scholarly journals Association of Lesion Pattern and Dysphagia in Acute Intracerebral Hemorrhage

Stroke ◽  
2021 ◽  
Author(s):  
Felix Hess ◽  
Christian Foerch ◽  
Fee Keil ◽  
Alexander Seiler ◽  
Sriramya Lapa
Keyword(s):  
Insular Cortex ◽  
Internal Capsule ◽  
Brain Regions ◽  
Lesion Size ◽  
Small Lesion ◽  
Clinical Predictors ◽  
Lesion Pattern ◽  
Swallowing Dysfunction ◽  
The Right ◽  
Deep Brain

Background and Purpose: Dysphagia is a common and severe symptom of acute stroke. Although intracerebral hemorrhages (ICHs) account for 10% to 15% of all strokes, the occurrence of dysphagia in this subtype of stroke has not been widely investigated. The aim of this study was to evaluate the overall frequency and associated lesion locations and clinical predictors of dysphagia in patients with acute ICH. Methods: Our analysis included 132 patients with acute ICH. Clinical swallowing assessment was performed within 48 hours after admission. All patients underwent computed tomography imaging. Voxel-based lesion-symptom mapping was performed to determine lesion sites associated with dysphagia. Results: Eighty-four patients (63.6%) were classified as dysphagic. Higher scores on the National Institutes of Health Stroke Scale, larger ICH volumes, and higher degree of disability were associated with dysphagia. Voxels showing a statistically significant association with dysphagia were mainly located in the right insular cortex, the right central operculum, as well as the basal ganglia, corona radiata, and the left thalamus and left internal capsule. In contrast to lobar regions, in subcortical deep brain areas also small lesion volumes (<10 mL) were associated with a substantial risk of dysphagia. Intraventricular ICH extension and midline shift as imaging findings indicating a space-occupying effect were not associated with dysphagia in multivariate analysis. Conclusions: Dysphagia is a frequent symptom in acute ICH. Distinct cortical and subcortical lesion sites are related to swallowing dysfunction and predictive for the development of dysphagia. Therefore, patients with ICH should be carefully evaluated for dysphagia independently from lesion size, in particular if deep brain regions are affected.

scholarly journals Organic Hallucinosis in Non-Hemorrhagic Stroke Caused by Thrombosis Process: A Case Report

2022 ◽  
Vol 9 (1) ◽  
pp. 51-58
Author(s):  
Pricella Maria Ismail ◽  
Anak Ayu Sri Wahyuni ◽  
Anak Agung Ayu Suryapraba Indradewi
Keyword(s):  
Cerebral Infarction ◽  
Defense Mechanisms ◽  
Hemorrhagic Stroke ◽  
Right Hemisphere ◽  
Insular Cortex ◽  
Internal Capsule ◽  
Brain Regions ◽  
Visual Contact ◽  
Nervous Disease ◽  
The Right

Background/aim: Hallucinations are the special ability to experience phenomena that are not visible to normal individuals. Hallucinations, delusions, and confabulations are common symptoms between neurology and psychiatry. Nervous disease that manifests with hallucinatory symptoms like this is one of them due to right hemispheric stroke. The authors report cases of new-onset organic hallucinosis. and stroke in brain regions similar to the salience network (insular cortex, parietal cortex, and striatum). Case: A 43-year-old man comes to the ER Sanglah Hospital Denpasar, Bali Indonesia with complaints of slurred speech using an incomprehensible language, and repeating the same words. Talking about seeing a shadow following him but actually not there. Patients often experience sleep disorders, from the results of neurological physical examination found right eye ptosis, pupil anisokor, nerve III dextra complete lesion, supranuclear left NVII paresis, supranuclear left NXII paresis, left flaccid hemiparesis. Psychiatric status obtained unnatural appearance, looks confused, verbal and visual contact is sufficient, mood dysphoric, confused affect and there is no harmony. The thought process obtained realistic, coherent, preoccupation with pain. Perceptual disturbances in the form of visual and auditory hallucinations. Insomnia mixed type and there is hypobulia. Psychomotor calm on examination, history increases. Narcissistic personality traits and defense mechanisms of ego repression. Grade 4 view. CT scan of the head with and without contrast shows subacute ischemic cerebral infarction in the right internal capsule to the right thalamus and midbrain. Conclusion: Organic hallucinosis occur in non-hemorrhagic stroke caused by thrombosis process if an infarction is found in the right hemisphere. Keywords: organic hallucinations, ischemic cerebral infarction, non-hemorrhagic stroke, right hemisphere.

scholarly journals Novel antibodies detect additional α-synuclein pathology in synucleinopathies: potential development for immunotherapy

2020 ◽  
Vol 12 (1) ◽  
Author(s):  
Jacqui T. Nimmo ◽  
Ajay Verma ◽  
Jean-Cosme Dodart ◽  
Chang Yi Wang ◽  
Jimmy Savistchenko ◽  
...  
Keyword(s):  
Human Brain ◽  
Guinea Pigs ◽  
Lewy Bodies ◽  
Insular Cortex ◽  
Internal Capsule ◽  
Brain Regions ◽  
Alpha Synuclein ◽  
Human Brain Tissue ◽  
Lewy Neurites ◽  
Slot Blot Analysis

Abstract Background Alpha-synuclein (α-Syn) aggregation is the primary characteristic of synucleinopathies including Parkinson’s disease (PD), dementia with Lewy bodies (DLB) and multiple system atrophy (MSA). Immunotherapy targeting α-Syn has shown promising results in animal models of the disease. This study investigates the target specificity of three different active vaccines for pathological α-Syn aggregates found in human brain tissue from synucleinopathies. Methods Guinea pigs were immunised with 3 vaccines developed by United Neuroscience, and IgG fractions purified from the resulting immune sera (IGG-1, IGG-2 or IGG-3) were used to perform immunohistochemical staining of human cases of PD, DLB and MSA. The resulting immunoreactivity was compared to a commercially available α-Syn antibody from Novacastra (NOV) commonly used for diagnostic purposes. Images were captured from the substantia nigra (SN), temporal lobe, internal capsule, insular cortex and putamen and quantified for the percentage area with α-Syn immunoreactivity. Lewy bodies (LB) and Lewy neurites (LN) were further analysed in PD and DLB cases. Results Vaccine-generated antibodies detected more α-Syn pathology compared to NOV. The levels of α-Syn immunoreactivity varied between brain region and disease type with IGG-3 recognising the highest levels of α-Syn in most cases and in all brain regions that are affected early in disease progression. IGG-3 had a high recognition for glial inclusions found in MSA which are known to have a more compact conformation. Slot blot analysis confirmed the specificity of IGG-3 for native oligomers and fibrillar α-Syn. Higher levels of α-Syn were recognised by IGG-2 in cortical regions, and by IGG-3 in SN of PD and DLB cases. This was due to increased immunolabelling of LNs in these brain regions suggesting that IGG-2 and IGG-3 recognised additional α-Syn pathology compared to IGG-1 and NOV. Whether the unique binding properties of the antibodies produced in guinea pigs will translate in the clinic remains to be addressed, which is the main limitation of this study. Conclusions These vaccines induce antibodies that bind α-Syn oligomers and aggregates in the human brain and specifically support the choice of the vaccine generating IGG-3 (i.e. UB-312) as a candidate for clinical trials for synucleinopathies.

Deep Brain Stimulator Electrodes Used for Lesioning: Proof of Principle

Neurosurgery ◽  
2001 ◽  
Vol 49 (2) ◽  
pp. 363-369 ◽  
Author(s):  
Michael Y. Oh ◽  
Mojgan Hodaie ◽  
Seong Ho Kim ◽  
Ahmed Alkhani ◽  
Anthony E. Lang ◽  
...  
Keyword(s):  
Subthalamic Nucleus ◽  
Lesion Size ◽  
Therapeutic Benefit ◽  
Ethical Review ◽  
Deep Brain Stimulator ◽  
Implanted Electrodes ◽  
Radiofrequency Lesions ◽  
The Right ◽  
Deep Brain

Abstract OBJECTIVE Patients with chronically implanted deep brain stimulator (DBS) electrodes can encounter complications requiring hardware removal. We assessed the safety and efficacy of using implanted DBS electrodes to create a therapeutic lesion before their removal. METHODS Revision or removal of the DBS electrodes was required in two patients who had previously undergone DBS implantation. We conducted a series of in vitro experiments to confirm that the DBS electrodes could be used to generate radiofrequency lesions and to assess the relationship between radiofrequency parameters and lesion size. With this information, and with the approval of the hospital ethical review board, implanted electrodes were used to create incremental radiofrequency lesions in the thalamus in one patient and in the subthalamic nucleus in another. The procedures were performed under local anesthesia with contiguous contacts of the DBS lead connected to the active and reference sites of the RF generator to create a bipolar lesion. RESULTS A 51-year-old man with essential tremor and a thalamic DBS required repeated battery changes secondary to tolerance and high voltage demands. Rather than replacing the battery, a radiofrequency thalamotomy was performed by using the existing left DBS electrode. At the 6-month follow-up examination, successful lesioning provided near complete tremor control. A second patient, a 50-year-old man with Parkinson's disease who had undergone bilateral subthalamic deep brain stimulation, developed skin erosion over the DBS hardware. A subthalamic nucleus lesion was made through the right DBS electrode. Lesion position and size were confirmed with magnetic resonance imaging. CONCLUSION Lesions can be made through chronically implanted DBS electrodes in a safe, graded fashion and can produce therapeutic benefit.

scholarly journals Insular Cortex Mediates Attentional Capture by Behaviorally Relevant Stimuli after Damage to the Right Temporoparietal Junction

2021 ◽  
Author(s):  
Radek Ptak ◽  
Elena Pedrazzini
Keyword(s):  
Attentional Capture ◽  
Mechanistic Model ◽  
Insular Cortex ◽  
Brain Regions ◽  
Attentional Focus ◽  
Functional Connection ◽  
Temporoparietal Junction ◽  
Spatial Cuing ◽  
Right Temporoparietal Junction ◽  
The Right

Abstract The right temporoparietal junction (rTPJ) and insula both play a key role for the processing of relevant stimuli. However, while both have been conceived as neural “switches” that detect salient events and redirect the focus of attention, it remains unclear how these brain regions interact to achieve this behavioral goal. Here, we tested human participants with focal left-hemispheric or right-hemispheric lesions in a spatial cuing task that requires participants to react to lateralized stimuli preceded by a distracter that shares or does not share a relevant feature with the target. Using machine learning to identify significant lesion–behavior relationships, we found that rTPJ damage produces distinctive, pathologically increased attentional capture, but only by relevant distracters. Functional connectivity analyses revealed that the degree of capture is positively associated with a functional connection between insula and rTPJ, together with functional isolation of the rTPJ from right dorsal prefrontal cortex (dPFC). These findings suggest a mechanistic model where the insula–rTPJ connection constitutes a crucial functional unit that breaks attentional focus upon detection of behaviorally relevant events, while the dPFC appears to attune this activity.

scholarly journals Frequency and Intensity of Premonitory Urges to tic in Tourette Syndrome is associated with SMA GABA+ levels

2021 ◽  
Author(s):  
Jason He ◽  
Mark Mikkelsen ◽  
David Huddleston ◽  
Deana Crocetti ◽  
Kim Cecil ◽  
...  
Keyword(s):  
Tourette Syndrome ◽  
Insular Cortex ◽  
Brain Regions ◽  
Resonance Spectroscopy ◽  
Typically Developing ◽  
Gabaergic Neurotransmission ◽  
Primary Sensorimotor Cortex ◽  
Tic Severity ◽  
The Right

Background. Individuals with Tourette syndrome (TS) often report that they express tics as a means of alleviating the experience of unpleasant sensations. These sensations are perceived as an urge to act and are referred to as premonitory urges. Premonitory urges have been the focus of recent efforts to develop interventions to reduce tic expression in those with TS. Increasing evidence points to the role of both structural and functional alterations of prefrontal and limbic brain regions regarding the experience of premonitory urges to tic in TS. This study examined the contribution of brain GABA and glutamate levels of the right primary sensorimotor cortex (SM1), supplementary motor area (SMA), and insular cortex (insula) to tic and urge severity in children with TS.Methods. Edited magnetic resonance spectroscopy was used to assess GABA+ (GABA + macromolecules) and Glx (glutamate + glutamine) of the right SM1, SMA and insula in 68 children with TS (MAge = 10.59, SDAge = 1.33) and 41 typically developing controls (MAge = 10.26, SDAge = 2.21). We first compared GABA+ and Glx levels of these brain regions between groups. We then explored the association between regional GABA+ and Glx levels with urge and tic severity. Results. GABA+ and Glx of the right SM1, SMA and insula were comparable between the children with TS and typically developing controls. In children with TS, lower levels of SMA GABA+ was associated with more severe and more frequent premonitory urges. Neither GABA+ nor Glx levels were associated with tic severity. Conclusions. These results broadly support the role of GABAergic neurotransmission within the SMA in the experience of premonitory urges in children with TS.

Altered thalamic connectivity during spontaneous attacks of migraine without aura: A resting-state fMRI study

Cephalalgia ◽  
2017 ◽  
Vol 38 (7) ◽  
pp. 1237-1244 ◽  
Author(s):  
Faisal Mohammad Amin ◽  
Anders Hougaard ◽  
Stefano Magon ◽  
Till Sprenger ◽  
Frauke Wolfram ◽  
...  
Keyword(s):  
Functional Connectivity ◽  
Resting State ◽  
Migraine Without Aura ◽  
Primary Motor Cortex ◽  
Premotor Cortex ◽  
Network Connectivity ◽  
Insular Cortex ◽  
Resting State Fmri ◽  
Brain Regions ◽  
The Right

Background Functional connectivity of brain networks may be altered in migraine without aura patients. Functional magnetic resonance imaging (fMRI) studies have demonstrated changed activity in the thalamus, pons and cerebellum in migraineurs. Here, we investigated the thalamic, pontine and cerebellar network connectivity during spontaneous migraine attacks. Methods Seventeen patients with episodic migraine without aura underwent resting-state fMRI scan during and outside of a spontaneous migraine attack. Primary endpoint was a difference in functional connectivity between the attack and the headache-free days. Functional connectivity was assessed in four different networks using seed-based analysis. The chosen seeds were in the thalamus (MNI coordinates x,y,z: right, 22,–24,0 and left, –22,–28,6), pons (right, 8,–24,–32 and left, –8,–24,–32), cerebellum crus I (right, 46,–58,–30 and left, –46,–58,–30) and cerebellum lobule VI (right, 34,–42,–36 and left, –32,–42,–36). Results We found increased functional connectivity between the right thalamus and several contralateral brain regions (superior parietal lobule, insular cortex, primary motor cortex, supplementary motor area and orbitofrontal cortex). There was decreased functional connectivity between the right thalamus and three ipsilateral brain areas (primary somatosensory cortex and premotor cortex). We found no change in functional connectivity in the pontine or the cerebellar networks. Conclusions The study indicates that network connectivity between thalamus and pain modulating as well as pain encoding cortical areas are affected during spontaneous migraine attacks.

Poststroke fixed dystonia of the foot relieved by chronic stimulation of the posterior limb of the internal capsule

2009 ◽  
Vol 111 (6) ◽  
pp. 1216-1219 ◽  
Author(s):  
Angelo Franzini ◽  
Giuseppe Messina ◽  
Carlo Marras ◽  
Franco Molteni ◽  
Roberto Cordella ◽  
...  
Keyword(s):  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
Internal Capsule ◽  
Chronic Stimulation ◽  
Posterior Limb ◽  
The Right ◽  
Globus Pallidus Externus ◽  
Fixed Dystonia ◽  
Deep Brain ◽  
Stimulation Of

The authors report the case of an adult patient with irreducible fixed dystonia (inward rotation) of the right foot that arose after cardioembolic ischemia of the left putamen and globus pallidus externus. Given the resistance of such symptomatology to all of the attempted conservative treatments (including botulinum toxin), the authors decided to perform deep brain stimulation, positioning the intracerebral electrode in the left internal capsule at the level of the motor fibers controlling the right foot, as confirmed by intraoperative electromyography. After the intervention, the patient was able to perform voluntary movements of outward rotation and abduction in the right foot and begin gait rehabilitation. Deep brain stimulation of the posterior limb of the internal capsule could be an alternative target used to treat poststroke fixed dystonic conditions.

Serotonin 5-HT2 receptor imaging in major depression: focal changes in orbito-insular cortex

1997 ◽  
Vol 171 (5) ◽  
pp. 444-448 ◽  
Author(s):  
Françoise Biver ◽  
David Wikler ◽  
Françoise Lotstra ◽  
Philippe Damhaut ◽  
Serge Goldman ◽  
...  
Keyword(s):  
Major Depression ◽  
Rating Scale ◽  
Right Hemisphere ◽  
Statistical Parametric Mapping ◽  
Insular Cortex ◽  
Brain Regions ◽  
Receptor Imaging ◽  
Depressed Patients ◽  
Positron Emission ◽  
The Right

BackgroundSerotonin receptors may play an important role in the pathophysiology of affective disorders. We studied type-2 serotonin (5-HT2) receptors in the brain of patients with major depression.MethodUsing positron emission tomography (PET) and the selective radioligand [18F]altanserin, we investigated 5-HT2 receptor distribution in eight drug-free unipolar depressed patients and 22 healthy subjects. Data were analysed using Statistical Parametric Mapping 95.ResultsIn depressed patients, [18F]altanserin uptake was significantly reduced in a region of the right hemisphere including the posterolateral orbitofrontal cortex and the anterior insular cortex. A trend to similar changes was found in the left hemisphere. No correlation was found between the uptake and the Hamilton rating scale score.ConclusionsPathophysiology of depression may involve changes in 5-HT2 receptor in brain regions selectively implicated in mood regulation.

Neural Underpinnings of Numerical and Spatial Cognition: An fMRI Meta-Analysis of Brain Regions Associated with Symbolic Number, Arithmetic, and Mental Rotation

2019 ◽  
Author(s):  
Zachary Hawes ◽  
H Moriah Sokolowski ◽  
Chuka Bosah Ononye ◽  
Daniel Ansari
Keyword(s):  
Mental Rotation ◽  
Parietal Lobe ◽  
Meta Analysis ◽  
Likelihood Estimation ◽  
Brain Regions ◽  
Angular Gyrus ◽  
Number Representation ◽  
Neural Underpinnings ◽  
The Right ◽  
Symbolic Number

Where and under what conditions do spatial and numerical skills converge and diverge in the brain? To address this question, we conducted a meta-analysis of brain regions associated with basic symbolic number processing, arithmetic, and mental rotation. We used Activation Likelihood Estimation (ALE) to construct quantitative meta-analytic maps synthesizing results from 86 neuroimaging papers (~ 30 studies/cognitive process). All three cognitive processes were found to activate bilateral parietal regions in and around the intraparietal sulcus (IPS); a finding consistent with shared processing accounts. Numerical and arithmetic processing were associated with overlap in the left angular gyrus, whereas mental rotation and arithmetic both showed activity in the middle frontal gyri. These patterns suggest regions of cortex potentially more specialized for symbolic number representation and domain-general mental manipulation, respectively. Additionally, arithmetic was associated with unique activity throughout the fronto-parietal network and mental rotation was associated with unique activity in the right superior parietal lobe. Overall, these results provide new insights into the intersection of numerical and spatial thought in the human brain.

Deep brain stimulation of the posterior limb of the internal capsule in the treatment of central poststroke neuropathic pain of the lower limb: case series with long-term follow-up and literature review

2020 ◽  
Vol 133 (3) ◽  
pp. 830-838 ◽  
Author(s):  
Andrea Franzini ◽  
Giuseppe Messina ◽  
Vincenzo Levi ◽  
Antonio D’Ammando ◽  
Roberto Cordella ◽  
...  
Keyword(s):  
Neuropathic Pain ◽  
Lower Limb ◽  
Internal Capsule ◽  
Posterior Limb ◽  
Vas Score ◽  
The Mean ◽  
Deep Brain ◽  
Stimulation Of

OBJECTIVECentral poststroke neuropathic pain is a debilitating syndrome that is often resistant to medical therapies. Surgical measures include motor cortex stimulation and deep brain stimulation (DBS), which have been used to relieve pain. The aim of this study was to retrospectively assess the safety and long-term efficacy of DBS of the posterior limb of the internal capsule for relieving central poststroke neuropathic pain and associated spasticity affecting the lower limb.METHODSClinical and surgical data were retrospectively collected and analyzed in all patients who had undergone DBS of the posterior limb of the internal capsule to address central poststroke neuropathic pain refractory to conservative measures. In addition, long-term pain intensity and level of satisfaction gained from stimulation were assessed. Pain was evaluated using the visual analog scale (VAS). Information on gait improvement was obtained from medical records, neurological examination, and interview.RESULTSFour patients have undergone the procedure since 2001. No mortality or morbidity related to the surgery was recorded. In three patients, stimulation of the posterior limb of the internal capsule resulted in long-term pain relief; in a fourth patient, the procedure failed to produce any long-lasting positive effect. Two patients obtained a reduction in spasticity and improved motor capability. Before surgery, the mean VAS score was 9 (range 8–10). In the immediate postoperative period and within 1 week after the DBS system had been turned on, the mean VAS score was significantly lower at a mean of 3 (range 0–6). After a mean follow-up of 5.88 years, the mean VAS score was still reduced at 5.5 (range 3–8). The mean percentage of long-term pain reduction was 38.13%.CONCLUSIONSThis series suggests that stimulation of the posterior limb of the internal capsule is safe and effective in treating patients with chronic neuropathic pain affecting the lower limb. The procedure may be a more targeted treatment method than motor cortex stimulation or other neuromodulation techniques in the subset of patients whose pain and spasticity are referred to the lower limbs.

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