Mood Changes After Right-Hemisphere Lesions

1989 ◽  
Vol 155 (1) ◽  
pp. 79-85 ◽  
Author(s):  
Sergio E. Starkstein ◽  
Robert G. Robinson ◽  
Marc A. Honig ◽  
Rajesh M. Parikh ◽  
John Joselyn ◽  
...  
Keyword(s):  
Major Depression ◽  
Daily Living ◽  
Right Hemisphere ◽  
Demographic Variables ◽  
Neurological Deficits ◽  
Mood Changes ◽  
Frontal Operculum ◽  
History Of ◽  
The Right

Ninety-three patients with acute stroke lesions restricted to the right hemisphere were examined for the presence of mood changes. While 46 patients showed no mood changes, 19 were unduly cheerful, 17 had developed major depression, and 11 had developed minor depression. Although there were no significant between-groups differences in other demographic variables, neurological deficits, activities of daily living, cognitive impairment, or quality of social support, patients with major depression had a significantly higher frequency of familial history of psychiatric disorder and lesions of the parietal cortex than patients with either no mood change or major depression following left-hemisphere lesions. On the other hand, undue cheerfulness was significantly associated with lesions of the right frontal operculum. These findings suggest that major depression following right-hemisphere lesions may have a different aetiology and mechanism than major depression following left frontal or basal ganglia lesions.

scholarly journals Depth Electrode Guided Anterior Insulectomy: 2-Dimensional Operative Video

2021 ◽  
Author(s):  
Mauricio Mandel ◽  
Layton Lamsam ◽  
Pue Farooque ◽  
Dennis Spencer ◽  
Eyiyemisi Damisah
Keyword(s):  
Right Hemisphere ◽  
Preoperative Evaluation ◽  
Epileptiform Activity ◽  
Neurological Deficits ◽  
Depth Electrodes ◽  
Depth Electrode ◽  
Patient Reported ◽  
Frontal Operculum ◽  
History Of ◽  
Electroencephalogram Eeg

Abstract The insula is well established as an epileptogenic area.1 Insular epilepsy surgery demands precise anatomic knowledge2-4 and tailored removal of the epileptic zone with careful neuromonitoring.5 We present an operative video illustrating an intracranial electroencephalogram (EEG) depth electrode guided anterior insulectomy.  We report a 17-yr-old right-handed woman with a 4-yr history of medically refractory epilepsy. The patient reported daily nocturnal ictal vocalization preceded by an indescribable feeling. Preoperative evaluation was suggestive of a right frontal-temporal onset, but the noninvasive results were discordant. She underwent a combined intracranial EEG study with a frontal-parietal grid, with strips and depth electrodes covering the entire right hemisphere. Epileptiform activity was observed in contact 6 of the anterior insula electrode. The patient consented to the procedure and to the publication of her images.  A right anterior insulectomy was performed. First, a portion of the frontal operculum was resected and neuronavigation was used for the initial insula localization. However, due to unreliable neuronavigation (ie, brain shift), the medial and anterior borders of the insular resection were guided by the depth electrode reference. The patient was discharged 3 d after surgery with no neurological deficits and remains seizure free.  We demonstrate that depth electrode guided insular surgery is a safe and precise technique, leading to an optimal outcome.

Interhemispheric Contralateral Transfalcine Approach for Subparacentral Arteriovenous Malformation: 3-Dimensional Operative Video

2021 ◽  
Author(s):  
Matías Baldoncini ◽  
Alvaro Campero ◽  
Sabino Luzzi ◽  
Juan F Villalonga
Keyword(s):  
Right Hemisphere ◽  
Vascular Lesion ◽  
Neurological Deficits ◽  
3 Dimensional ◽  
Postoperative Mri ◽  
Drainage Vein ◽  
History Of ◽  
Magnetic Resonance Imaging Mri ◽  
Superior Longitudinal Sinus ◽  
The Right

Abstract Neurovascular procedures along the interhemispheric fissure harbor unique features differentiating them from those arteriovenous malformations (AVMs) located at the lateral surface of the brain.1-4  The aim of this 3-dimensional operative video is to present a microsurgical resection of an AVM in a subparacentral location, operated through an interhemispheric contralateral transfalcine approach.1,3,5  This is a case of a 29-yr-old female, with headaches and history of seizures. The patient presented an interhemispheric bleeding 6 mo before the surgery. The magnetic resonance imaging (MRI) showed a vascular lesion located on the medial surface of the right hemisphere at the confluence between the cingulate sulcus and its ascending sulcus. In the cerebral angiography, a right medial AVM was observed, receiving afference from the right anterior cerebral artery and draining to the superior longitudinal sinus. The patient signed an informed consent for the procedure and agreed with the use of her images and surgical video for research and academic purposes.  The patient was in a supine position, and a left interhemispheric contralateral transfalcine approach was performed,1-3 a circumferential dissection of the nidus, and, finally, the AVM was resected in one piece.  The patient evolved without neurological deficits after the surgery. The postoperative MRI and angiography showed a complete resection of the AVM.  In the case presented, to avoid exposing the drainage vein first and to use the gravity of the exposure, the contralateral transfalcine interhemispheric approach was used,1,2 which finally accomplished the proposed objectives.

scholarly journals Dissociated Crossed Speech Areas in a Tumour Patient

2017 ◽  
Vol 9 (2) ◽  
pp. 131-136 ◽  
Author(s):  
Jörg Mauler ◽  
Irene Neuner ◽  
Georg Neuloh ◽  
Bruno Fimm ◽  
Frank Boers ◽  
...  
Keyword(s):  
Right Hemisphere ◽  
Insular Cortex ◽  
Low Grade ◽  
Wada Test ◽  
Brain Hemispheres ◽  
Eloquent Areas ◽  
Tumour Removal ◽  
Frontal Operculum ◽  
The Right ◽  
Impaired Speech

In the past, the eloquent areas could be deliberately localised by the invasive Wada test. The very rare cases of dissociated crossed speech areas were accidentally found based on the clinical symptomatology. Today functional magnetic resonance imaging (fMRI)-based imaging can be employed to non-invasively localise the eloquent areas in brain tumour patients for therapy planning. A 41-year-old, left-handed man with a low-grade glioma in the left frontal operculum extending to the insular cortex, tension headaches, and anomic aphasia over 5 months underwent a pre-operative speech area localisation fMRI measurement, which revealed the evidence of the transhemispheric disposition, where the dominant Wernicke speech area is located on the left and the Broca’s area is strongly lateralised to the right hemisphere. The outcome of the Wada test and the intraoperative cortico-subcortical stimulation mapping were congruent with this finding. After tumour removal, language area function was fully preserved. Upon the occurrence of brain tumours with a risk of impaired speech function, the rare dissociate crossed speech areas disposition may gain a clinically relevant meaning by allowing for more extended tumour removal. Hence, for its identification, diagnostics which take into account both brain hemispheres, such as fMRI, are recommended.

#3117 Fregoli syndrome in primary and secondary psychosis: a case level meta-analysis

2021 ◽  
Vol 92 (8) ◽  
pp. A18-A18
Author(s):  
Maria Teixeira-Dias ◽  
Amber Kaur Dadwal ◽  
Graham Blackman
Keyword(s):  
Right Hemisphere ◽  
English Literature ◽  
Meta Analysis ◽  
First Episode ◽  
Bias Assessment ◽  
Random Effects Models ◽  
Episode Psychosis ◽  
Treatment Responses ◽  
The Right

Objectives/AimsFregoli syndrome is a rare delusion characterised by the misidentification of an individual, typically of someone who the patient has an emotional link towards. The pathoaetiology of Fregoli syndrome remains largely a mystery, however, it has been described in patients experiencing either a primary or secondary (organic) psychosis. We sought to compare the neuropsychiatric features of Fregoli syndrome in primary and secondary psychosis.MethodsA patient-level meta-analysis was conducted. Five databases were searched for any descriptions of Fregoli syndrome. The patients and the psychotic episodes details alongside the co-occurring neuropsychiatric features and treatment responses were extracted. A risk of bias assessment was carried by scoring the methodological quality of all case studies. Random-effects models were used to pool the data and odds ratios and 95% confidence intervals were estimated for each of the neuropsychiatric features extracted between primary and secondary psychoses groups.ResultsA total of 119 patients (62 with primary psychosis, 50 with secondary psychosis and 7 with mixed or unknown aetiology) with Fregoli syndrome were identified in the English literature. Persecutory features were more likely to occur in patients with primary Fregoli syndrome (OR = 0.26, 95% CI[0.10;0.67], p < 0.01). In addition, Fregoli syndrome in the context of a first-episode psychosis (OR = 11.00, 95% CI [2.45;49.39], p < 0.01) and in the presence of neuroimaging abnormalities (OR = 20.19, 95% CI [4.36; 93.47], p < 0.01) was significantly associated with secondary aetiology. Patients in the secondary psychosis group (n=14) showed more right hemisphere lesions than patients in the primary psychosis group (n=1), however this trend was not significant (p = 0.10). Furthermore, no statistical differences between psychoses groups were found for the demographic, clinical and neurophysiological features analysed.ConclusionsThis is the first meta-analysis investigating the features of Fregoli syndrome in primary and secondary psychosis.Findings suggest that secondary causes of Fregoli syndrome are associated with a first-episode of psychosis and that neuroimaging abnormalities, particularly in the right hemisphere, are associated with a secondary organic cause.

scholarly journals Bebês em creches nas zonas rurais do Brasil

2020 ◽  
Vol 6 (10) ◽  
pp. 264
Author(s):  
Patricia Maria Uchôa SIMÕES ◽  
Mariana Uchôa Simões BARBOSA
Keyword(s):  
Early Childhood ◽  
Early Childhood Education ◽  
Rural Areas ◽  
Rural Populations ◽  
Childhood Education ◽  
Daycare Centers ◽  
History Of ◽  
The Right ◽  
Educational Indicators

RESUMONo Brasil, a história da educação institucionalizada dos bebês inicia-se com instituições voltadas para o atendimento das populações mais pobres das cidades e está relacionada à industrialização e urbanização. Essa origem explica, em parte, a escassa oferta de Educação Infantil para as populações rurais, até hoje. O estudo debate a trajetória das creches das zonas rurais, analisa alguns dos indicadores educacionais e dados da implantação do Proinfância nessas áreas. As conclusões apontam para os avanços na legislação e a melhoria dos indicadores educacionais nas primeiras décadas desse século, também apresenta o Proinfância como uma alternativa para as zonas rurais, com a oferta de apoio aos municípios na construção de políticas de inclusão dos bebês em creche com maior qualidade de atendimento. Faz-se necessário a afirmação desses bebês como sujeitos de direitos, da sua educação como condição de cidadania e da especificidade da creche nas zonas rurais como direito à diferença.Bebês. Creche. Educação Infantil do Campo. Babies in daycare centers in rural BrazilABSTRACT In Brazil, the history of institutionalized baby education begins with institutions aimed at serving the poorest populations in cities and is related to industrialization and urbanization. This origin explains, in part, the scarce offer of Early Childhood Education for rural populations, even today. The study debates the trajectory of daycare centers in rural areas, analyzes some of the educational indicators and data on the implementation of Proinfância in these areas. The conclusions point to advances in legislation and the improvement of educational indicators in the first decades of this century, it also presents Proinfância as an alternative for rural areas, with the offer of support to municipalities in the construction of policies for the inclusion of babies in daycare centers with higher quality of care. It is necessary to affirm these babies as subjects of rights, their education as a condition of citizenship and the specificity of daycare in rural areas as the right to difference.Babies. Nursery. Rural Early Childhood Education. Bebés en guarderías en zonas rurales de BrasilRESUMEN En Brasil, la historia de la educación institucionalizada de bebes comienza con instituciones destinadas a servir a las poblaciones más pobres de las ciudades y está relacionada con la industrialización y la urbanización. Este origen explica, en parte, la escasa oferta de educación de la primera infancia para las poblaciones rurales, incluso hoy en día. El estudio debate la trayectoria de las guarderías en áreas rurales, analiza algunos de los indicadores educacionales y los datos sobre la implementación de “Proinfância” en estas áreas. Las conclusiones apuntan a avances en la legislación y la mejora de los indicadores educacionales en las primeras décadas de este siglo, también presenta a “Proinfância” como una alternativa para las zonas rurales, ofreciendo apoyo a los municipios en la construcción de políticas para la inclusión de bebés en guarderías con mejor calidad de cuidado. Es necesario afirmar que estos bebés son sujetos de derechos, su educación debe ser entendida como condición de ciudadanía y la especificidad de la guardería en las zonas rurales como un derecho a la diferencia.Bebés. Guardería. Educación de la primera infancia rural. Bambini in asili nele aree rurali del BrasileSINTESEIn Brasile, la storia dell'educazione al bambino istituzionalizzata inizia con istituzioni progettate per servire le popolazioni più povere delle città ed è legata all'industrializzazione e all'urbanizzazione. Questa origine spiega, in parte, l'offerta limitata di educazione della prima infanzia per le popolazioni rurali, anche oggi. Lo studio discute la traiettoria degli asili nelle aree rurali, analizza alcuni degli indicatori e dati educativi sull'attuazione di "Proinfância" in queste aree. Le conclusioni indicano i progressi della legislazione e il miglioramento degli indicatori educativi nei primi decenni di questo secolo, inoltre presenta "Proinfância" come alternativa alle aree rurali, offrendo supporto ai comuni nella costruzione di politiche per l'inclusione dei bambini negli asili nido con una migliore qualità delle cure. È necessario affermare che questi bambini sono soggetti di diritti, la loro educazione deve essere intesa come una condizione di cittadinanza e la specificità dell'assistenza all'infanzia nelle aree rurali come un diritto alla differenza.

scholarly journals Integument: Guidelines for the care of people with spina bifida

2020 ◽  
Vol 13 (4) ◽  
pp. 543-548
Author(s):  
Patricia Beierwaltes ◽  
Sharon Munoz ◽  
Jennifer Wilhelmy
Keyword(s):  
Spina Bifida ◽  
Daily Living ◽  
Wound Care ◽  
Consensus Building ◽  
Existing Problems ◽  
The Past ◽  
Whole Person ◽  
History Of ◽  
Evidence Based Guidelines

PURPOSE: Skin-related issues have a significant impact on health, activities of daily living, and quality of life among people with spina bifida. Data presented by select clinics that participate in the National Spina Bifida Patient Registry reported that 26% of individuals had a history of pressure injuries with 19% having had one in the past year. The spina bifida community lack direct guidelines on prevention of these and other skin related issues. The Integument (skin) Guidelines focus on prevention, not treatment, of existing problems. METHODS: Using a consensus building methodology, the guidelines were written by experts in spina bifida and wound care. RESULTS: The guidelines include age-grouped, evidence-based guidelines written in the context of an understanding of the whole person. They are presented in table format according to the age of the person with spina bifida. CONCLUSION: These guidelines present a standardized approach to prevention of skin-related issues in spina bifida. Discovering what results in successful minimization of skin-related issues with testing of technology or prevention strategies is the next step in protecting this vulnerable population.

Advocacy and Coordination of Services

1985 ◽  
Vol 2 (1) ◽  
pp. 8-14
Author(s):  
Wanda Jean Rainbolt
Keyword(s):  
Physical Educators ◽  
History Of ◽  
Adapted Physical Educators ◽  
The 1960S ◽  
The Many ◽  
The Right ◽  
Time And Energy ◽  
Consumer Advocates ◽  
Architectural Barriers

Adapted physical educators are spending much of their time and energy advocating for the right of all children and youth to a high quality of physical education service delivery and the elimination of attitudinal, aspirational, and architectural barriers experienced by handicapped persons. Prior to the 1960s, lawyers or legal advocates were the ones who would plead the cause for others. Since then, however, three types of advocates have evolved: citizen, professional, and consumer advocates. Adapted physical educators are professional advocates, but they must have an understanding of the other types of advocates. The purpose of this article is to acquaint adapted physical educators with the job function of advocacy, the history of advocacy, and the many roles advocates play.

Outcome of no resection after long-term subdural electroencephalography evaluation in children with epilepsy

2011 ◽  
Vol 8 (3) ◽  
pp. 269-278 ◽  
Author(s):  
Elia M. Pestana Knight ◽  
Tobias Loddenkemper ◽  
Deepak Lachhwani ◽  
Prakash Kotagal ◽  
Elaine Wyllie ◽  
...  
Keyword(s):  
Right Hemisphere ◽  
Demographic Data ◽  
Neurological Deficits ◽  
Epileptogenic Zone ◽  
Dominant Hand ◽  
Resection Group ◽  
Group 2 ◽  
The Right ◽  
Permanent Neurological Deficit

Object The aim of this study was to identify the reasons for and predictors of no resection of the epileptogenic zone in children with epilepsy who had undergone long-term invasive subdural grid electroencephalography (SDG-EEG) evaluation. Methods The authors retrospectively reviewed the consecutive medical records of children (< 19 years of age) who had undergone SDG-EEG evaluation over a 7-year period (1997–2004). To determine the predictors of no resection, the authors obtained the clinical characteristics and imaging and EEG findings of children who had no resection after long-term invasive SDG-EEG evaluation and compared these data with those in a group of children who did undergo resection. They describe the indications for SDG-EEG evaluation and the reasons for no resection in these patients. Results Of 66 children who underwent SDG-EEG evaluation, 9 (13.6%) did not undergo subsequent resection (no-resection group; 6 males). Of these 9 patients, 6 (66.7%) had normal neurological examinations and 5 (55.6%) had normal findings on brain MR imaging. Scalp video EEG localized epilepsy to the left hemisphere in 6 of the 9 patients and to the right hemisphere in 2; it was nonlocalizable in 1 of the 9 patients. Indications for SDG-EEG in the no-resection group were ictal onset zone (IOZ) localization (9 of 9 patients), motor cortex localization (5 of 9 patients), and language area localization (4 of 9 patients). Reasons for no resection after SDG-EEG evaluation were the lack of a well-defined IOZ in 5 of 9 patients (4 multifocal IOZs and 1 nonlocalizable IOZ) and anticipated new permanent postoperative neurological deficits in 7 of 9 patients (3 motor, 2 language, and 2 motor and language deficits). Comparison with the resection group (57 patients) demonstrated that postictal Todd paralysis in the dominant hand was the only variable seen more commonly (χ2 = 4.781, p = 0.029) in the no-resection group (2 [22.2%] of 9 vs 2 [3.5%] of 57 patients). The no-resection group had a larger number of SDG electrode contacts (mean 126. 5 ± 26.98) as compared with the resection group (100.56 ± 25.52; p = 0.010). There were no significant differences in the demographic data, seizure characteristics, scalp and invasive EEG findings, and imaging variables between the resection and no-resection groups. Conclusions Children who did not undergo resection of the epileptogenic zone after SDG-EEG evaluation were likely to have normal neurological examinations without preexisting neurological deficits, a high probability of a new unacceptable permanent neurological deficit following resection, or multifocal or nonlocalizable IOZs. In comparison with the group that underwent resection after SDG-EEG, a history of Todd paralysis in the dominant hand and arm was the only predictor of no resection following SDG-EEG evaluation. Data in this study will help to better select pediatric patients for SDG-EEG and to counsel families prior to epilepsy surgery.

Primary cerebellar histiocytic sarcoma in a 17-month-old girl

2012 ◽  
Vol 10 (2) ◽  
pp. 126-129 ◽  
Author(s):  
Kiyoshi Gomi ◽  
Mio Tanaka ◽  
Mariko Yoshida ◽  
Susumu Ito ◽  
Masaki Sonoda ◽  
...  
Keyword(s):  
Right Hemisphere ◽  
Brain Mri ◽  
Histiocytic Sarcoma ◽  
Cerebellar Tumor ◽  
Pediatric Age Group ◽  
Old Japanese ◽  
History Of ◽  
Dural Attachment ◽  
The Right ◽  
Aggressive Clinical Course

The authors report on a case of histiocytic sarcoma (HS) in a pediatric patient presenting with a solitary tumor in the cerebellum, with the aim of providing insight into primary HS in the CNS, which is especially rare. A 17-month-old Japanese girl presented with a 2-week history of progressive gait disturbance. Brain MRI revealed a 4.7 × 4.3 × 4.3–cm well-demarcated solitary mass in the right hemisphere of the cerebellum, initially suggestive of medulloblastoma, ependymoma, or anaplastic astrocytoma. On intraoperative inspection the cerebellar tumor showed intensive dural attachment and was subtotally removed. Histological and immunohistochemical findings were consistent with HS. The patient subsequently received chemotherapy, and her preoperative neurological symptoms improved. Primary HS in the CNS usually demonstrates an aggressive clinical course and is currently considered to have a poor prognosis. The possibility of this rare tumor should be included in the differential diagnosis of localized cerebellar tumors in the pediatric age group.

Aprosodia and Its Treatment

2008 ◽  
Vol 18 (2) ◽  
pp. 66-72 ◽  
Author(s):  
Susan A. Leon ◽  
Amy D. Rodriguez
Keyword(s):  
Right Hemisphere ◽  
Hemispheric Lateralization ◽  
Motor Deficit ◽  
Emotional Communication ◽  
Emotional Information ◽  
Cognitive Linguistic ◽  
Linguistic Cues ◽  
Tone Of Voice ◽  
The Right

Abstract Aprosodia is a deficit in comprehending or expressing variations in tone of voice used to express both linguistic and emotional information. Affective aprosodia refers to a specific deficit in producing or comprehending the emotional or affective tones of voice. Aprosodia is most commonly associated with right hemisphere strokes; however, it may also result from other types of brain damage such as traumatic brain injury. Although research investigating hemispheric lateralization of prosody continues, there is strong evidence that most aspects of affective prosody are directed by the right hemisphere. Disorders of emotional communication can have a significant impact on quality of life for those affected and their families. However, there has been relatively little research regarding treatment for this disorder. Recently, 14 individuals were treated for affective aprosodia using two treatments, one based on cognitive-linguistic cues and the other on imitation of prosodic modeling. Most of the participants responded to at least one of the two treatments, and a refinement of the treatments are currently underway. Because researchers are finding support for the hypothesis that expressive aprosodia can result from a motor deficit, the refined treatment incorporates principles of motor learning to enhance imitation of prosodic models, as well as cognitive-linguistic cues.

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