scholarly journals The Opercular-Subopercular Syndrome: Four Cases with Review of the Literature

1998 ◽  
Vol 11 (2) ◽  
pp. 97-103 ◽  
Author(s):  
M. Bakar ◽  
H. S. Kirshner ◽  
F. Niaz
Keyword(s):  
Right Hemisphere ◽  
Cortical Lesions ◽  
Review Of The Literature ◽  
Case Histories ◽  
Brain Images ◽  
Frontal Operculum ◽  
Opercular Syndrome ◽  
Ct Brain ◽  
Bilateral Lesions ◽  
The Brain

We present four cases of the ‘opercular syndrome’ of volitional paresis of the facial, lingual, and laryngeal muscles (bilateral facio-glosso-pharyngo-masticatory paresis). Case histories and CT brain images are presented, along with a review of the literature concerning this long-recognized but little-known syndrome. The neuroanatomic basis of the syndrome classically involves bilateral lesions of the frontal operculum. We propose, on the basis of our cases and others, that the identical syndrome can arise from lesions of the corticobulbar tracts, not involving the cortical operculum. Our cases included one with bilateral subcortical lesions, one with a unilateral left opercular lesion and a possible, non-visualized right hemisphere lesion, one with unilateral cortical and unilateral subcortical pathology, and one with bilateral cortical lesions. These lesion localizations suggest that any combination of cortical or subcortical lesions of the operculum or its connections on both sides of the brain can produce a syndrome indistinguishable from the classical opercular syndrome. We propose the new term ‘opercular-subopercular syndrome’ to encompass cases with predominantly or partially subcortical lesions.

Visual Organization Ability in Brain-Damaged Adults

1977 ◽  
Vol 45 (3) ◽  
pp. 723-728 ◽  
Author(s):  
Paul L. Wang
Keyword(s):  
Left Hemisphere ◽  
Right Hemisphere ◽  
Functional Dynamics ◽  
Visual Organization ◽  
Bilateral Lesions ◽  
The Brain ◽  
Better Than

49 brain-damaged patients (15 with left-hemisphere lesions, 19 with right-hemisphere lesions, and 15 with bilateral lesions) and 17 non-brain-damaged patients were administered the Hooper Visual Organization Test. Non-brain-damaged patients performed significantly better than the brain-damaged patients; however, the differences among the brain-damaged patients were not significant. Hooper Visual Organization Test seems valuable for identifying organicity but its usefulness for determining lateralization is limited. It is also suggested that both hemispheres form a close functional loop in subserving visual organization ability. A hypothetical diagram has been proposed to describe the functional dynamics of the visual synthesis ability measured by the Visual Organization Test.

scholarly journals Features Determination from Super-Voxels Obtained with Relative Linear Interactive Clustering

2016 ◽  
Vol 21 (3) ◽  
pp. 69-79 ◽  
Author(s):  
Abdelkhalek Bakkari ◽  
Anna Fabijańska
Keyword(s):  
Computational Cost ◽  
Brain Images ◽  
3D Images ◽  
New Approach ◽  
Magnetic Resonance Imaging Mri ◽  
Ct Brain ◽  
Interactive Clustering ◽  
The Brain ◽  
Low Computational Cost ◽  
3D Magnetic Resonance Imaging

Abstract In this paper, the problem of segmentation of 3D Magnetic Resonance Imaging (MRI) and Computed Tomography (CT) brain images is considered. A supervoxel-based segmentation is regarded. In particular, a new approach called Relative Linear Interactive Clustering (RLIC) is introduced. The method, dedicated to image division into super-voxels, is an extension of the Simple Linear Interactive Clustering (SLIC) super-pixels algorithm. During RLIC execution firstly, the cluster centres and the regular grid size are initialized. These are next clustered by Fuzzy C-Means algorithm. Then, the extraction of the super-voxels statistical features is performed. The method contributes with 3D images and serves fully volumetric image segmentation. Five cases are tested demonstrating that our Relative Linear Interactive Clustering (RLIC) is apt to handle huge size of images with a significant accuracy and a low computational cost. The results of applying the suggested method to segmentation of the brain tumour are exposed and discussed.

scholarly journals Review of Computational Methods on Brain Symmetric and Asymmetric Analysis from Neuroimaging Techniques

2016 ◽  
Author(s):  
P. Kalavathi ◽  
K. Senthamilselvi ◽  
V. B. Surya Prasath
Keyword(s):  
Right Hemisphere ◽  
Sagittal Plane ◽  
Correct Diagnosis ◽  
Brain Structures ◽  
Diagnostic Tools ◽  
Computational Techniques ◽  
Brain Images ◽  
Left And Right ◽  
The Brain ◽  
Neuroimaging Techniques

Brain is the most complex organ in the human body and it is divided into two hemispheres - left and right hemispheres. Left hemisphere is responsible for control of right side of our body whereas right hemisphere is responsible for control of left side of our body. Brain image segmentation from different neuroimaging modalities is one of the important parts in clinical diagnostic tools. Neuroimaging based digital imagery generally contain noise, inhomogeneity, aliasing artifacts, and orientational deviations. Therefore, accurate segmentation of brain images is a very difficult task. However, the development of accurate segmentation of brain images is very important and crucial for a correct diagnosis of any brain related diseases. One of the fundamental segmentation tasks is to identify and segment inter-hemispheric fissure/mid-sagittal plane, which separate the two hemispheres of the brain. Moreover, the symmetric/asymmetric analyses of left and right hemispheres of brain structures are important for radiologists to analyze diseases such as Alzheimer's, Autism, Schizophrenia, Lesions and Epilepsy. Therefore, in this paper we have analyzed the existing computational techniques used to find brain symmetric/asymmetric analysis in various neuroimaging techniques (MRI/CT/PET/SPECT), which are utilized for detecting various brain related disorders.

scholarly journals Unilateral opercular lesion mimicking opercular syndrome

2021 ◽  
Author(s):  
João Nicoli Ferreira dos Santos ◽  
Izadora Fonseca Zaiden Soares ◽  
Lis Gomes Silva
Keyword(s):  
Mouth Opening ◽  
Cranial Computed Tomography ◽  
Ischemic Lesion ◽  
Articulatory Movements ◽  
Frontal Operculum ◽  
History Of ◽  
Opercular Syndrome ◽  
The Right ◽  
Bilateral Lesions ◽  
Carotid Doppler

Introduction: Foix-Chavany-Marie syndrome, also known as opercular syndrome, consists of voluntary orofacial muscle paralysis due to bilateral lesions in the anterior frontotemporal operculum. Classically, there is an automatic-voluntary dissociation, with impairment of speech and chewing. We present a case of a patient who had a similar presentation to opercular syndrome, secondary to unilateral ischemic lesion in the right frontal operculum. Case report: A 55-year-old, right-handed, black woman with history of arterial hypertension was admitted to the emergency department presenting left-sided weakness and inability to speak, noticed upon waking. When approached, the patient was unable to produce sounds but managed to communicate through articulatory movements of lips and was able to write correctly without signs of aphasia. On examination, there was left central facial paralysis, marked reduction in mouth opening amplitude, inability to perform tongue protrusion without lateral deviation and bilateral reduction in palate elevation. There was also a mild left brachial- predominant hemiparesis (grade IV). A cranial computed tomography scan exhibited an acute ischemic lesion of the right frontal opercular region, without other lesions in the homologous contralateral area. The etiological investigation with electrocardiogram, echocardiogram and carotid doppler ultrasound had no significant abnormalities. Conclusion: We reported a case of a patient presenting with aphonia and bulbar musculature paresis due to a right unilateral frontal opercular lesion, mimicking the opercular syndrome presentation.

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.

Neurospect Findings in Patients Exposed to Neurotoxic Chemicals

1994 ◽  
Vol 10 (4-5) ◽  
pp. 561-571
Author(s):  
Gunnar Heuser ◽  
Ismael Mena ◽  
Francisca Alamos
Keyword(s):  
Elderly Patients ◽  
Qualitative Analysis ◽  
Right Hemisphere ◽  
Young Patients ◽  
Chronic Fatigue ◽  
Psychiatric Symptomatology ◽  
Elderly Individuals ◽  
Parietal Lobes ◽  
The Right ◽  
The Brain

Exposures to neurotoxic chemicals such as pesticides, glues, solvents, etc. are known to induce neurologic and psychiatric symptomatology. We report on 41 patients 16 young patients (6 males, 10 females, age 34 8 yrs.) and 25 elderly patients (9 males, 16 females, age 55 7 yrs). Fifteen of them were exposed to pesticides, and 29 to solvents. They were studied with quantitative and qualitative analysis of regional cerebral bood flow (rCBF), performed with 30 mCi of Xe-133 by inhalation, followed by 30 mCi of Tc-HMPAO given intravenously. Imaging was performed with a brain dedicated system, distribution of rCBF was assessed with automatic ROI definition, and HMPAO was normalized to maximal pixel activity in the brain. Results of Xe rCBF are expressed as mean and S.D. in ml/min/100g, and HMPAO as mean and S.D. uptake per ROI, and compared with age-matched controls 10 young and 20 elderly individuals. Neurotoxics HMPAO Uptake Young Elderly R. Orbital frontal R. Dorsal frontal .70 .66 p < 0.05 R. Temporal .64 p < 0.001 R. Parietal .66 .66 We conclude that patients exposed to chemicals present with diminished CBF, worse in the right hemisphere, with random presentation of areas of hypoperfusion, more prevalent in the dorsal frontal and parietal lobes. These findings are significantly different from observations in patients with chronic fatigue and depression, suggesting primary cortical effect, possibly due to a vasculitis process.

scholarly journals Medical Adjuvants in the Treatment of Surgically Refractory Arteriovenous Malformations of the Head and Face: Case Report and Review of Literature

2021 ◽  
pp. 1-7
Author(s):  
Vaidya Govindarajan ◽  
Joshua D. Burks ◽  
Evan M. Luther ◽  
John W. Thompson ◽  
Robert M. Starke
Keyword(s):  
Arteriovenous Malformations ◽  
Mtor Inhibitors ◽  
Molecular Target ◽  
Review Of Literature ◽  
Review Of The Literature ◽  
Early Results ◽  
Number Of Patients ◽  
Initiation Of Therapy ◽  
The Brain ◽  
Radiographic Improvement

<b><i>Background:</i></b> Arteriovenous malformations (AVMs) of the brain and face present unique challenges for clinicians. Cerebral AVMs may induce hemorrhage or form aneurysms, while facial AVMs can cause significant disfigurement and pain. Moreover, facial AVMs often draw blood supply from arteries providing critical blood flow to other important structures of the head which may make them impossible to treat curatively. Medical adjuvants may be an important consideration in the management of these patients. <b><i>Summary:</i></b> We conducted a systematic review of the literature to identify other instances of molecular target of rapamycin (mTOR) inhibitors used as medical adjuvants for the treatment of cranial and facial AVMs. We also present 2 cases from our own institution where patients were treated with partial embolization, followed by adjuvant therapy with rapamycin. After screening a total of 75 articles, 7 were identified which described use of rapamycin in the treatment of inoperable cranial or facial AVM. In total, 21 cases were reviewed. The median treatment duration was 12 months (3–24.5 months), and the highest recorded dose was 3.5 mg/m<sup>2</sup>. 76.2% of patients demonstrated at least a partial response to rapamycin therapy. In 2 patients treated at our institution, symptomatic and radiographic improvement were noted 6 months after initiation of therapy. <b><i>Key Messages:</i></b> Early results have been encouraging in a small number of patients with inoperable AVM of the head and face treated with mTOR inhibitors. Further study of medical adjuvants such as rapamycin may be worthwhile.

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.

The Korsakov Syndrome in Spontaneous Subarachnoid Haemorrhage

1953 ◽  
Vol 99 (416) ◽  
pp. 521-530 ◽  
Author(s):  
John N. Walton
Keyword(s):  
Subarachnoid Haemorrhage ◽  
Neurological Disorders ◽  
Review Of The Literature ◽  
Case Histories ◽  
Actual Case ◽  
Mental Symptoms ◽  
Symptom Complex ◽  
Excellent Description ◽  
The Subject ◽  
Neurological Conditions

The amnestic-confabulatory symptom-complex to which the eponymous title of Korsakov's syndrome is usually given was probably first described by the Swedish physician Magnus Huss (1807–90), who spent the greater part of his lifetime in the study of alcoholism. There is, however, no doubt that Korsakov's (1890) paper on the subject gave an excellent description of the syndrome, and stressed the fact that whereas it often developed in patients with alcoholism and polyneuritis, numerous other metabolic and neurological disorders could be complicated by the characteristic mental changes. Indeed, in Korsakov's (1890) own series of cases alcoholics were in the minority. One of the neurological conditions in which the syndrome has been described significantly often is spontaneous subarachnoid haemorrhage. The first reports of the association were probably those of Flatau (1918 and 1921), and it was discussed in some detail by Goldflam (1923) and Herman (1925 and 1926). Each of these authors described the mental symptoms exhaustively but gave no actual case-histories; the first fully documented cases in the literature were the two reported by Hall (1929). Single cases have since been described by Cubitt (1930), Popow (1930) and Kulkow (1935), and in 1939 Tarachow gave an extensive review of the literature and reported an additional 3 cases. It is remarkable that since 1939 the association has received little attention, although it has been mentioned by Sands (1941) and Meadows (1951).

Abnormalities of the HPA axis in affective disorders: clinical subtypes and potential treatments

2006 ◽  
Vol 18 (5) ◽  
pp. 193-209 ◽  
Author(s):  
Richard J. Porter ◽  
Peter Gallagher
Keyword(s):  
Bipolar Disorder ◽  
Cognitive Impairment ◽  
Hpa Axis ◽  
Affective Disorders ◽  
Psychotic Depression ◽  
Review Of The Literature ◽  
Hpa Axis Dysregulation ◽  
New Evidence ◽  
The Brain

Background:New evidence is emerging regarding abnormalities of hypothalamic-pituitary-adrenal (HPA) axis function in subtypes of affective disorders. Adverse effects of HPA axis dysregulation may include dysfunction of monoaminergic transmitter systems, cognitive impairment and peripheral effects. Newer treatments specifically targeting the HPA axis are being developed.Objective:To review these developments focusing particularly on the glucocorticoid receptor (GR) antagonist mifepristone.Method:A selective review of the literature.Results:The function of GRs is increasingly being defined. The role of corticotrophin-releasing hormone (CRH) and dehydroepiandrosterone (DHEA) in the brain is also increasingly understood. HPA axis function is particularly likely to be abnormal in psychotic depression and bipolar disorder, and it is in these conditions that trials of the GR antagonist mifepristone are being focused. CRH antagonists and DHEA are also being investigated as potential treatments.Conclusion:Initial studies of mifepristone and other HPA-axis-targeting agents in psychotic depression and bipolar disorder are encouraging and confirmatory studies are awaited.

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