relative lateralizing usefulness of three different language tasks in fMRI. An automated, hemispheric analysis of laterality was used to analyze whole brain fMRI data sets. To evaluate the clinical usefulness of this method, we compared fMRI-determined laterality with laterality determined by Wada testing or electrocortical stimulation mapping, or both, in 23 consecutive patients undergoing presurgical evaluation of language dominance. Results: Only the verb generation task was reliably lateralizing. fMRI, using the verb generation task and an automated hemispheric analysis method, was concordant with invasive measures in 22 of 23 patients (12 Wada, 11 cortical stimulation). For the single patient who was discordant, in whom a tumor involved one-third of the left hemisphere, fMRI became concordant when the tumor and its reflection in the right hemisphere were excluded from laterality analysis. No significant negative correlation was obtained between lesion size and strength of laterality for the patients with lesions involving the dominant hemisphere. Conclusion: This fMRI method shows potential for evaluating language dominance in patients with a variety of brain lesions.

Effects of Donepezil on Verbal Memory After Semantic Processing in Healthy Older Adults

ObjectiveTo learn if acetylcholinesterase inhibitors alter verbal recall by improving semantic encoding in a double-blind randomized placebo-controlled trial. BackgroundCholinergic supplementation has been shown to improve delayed recall in adults with Alzheimer disease. With functional magnetic resonance imaging, elderly adults, when compared with younger participants, have reduced cortical activation with semantic processing. There have been no studies investigating the effects of cholinergic supplementation on semantic encoding in healthy elderly adults. MethodTwenty elderly participants (mean age 71.5, SD±5.2) were recruited. All underwent memory testing before and after receiving donepezil (5 mg, n=11 or 10 mg, n=1) or placebo (n=8) for 6 weeks. Memory was tested using a Levels of Processing task, where a series of words are presented serially. Subjects were either asked to count consonants in a word (superficially process) or decide if the word was “pleasant” or “unpleasant” (semantically process). ResultsAfter 6 weeks of donepezil or placebo treatment, immediate and delayed recall of superficially and semantically processed words was compared with baseline performance. Immediate and delayed recall of superficially processed words did not show significant changes in either treatment group. With semantic processing, both immediate and delayed recall performance improved in the donepezil group. ConclusionsOur results suggest that when using semantic encoding, older normal subjects may be aided by anticholinesterase treatment. However, this treatment does not improve recall of superficially encoded words.

Lesion characteristics related to treatment improvement in object and action naming for patients with chronic aphasia

UNLABELLED Few studies have examined the relationship between degree of lesion in various locations and improvement during treatment in stroke patients with chronic aphasia. The main purpose of this study was to determine whether the degree of lesion in specific brain regions was related to magnitude of improvement over the course of object and action naming treatments. PARTICIPANTS AND METHODS Fifteen left hemisphere stroke patients with aphasia participated in treatments for object and/or action naming. Two raters assessed extent of lesion in 18 left hemisphere cortical and subcortical regions of interest (ROIs) on CT or MRI scans. Correlations were calculated between composite basal ganglia, anterior cortical, and posterior cortical lesion ratings, on the one hand, and both pretreatment scores and treatment change for both object and action naming, on the other hand. RESULTS Unexpectedly, greater anterior cortical lesion extent was highly correlated with better object and action naming scores prior to treatment and with greater improvement during treatment when partial correlations controlled for total basal ganglia lesion extent (r ranging from .730 to .858). Greater total basal ganglia lesion extent was highly correlated with worse object and action naming scores prior to treatment and with less improvement during treatment when partial correlations controlled for total anterior lesion extent (r ranging from -.623 to -.785). Correlations between degree of posterior cortical lesion and naming indices generally were not significant. No consistent differences were found between the correlations of ROI lesion ratings with object naming versus action naming scores. CONCLUSION Large anterior cortical lesions and intactness of the basal ganglia may both contribute to more efficient reorganization of language functions.

Diffusion weighted imaging and neuropsychological correlates in adults with mild traumatic brain injury

Diffusion Tensor Imaging (DTI) is increasingly being used as a research tool in mild Traumatic Brain Injury (mTBI). This article reviews the concepts of diffusion tensor imaging, neuropsychological testing and results to date when applied to mTBI in adults. DTI is being used in conjunction with neuropsychological and electrophysiological measures to provide improved structural/functional correlations of mTBI. Future directions and applications of DTI in mTBI research are suggested.

What’s inside the art? The influence of frontotemporal dementia in art production

We evaluated the productions of an artist with frontotemporal lobar degeneration from before dementia onset until she was fully symptomatic. We noted an improvement of technique that might be related to sparing and disinhibition of the right posterior neocortex. There was a reduction of closure (completeness of the painting), possibly induced by impersistence and a decrease in evocative impact that might be explained by frontal and anterotemporal-limbic dysfunction.

Asymmetrical alien hands in corticobasal degeneration

There are several forms of alien limb, but alien limb in corticobasal degeneration (CBD) is not well understood. We studied a patient with CBD who demonstrated two different types of alien limb. With his right hand he demonstrated a tactile avoidance response with levitation. With his left hand, he demonstrated continuous tactile pursuit of the examiners hand (“tactile mitgehen”). Mitgehen is often associated with frontal dysfunction, but avoidance response and levitation are often associated with parietal dysfunction.

Spreading activation of lexical-semantic networks in Parkinson's disease.

Although dopamine may act as a neuromodulator of spreading activation within semantic networks, this role of dopamine in lexical networks has not been investigated. Hence, we sought to investigate the effects of Parkinsons disease (PD), which is associated with dopamine depletion, on spreading activation in the lexical networks. Ten Parkinsons disease patients and 11 normal controls performed the controlled oral word association test and the average word frequency for their responses was calculated and used as an index of spreading activation. The PD patients exhibited a lower average word frequency, suggesting increased spreading activation, and a significant relationship between the strength of the initial activation and subsequent extent of spreading activation. Most patients were taking dopaminergic medication and future studies may benefit from examining the changes in spreading activation in lexical networks in PD patients on versus off medication or in healthy controls taking either a placebo or a dopaminergic medication. Although these alterations in lexical access might be related to the reduction of dopamine, one of the hallmarks of PD, these patients also have alterations of other neurotransmitter systems and further studies are needed to more clearly identify the role played by these neurotransmitter on lexical access.

Posterior circulation infarct after bronchial artery embolization and coiling

A 51-year-old left-handed woman developed acute hemoptysis. The day after admission, her bronchoscopy showed active bleeding in the apical segment of the right upper lobe. Pulmonary angiography showed a small vascular lesion in the apex. The right bronchial artery was embolized using 300- to 500-μm Embosphere microspheres and three 2 × 10–mm coils. The patient had a headache the following day. Noncontrast CT showed multiple hypodensities in the cerebellum. Follow-up MRI showed multiple areas of …

Ipsilesional Attentional-Approach Neglect or Crossover Effect*

Patients with ipsilateral neglect (IN) bisect lines toward contralesional space. It has been posited that IN might be induced by an attempt at compensation, as part of the crossover effect, where patients with an ipsilesional bias when bisecting long lines, cross over and develop a contralesional bias on short lines or as a release of an approach (grasp) behavior that might be attentional or intentional. To test these alternative hypotheses we had a patient with IN from a right medial frontal lesion bisect lines that contained no cue, a left-sided cue, a right-sided cue, and bilateral cues. If this patient had ipsilateral neglect (IN) because of a crossover effect or compensation, right-sided cues should have influenced bisection more than left-sided cues. We, however, found that only left-sided cues induced a significant change (left-sided deviation) providing support for the attentional-approach (grasp) hypothesis. Further support of this contralesional attentional grasp hypothesis comes from the observation that this patient also had ipsilesional extinction to simultaneous stimuli.

Spatial attentional bias in normal people: object or viewer-centered.

When bisecting radial lines, normal subjects often have a distal bias. To help in explaining this systematic bias, it has been proposed that normal people have an attentional bias to the top of the lines (object centered hypothesis) or toward stimuli falling in the lower portion of the retina (retinotopic hypotheses) or to distal peripersonal space (body centered hypotheses). The primary aim of this study is to test these hypotheses by having normal subjects bisect radial lines, placed in a clockwise distribution in the transverse plane, below eye level. Our results demonstrate that the perception of the midpoint progressively changes as a function of the body centered orientation of the lines, with subjects demonstrating a progressively greater distal bias as they approached the midsagittal plane or radial condition. These findings provide support for the postulate that distal bias on radial lines bisections is body centered.