An unusual association of headache, epilepsy, and late-onset Kleist’s pseudodepression syndrome in frontal lobe cavernoma of the cerebral left hemisphere

ABSTRACTA late onset frontal lobe syndrome (LOF) refers to a clinical syndrome with apathy, disinhibition, or stereotypical behavior arising in middle or late adulthood. Diagnostics are challenging, and both clinicians and patients need reliable predictors of progression to improve clinical guidance. In this longitudinal multicenter and genetically screened prospective study, 137 LOF patients with frontal behavior (FBI score≥11) and/or stereotypical behavior (SRI≥10) were included. Progression was defined as institutionalization, death, or progression of frontal or temporal atrophy at magnetic resonance imaging (MRI) after two years of follow up. Absence of progression at MRI in addition to stable or improved Mini Mental State Examination and Frontal Assessment Battery scores after two years was indicative for non-progression. The presence of stereotypy and a neuropsychological profile with executive deficits at baseline were found to be predictive for progression, while a history and family history with psychiatric disorders were predictors for non-progression. The combination of these clinical markers had a predictive value of 80.4% (p < 0.05). In patients presenting with late onset behavioral symptoms, an appraisal of the rate of deterioration can be made by detailed mapping of clinical symptoms. Distinction of progressive discourses from non-progressive or treatable conditions is to be gained.

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Impact of Imaging and Cerebrospinal Fluid Biomarkers on Behavioral Variant Frontotemporal Dementia Diagnosis within a Late-Onset Frontal Lobe Syndrome Cohort

Dementia and Geriatric Cognitive Disorders ◽

10.1159/000441023 ◽

2015 ◽

Vol 41 (1-2) ◽

pp. 16-26 ◽

Cited By ~ 7

Author(s):

Welmoed A. Krudop ◽

Annemiek Dols ◽

Cora J. Kerssens ◽

Niels D. Prins ◽

Christiane Möller ◽

...

Keyword(s):

Cerebrospinal Fluid ◽

Frontotemporal Dementia ◽

Frontal Lobe ◽

Fdg Pet ◽

Late Onset ◽

Behavioral Variant Frontotemporal Dementia ◽

Diagnostic Certainty ◽

18F Fdg ◽

Frontal Lobe Syndrome ◽

The Impact

Background: The criteria for behavioral variant frontotemporal dementia (bvFTD) incorporate MRI and [18F]-FDG-PET. Cerebrospinal fluid (CSF) analysis is merely advised for excluding Alzheimer's disease. Aims: We aimed to assess the impact of biomarkers on diagnostic certainty and contingent changes of bvFTD diagnosis within the clinically relevant neuropsychiatric differential diagnosis of subjects with a late-onset frontal lobe syndrome (LOF). Methods: We included 137 patients with LOF, aged 45-75 years, 72% males. Biomarker disclosure was considered contributing after any substantial difference in diagnostic certainty or a diagnostic change. Percentages of contributing biomarkers were compared between three major diagnostic groups (bvFTD, psychiatry, other neurological disorders). Certainty levels in stable diagnostic groups were compared to those with a diagnostic change. Results: Biomarkers contributed in 53, 60 and 41% of the LOF patients for MRI, [18F]-FDG-PET and CSF, respectively. Biomarkers changed the diagnosis in 14% of cases towards bvFTD and in 13% from bvFTD into an alternative. Those that changed had a lower level of a priori diagnostic certainty compared to stable diagnoses. Conclusion: Our study not only supports the widely accepted use of MRI and [18F]-FDG-PET in diagnosing or excluding bvFTD, but also shows that CSF biomarkers aid clinicians in the diagnostic process.

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Agrammatism in Adult Persian Broca's Aphasia: A Case Study

Journal of Language Teaching and Research ◽

10.17507/jltr.0705.24 ◽

2016 ◽

Vol 7 (5) ◽

pp. 1014 ◽

Cited By ~ 1

Author(s):

Leila Salehnejad ◽

Mansoore Shekaramiz

Keyword(s):

Frontal Lobe ◽

Left Hemisphere ◽

Native Speaker ◽

Spontaneous Speech ◽

Broca's Aphasia ◽

Control Data ◽

Grammatical Morphemes ◽

Broca’S Aphasia ◽

Frontal Lobe Lesion

The grammar of a right-handed monolingual adult native speaker of Persian who suffered from Broca's aphasic following a left hemisphere frontal lobe lesion subsequent to CVA was analyzed, discussed, and compared with control data. The spontaneous speech and descriptive speech were designed and performed. The data suggested that Persian agrammatism appears like this syndrome in other studied languages; there are severe impairments in the verbs and patients rely more on nouns than on verbs. The patterns of omissions and substitutions of grammatical morphemes seem show extreme variations in different patients, both in terms of the occurrence of errors in different grammatical morphemes as and in terms of the occurrence of omissions versus substitutions. There were also some language-particular patterns.

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Cerebral Lateralization of Frontal Lobe Language Processes and Lateralization of the Posterior Visual Word Processing System

Journal of Cognitive Neuroscience ◽

10.1162/jocn.2008.20043 ◽

2008 ◽

Vol 20 (4) ◽

pp. 672-681 ◽

Cited By ~ 56

Author(s):

Qing Cai ◽

Michal Lavidor ◽

Marc Brysbaert ◽

Yves Paulignan ◽

Tatjana A. Nazir

Keyword(s):

Frontal Lobe ◽

Left Hemisphere ◽

Language Production ◽

Word Processing ◽

Right Hemisphere ◽

Alternative Hypothesis ◽

Visual Word ◽

Related Potentials ◽

Hemisphere Dominance ◽

Visual Word Processing

The brain areas involved in visual word processing rapidly become lateralized to the left cerebral hemisphere. It is often assumed this is because, in the vast majority of people, cortical structures underlying language production are lateralized to the left hemisphere. An alternative hypothesis, however, might be that the early stages of visual word processing are lateralized to the left hemisphere because of intrinsic hemispheric differences in processing low-level visual information as required for distinguishing fine-grained visual forms such as letters. If the alternative hypothesis was correct, we would expect posterior occipito-temporal processing stages still to be lateralized to the left hemisphere for participants with right hemisphere dominance for the frontal lobe processes involved in language production. By analyzing event-related potentials of native readers of French with either left hemisphere or right hemisphere dominance for language production (determined using a verb generation task), we were able to show that the posterior occipito-temporal areas involved in visual word processing are lateralized to the same hemisphere as language production. This finding could suggest top-down influences in the development of posterior visual word processing areas.

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NIMG-64. IMPACT OF TUMOR LOCATION ON IMAGE-DERIVED VOLUME, PROLIFERATION RATE AND GROWTH VELOCITY IN GLIOBLASTOMA PATIENTS

Neuro-Oncology ◽

10.1093/neuonc/noz175.733 ◽

2019 ◽

Vol 21 (Supplement_6) ◽

pp. vi175-vi176

Author(s):

Julia Lorence ◽

Kristin Swanson ◽

Cassandra Rickertsen ◽

Sara Ranjbar ◽

Sandra Johnston ◽

...

Keyword(s):

Brain Tumor ◽

Tumor Growth ◽

Frontal Lobe ◽

Left Hemisphere ◽

Growth Kinetics ◽

Parietal Lobe ◽

Prognostic Significance ◽

Tumor Location ◽

Tumor Proliferation ◽

Tumor Growth Kinetics

Abstract INTRODUCTION Glioblastoma (GBM) is the most common malignant primary brain tumor in adults with a median overall survival (OS) of 15months. Despite advancements in treatments, prognosis is dismal and the prognostic significance of tumor location is not entirely understood. METHODOLOGY: In our study, we investigated sex-specific volumetric, tumor growth kinetics, and outcome differences among GBMs in various brain locations. Primary GBM patients with pretreatment magnetic resonance imaging (MRI) data (N=289, 173 males, 116 females) were selected from our brain tumor repository. Tumor abnormality was segmented on T1-weighted post-gadolinium contrast agent (T1Gd) MRIs. We utilized the Harvard-Oxford brain atlases to determine the location of GBMs. RESULTS Overall, our study found smaller tumors in the left hemisphere. This may be expected as left-hemispheric GBM symptoms could present earlier, leading to earlier diagnosis and treatment. However, when the cohort was split by sex, we found this observation significant for females only in the parietal lobe (p < 0.0001). Further, female GBMs demonstrated smaller necrotic volume in the left hemisphere (p = 0.030). Sex-specific differences in incidence were noted in the temporal and occipital lobes (2M:1F). Comparing tumor growth kinetics in different brain locations and hemispheres, females had significantly lower tumor proliferation rates in the left hemisphere (p = 0.009) and lower tumor proliferation rates in the left frontal lobe (p = 0.031). Controlling for treatment, patients with frontal lobe tumors had significantly longer OS compared to those with GBMs in the temporal lobe (p = 0.046, 312 days). Differences in growth velocities were noted between frontal and parietal lobe with frontal GBMs having lower velocities in comparison to parietal lobe GBMs. CONCLUSION Together, our results demonstrate that tumor growth and proliferation rates may vary based on location and sex. Additional research is needed to further explore the clinical significance of tumor location.

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Late-onset nonlesional nondominant frontal lobe seizures presenting as ictal dyscalculia

The Kaohsiung Journal of Medical Sciences ◽

10.1016/j.kjms.2016.08.005 ◽

2017 ◽

Vol 33 (1) ◽

pp. 52-54

Author(s):

Meng-Tsang Hsieh ◽

Ming-Chi Lai ◽

Kao-Min Lin ◽

Chin-Wei Huang

Keyword(s):

Frontal Lobe ◽

Late Onset ◽

Frontal Lobe Seizures

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Diagnostic Accuracy of the Frontotemporal Dementia Consensus Criteria in the Late-Onset Frontal Lobe Syndrome

Dementia and Geriatric Cognitive Disorders ◽

10.1159/000444849 ◽

2016 ◽

Vol 41 (3-4) ◽

pp. 210-219 ◽

Cited By ~ 15

Author(s):

Everard G.B. Vijverberg ◽

Annemiek Dols ◽

Welmoed A. Krudop ◽

Anne Peters ◽

Cora J. Kerssens ◽

...

Keyword(s):

Diagnostic Accuracy ◽

Psychiatric Disorders ◽

Frontotemporal Dementia ◽

Frontal Lobe ◽

Late Onset ◽

Diagnostic Process ◽

International Consensus ◽

Good Diagnostic Accuracy ◽

Frontal Lobe Syndrome

Background/Aims: We aimed to prospectively assess the diagnostic accuracy of the revised criteria for behavioural variant frontotemporal dementia (bvFTD) among subjects presenting with a frontal lobe syndrome in middle-late adulthood. Methods: Patients were included based on a predominant behavioural clinical presentation, a Frontal Behavioural Inventory (FBI) score of ≥11 and/or a Stereotypy Rating Inventory (SRI) score of ≥10. At baseline, the fulfilment of the international consensus criteria for behavioural variant FTD (FTDC) was systematically recorded. The 2-year follow-up consensus diagnosis was used as the gold standard to calculate sensitivity and specificity of the FTDC criteria for possible and probable bvFTD. Results: Two-year follow-up data were available for 116 patients (85%). Two-year follow-up consensus diagnoses consisted of probable/definite bvFTD (n = 27), other dementia (n = 30), psychiatric disorders (n = 46) and other neurological disorders (n = 13). Sensitivity for possible bvFTD was 85% (95% CI 70-95%) at a specificity of 27% (95% CI 19-37%). Sensitivity for probable bvFTD was 85% (95% CI 69-95%), whereas their specificity was 82% (95% CI 73-89%). Conclusions: We found a good diagnostic accuracy for FTDC probable bvFTD. However, the specificity for FTDC possible bvFTD was low. Our results reflect the symptomatic overlap between bvFTD, other neurological conditions and psychiatric disorders, and the relevance of adding neuroimaging to the diagnostic process.

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