Postcallosotomy language impairments in patients with crossed cerebral dominance

1990 ◽  
Vol 72 (1) ◽  
pp. 85-90 ◽  
Author(s):  
Kimberlee J. Sass ◽  
Robert A. Novelly ◽  
Dennis D. Spencer ◽  
Susan S. Spencer
Keyword(s):  
Left Hemisphere ◽  
Verbal Memory ◽  
Right Hemisphere ◽  
Cerebral Dominance ◽  
Language Impairments ◽  
Content Type ◽  
Left Handed ◽  
Buccofacial Apraxia ◽  
Clinically Significant ◽  
Fine Print

✓ Language impairments were reviewed retrospectively in patients who underwent partial or total corpus callosum section for medically refractory secondary generalized epilepsy. Postoperatively, four of 32 patients had clinically significant language impairments that were not present prior to the operation. All involved primarily verbal output (speech and writing) and spared verbal comprehension. Written language skills (reading and spelling), verbal memory, and verbal reasoning abilities were impaired to varying degrees. These impairments were associated with crossed cerebral dominance. Three patients with severe speech difficulties after surgery were right hemisphere-dominant for speech and were right-handed. One left hemisphere speech-dominant, left-handed patient was agraphic after surgery, but spoke normally. It is concluded from these data and from other reports in the literature that three syndromes of language disturbance may follow callosotomy. The first, involving speech difficulty but sparing writing, is attributable to buccofacial apraxia. The second involves speech and writing difficulties and occurs in right hemisphere-dominant right-handed patients. The third involves dysgraphia with intact speech and occurs in left hemisphere-dominant left-handed patients.

Intracarotid Amytal memory test and hippocampal magnetic resonance imaging volumetry: validity of the Wada test as an indicator of hippocampal integrity among candidates for epilepsy surgery

2004 ◽  
Vol 101 (6) ◽  
pp. 926-931 ◽  
Author(s):  
Aaron A. Cohen-Gadol ◽  
Michael Westerveld ◽  
Juan Alvarez-Carilles ◽  
Dennis D. Spencer
Keyword(s):  
Magnetic Resonance ◽  
Left Hemisphere ◽  
Epilepsy Surgery ◽  
Verbal Memory ◽  
Right Hemisphere ◽  
Hippocampal Volume ◽  
Temporal Lobectomy ◽  
Wada Test ◽  
Content Type ◽  
Fine Print

Object. Intracarotid Amytal testing (the Wada test) has been used to lateralize language and identify patients who may be at risk for memory impairment after temporal lobectomy. The goal of this study was to determine the validity of the Wada test in the assessment of pathological conditions of the hippocampus among candidates for epilepsy surgery. The authors examined the correlation between the functional integrity of the hippocampus, measured using the Wada test, and quantitative measures of hippocampal pathology, determined by obtaining volumetric measurements of the hippocampus with the aid of magnetic resonance (MR) imaging. Methods. The authors reviewed the relationship between memory scores on the Wada test and hippocampal volumes measured on preoperative MR images in 76 patients who underwent anteromedial temporal lobectomy and amygdalohippocampectomy for the treatment of medically refractory temporal lobe epilepsy. The data were analyzed with respect to their usefulness in lateralizing the seizure focus and predicting the long-term postoperative memory outcome. Right and left hippocampal volume measurements did not correlate with one another (p > 0.1). Similarly, following a left carotid artery injection of Amytal the patients' right hemisphere memory was not significantly related to their left hemisphere memory on the Wada test (p > 0.1). On the other hand, the patients' right hemisphere memory significantly correlated with their right hippocampal volume (r = 0.51; p < 0.001) and their left hemisphere memory significantly correlated with their left hippocampal volume (r = 0.51; p < 0.001). Both right and left hemisphere memory scores correlated with the hippocampal volumetry ratio (r = 0.47 and r = 0.45, respectively; both p < 0.001). Lateralization of a seizure focus based on hippocampal volumetry results was significantly related to lateralization based on the results of the Wada test (r = 0.49; p < 0.01). The disparity between the Wada memory scores on ipsilateral and contralateral sides was significantly and inversely related to the change in verbal memory following temporal lobectomy (r = −0.28; p < 0.02). The preoperative hippocampal volumetry ratio also significantly and inversely correlated with the change in verbal memory after surgery (r = −0.31; p < 0.01). Conclusions. The Wada memory test may be a valuable method of measuring the functional integrity of the hippocampus. The systematic study of MR imaging—acquired morphological data and Wada-acquired neuropsychological data may increase our understanding of the location of material-specific memory and the selection of eligible candidates for epilepsy surgery.

Right-Hemisphere Language Dominance in a Case of Left-Hemisphere Arteriovenous Malformation

1977 ◽  
Vol 42 (1) ◽  
pp. 106-112 ◽  
Author(s):  
Robert T. Wertz ◽  
Bernard Messert ◽  
Michael Collins ◽  
Jay C. Rosenbek ◽  
Chun C. Kao
Keyword(s):  
Arteriovenous Malformation ◽  
Left Hemisphere ◽  
Right Hemisphere ◽  
Surgical Removal ◽  
Language Dominance ◽  
Language Deficit ◽  
Left Handed ◽  
Motor Areas

This paper reports a case of surgical removal of a left-hemisphere arteriovenous malformation (AVM) in a left-handed adult without subsequent speech or language deficit. Preoperative intracarotid amobarbital testing indicated right-hemisphere language dominance. Our patient demonstrated no language involvement prior to or following surgery. We speculate the congenital nature of a left-hemisphere AVM may dictate right-hemisphere language dominance, thereby explaining the lack of residuals following removal of AVMs in left-hemisphere speech and motor areas.

Coerced training of the nondominant hand resulting in cortical reorganization: a high-field functional magnetic resonance imaging study

2004 ◽  
Vol 101 (2) ◽  
pp. 310-313 ◽  
Author(s):  
Tsutomu Nakada ◽  
Yukihiko Fujii ◽  
Ingrid L. Kwee
Keyword(s):  
Magnetic Resonance Imaging ◽  
High Field ◽  
Cortical Reorganization ◽  
Functional Magnetic Resonance ◽  
Resonance Imaging ◽  
Content Type ◽  
Hand Motion ◽  
Left Handed ◽  
The Right ◽  
Fine Print

Object. The authors investigated brain strategies associated with hand use in an attempt to clarify genetic and nongenetic factors influencing handedness by using high-field functional magnetic resonance imaging. Methods. Three groups of patients were studied. The first two groups comprised individuals in whom handedness developed spontaneously (right-handed and left-handed groups). The third group comprised individuals who were coercively trained to use the right hand and developed mixed handedness, referred to here as trained ambidexterity. All trained ambidextrous volunteers were certain that they were innately left-handed, but due to social pressure had modified their preferred hand use for certain tasks common to the right hand. Although right-handed and left-handed volunteers displayed virtually identical cortical activation, involving homologous cortex primarily located contralateral to the hand motion, trained ambidextrous volunteers exhibited a clearly unique activation pattern. During right-handed motion, motor areas in both hemispheres were activated in these volunteers. During left-handed motion, the right supplemental motor area and the right intermediate zone of the anterior cerebellar lobe were activated significantly more frequently than observed in naturally right-handed or left-handed volunteers. Conclusions. The results provide strong evidence that cortical organization of spontaneously developed right- and left-handedness involves homologous cortex primarily located contralateral to the hand motion, and this organization is likely to be prenatally determined. By contrast, coerced training of the nondominant hand during the early stages of an individual's development results in mixed handedness (trained ambidexterity), indicating cortical reorganization.

Coagulopathy with the use of hetastarch in the treatment of vasospasm

1995 ◽  
Vol 82 (1) ◽  
pp. 44-47 ◽  
Author(s):  
Eric R. Trumble ◽  
J. Paul Muizelaar ◽  
John S. Myseros ◽  
Sung C. Choi ◽  
Brian B. Warren
Keyword(s):  
Volume Expansion ◽  
Clinical Symptoms ◽  
Standard Of Care ◽  
The Other ◽  
Appropriate Use ◽  
Content Type ◽  
Prevention And Treatment ◽  
Plasma Protein Fraction ◽  
Clinically Significant ◽  
Fine Print

✓ The use of colloid agents to achieve hypervolemia in the prevention and treatment of postsubarachnoid hemorrhage (post-SAH) vasospasm is included in the standard of care at many institutions. Risk profiles are necessary to ensure appropriate use of these agents. In a series of 85 patients with recent aneurysmal SAH, 26 developed clinical symptoms of vasospasm. Fourteen of the 26 were treated with hetastarch for volume expansion while the other 12 received plasma protein fraction (PPF). Clinically significant bleeding pathologies were noted in six patients who received hetastarch as a continuous intravenous infusion. Hetastarch increased partial thromboplastin time from a mean of 23.9 seconds to a mean of 33.1 seconds (p < 0.001) in all patients who received infusions of this agent, while no effect was noted in the 12 patients who received PPF infusions. No other coagulation parameters were altered. This study shows an increase in coagulopathy with the use of hetastarch as compared with the use of PPF for the treatment of postaneurysmal vasospasm.

scholarly journals Unanticipated memory loss during superselective Wada testing for right cerebral arteriovenous malformation.

Stroke ◽  
2001 ◽  
Vol 32 (suppl_1) ◽  
pp. 337-338
Author(s):  
Ronald M Lazar ◽  
Randolph S Marshall ◽  
J P Mohr ◽  
William L Young ◽  
John Pile-Spellman
Keyword(s):  
Verbal Memory ◽  
Right Hemisphere ◽  
Memory Loss ◽  
Read Aloud ◽  
Maximum Score ◽  
Left Handed ◽  
Unusual Distribution ◽  
The Mean ◽  
Amobarbital Sodium ◽  
Anatomic Locations

120 Background: A major concern in the treatment of cerebral AVMs is whether so-called eloquent regions occupy normal anatomic locations. Recently, we have shown with selective anesthetic injections that language has a wide and unusual distribution in patients with left cerebral AVM. Our Objective here was to determine whether superselective Wada testing in medial right-hemisphere arteries would produce verbal memory loss in patients with right cerebral AVM. Methods: Nine patients, 8 right- and 1 left-handed, had superselective injections of amobarbital sodium plus lidocaine into vessels near or feeding right medial AVMs. Five patients had AVMs supplied by PCA feeders and four had ACA feeders. Memory testing occurred in a no-anesthetic baseline, 1 minute after anesthetic injection, and 12 minutes after injection. A memory test consisted of 5 words presented on a computer screen which the patient had to read aloud. After 3 minutes, recall was tested. A maximum score was 15, with uncued recall of a word = 3 points, prompted recall = 2 points, and multiple choice = 1 point. Based on clinical considerations, various numbers of vessels were tested in each patient. Results: Superselective anesthetic testing in most vessels yielded memory scores no different than baseline, and embolization took place. In each patient, however, there was at least one vessel feeding the AVM in which significant short-term verbal memory loss took place. In these instances, the mean memory score at baseline was 14 (s.d. = 1.5). Following injection of anesthetics, the mean score fell significantly to 7.1 (t-test, p<.00001). Attention was unaltered. After dissipation of the anesthesia at 12 minutes, memory returned to baseline levels in every case. Conclusions: In nine patients, superselective Wada injection into arteries feeding right medial AVMs produced unanticipated verbal memory deficits. Traditional assumptions about eloquent regions would have suggested that such testing would have been unnecessary, but embolization here would have yielded significant morbidity. Our findings also question established notions of verbal memory restricted to the left hemisphere.

The right hemisphere: neuropsychological functions

1986 ◽  
Vol 64 (5) ◽  
pp. 693-704 ◽  
Author(s):  
Kenneth M. Heilman ◽  
Dawn Bowers ◽  
Edward Valenstein ◽  
Robert T. Watson
Keyword(s):  
Emotional Disorders ◽  
Right Hemisphere ◽  
Content Type ◽  
Reading And Writing ◽  
The Past ◽  
Right Hemisphere Damage ◽  
Right Hemisphere Dysfunction ◽  
Neuropsychological Functions ◽  
The Right ◽  
Fine Print

✓ In the past two to three decades, clinicians and neuroscientists have been studying the functions of the right hemisphere. Neither hemisphere seems to be dominant in the absolute sense. Each appears to be specialized and is dominant for different functions. However, most functions require the cooperation of both hemispheres. When one is damaged, the other can often compensate for the damaged one. Lesions of the left hemisphere are associated with language (speech, reading, and writing) and praxic disorders, and lesions of the right hemisphere can result in visuospatial, attentional, and emotional disorders. The authors review some of the major behavioral disorders associated with right hemisphere dysfunction and concentrate on three major types of disorders — visuospatial, attentional, and emotional. Although not all the behavioral defects associated with right hemisphere damage can be subgrouped under these three types, they are the ones most often associated with right hemisphere lesions.

Preoperative predictors of anterior temporal language areas

1998 ◽  
Vol 89 (6) ◽  
pp. 962-970 ◽  
Author(s):  
Theodore H. Schwartz ◽  
Orrin Devinsky ◽  
Werner Doyle ◽  
Kenneth Perrine
Keyword(s):  
Temporal Lobe ◽  
Right Hemisphere ◽  
Temporal Lobectomy ◽  
Seizure Onset ◽  
Anterior Temporal Lobe ◽  
Verbal Iq ◽  
Content Type ◽  
Language Areas ◽  
Fine Print

Object. Although it is known that 5 to 10% of patients have language areas anterior to the rolandic cortex, many surgeons still perform standard anterior temporal lobectomies for epilepsy of mesial onset and report minimal long-term dysphasia. The authors examined the importance of language mapping before anterior temporal lobectomy. Methods. The authors mapped naming, reading, and speech arrest in a series of 67 patients via stimulation of long-term implanted subdural grids before resective epilepsy surgery and correlated the presence of language areas in the anterior temporal lobe with preoperative demographic and neuropsychometric data. Naming (p < 0.03) and reading (p < 0.05) errors were more common than speech arrest in patients undergoing surgery in the anterior temporal lobe. In the approximate region of a standard anterior temporal lobectomy, including 2.5 cm of the superior temporal gyrus and 4.5 cm of both the middle and inferior temporal gyrus, the authors identified language areas in 14.5% of patients tested. Between 1.5 and 3.5 cm from the temporal tip, patients who had seizure onset before 6 years of age had more naming (p < 0.02) and reading (p < 0.01) areas than those in whom seizure onset occurred after age 6 years. Patients with a verbal intelligence quotient (IQ) lower than 90 had more naming (p < 0.05) and reading (p < 0.02) areas than those with an IQ higher than 90. Finally, patients who were either left handed or right hemisphere memory dominant had more naming (p < 0.05) and reading (p < 0.02) areas than right-handed patients with bilateral or left hemisphere memory lateralization. Postoperative neuropsychometric testing showed a trend toward a greater decline in naming ability in patients who were least likely to have anterior language areas, that is, those with higher verbal IQ and later seizure onset. Conclusions. Preoperative identification of markers of left hemisphere damage, such as early seizure onset, poor verbal IQ, left handedness, and right hemisphere memory dominance should alert neurosurgeons to the possibility of encountering essential language areas in the anterior temporal lobe (1.5–3.5 cm from the temporal tip). Naming and reading tasks are required to identify these areas. Whether removal of these areas necessarily induces long-term impairment in verbal abilities is unknown; however, in patients with a low verbal IQ and early seizure onset, these areas appear to be less critical for language processing.

Cerebral Dominance and Its Relation To Psychological Function

PEDIATRICS ◽  
1963 ◽  
Vol 31 (3) ◽  
pp. 395-395
Author(s):  
RANDOLPH K. BYERS
Keyword(s):  
Left Hemisphere ◽  
Cerebral Dominance ◽  
Language Function ◽  
Psychological Function ◽  
Language Functions ◽  
Left Handed ◽  
The Subject

This little book is a review of and contribution to the subject of language and its relationship to cerebral dominance. In general it emphasizes that in right-handed people language function is nearly regularly and fairly strictly localized to the left hemisphere. In left-handed and clearly ambidextrous people there is still a tendency for language to be localized in the left hemisphere, but its localization is not as complete, and various language functions may escape in injury to one hemisphere. Recovery tends to be more complete following acute lesions of the left hemisphere in predominantly left-handed individuals.

scholarly journals Regional Shape Abnormalities in Thalamus and Verbal Memory Impairment After Subcortical Infarction

2019 ◽  
Vol 33 (6) ◽  
pp. 476-485 ◽  
Author(s):  
Gang Liu ◽  
Xiaoqing Tan ◽  
Chao Dang ◽  
Shuangquan Tan ◽  
Shihui Xing ◽  
...  
Keyword(s):  
Left Hemisphere ◽  
Verbal Memory ◽  
Memory Impairment ◽  
Right Hemisphere ◽  
Brain Structures ◽  
Change Rate ◽  
Immediate Recall ◽  
Stroke Group ◽  
Left Hemisphere Stroke ◽  
Subcortical Infarction

Background. Subcortical infarcts can result in verbal memory impairment, but the potential underlying mechanisms remain unknown. Objective. We investigated the spatiotemporal deterioration patterns of brain structures in patients with subcortical infarction and identified the regions that contributed to verbal memory impairment. Methods. Cognitive assessment and structural magnetic resonance imaging were performed 1, 4, and 12 weeks after stroke onset in 28 left-hemisphere and 22 right-hemisphere stroke patients with subcortical infarction. Whole-brain volumetric analysis combined with a further-refined shape analysis was conducted to analyze longitudinal morphometric changes in brain structures and their relationship to verbal memory performance. Results. Between weeks 1 and 12, significant volume decreases in the ipsilesional basal ganglia, inferior white matter, and thalamus were found in the left-hemisphere stroke group. Among those 3 structures, only the change rate of the thalamus volume was significantly correlated with that in immediate recall. For the right-hemisphere stroke group, only the ipsilesional basal ganglia survived the week 1 to week 12 group comparison, but its change rate was not significantly correlated with the verbal memory change rate. Shape analysis of the thalamus revealed atrophies of the ipsilesional thalamic subregions connected to the prefrontal, temporal, and premotor cortices in the left-hemisphere stroke group and positive correlations between the rates of those atrophies and the change rate in immediate recall. Conclusions. Secondary damage to the thalamus, especially to the left subregions connected to specific cortices, may be associated with early verbal memory impairment following an acute subcortical infarct.

Writing-specific sites in frontal areas: a cortical stimulation study

2004 ◽  
Vol 101 (5) ◽  
pp. 787-798 ◽  
Author(s):  
Vincent Lubrano ◽  
Franck-Emmanuel Roux ◽  
Jean-François Démonet
Keyword(s):  
Brain Tumors ◽  
Individual Variability ◽  
Cortical Stimulation ◽  
Awake Surgery ◽  
Direct Stimulation ◽  
Content Type ◽  
Left Handed ◽  
Language Areas ◽  
Fine Print ◽  
Stimulation Of

Object. The aim of this study was to determine whether cortical areas involved in the writing process are associated with reading or naming areas in patients undergoing surgery for brain tumors in frontal areas. This study was undertaken to spare all language areas found in patients during surgery. Methods. Fourteen patients (eight women and six men [mean age 47 years] of whom 12 were right handed, two left handed, 12 monolingual, and two bilingual) who harbored brain tumors in the left (11 patients) or right (three patients) frontal gyri or in rolandic areas, were tested by direct stimulation by using the awake surgery technique for direct brain mapping. Mapping of the frontal gyri was performed using naming, reading, and writing under dictation tasks in the appropriate language(s). Considerable individual variability in language organization among patients was observed. Interferences in writing were found during direct stimulation in the frontal gyri, in cortical sites common or not common to interferences in naming or reading. In dominant regions, patterns of writing dysfunctions were variable and included writing arrest, illegible script, letter omissions, and paragraphia. These dysfunctions were nonspecific (stimulation-induced eye movements) in nondominant frontal regions and in rolandic gyri (hand contractions). In the same patient, different writing impairments could sometimes be observed during stimulation of different sites. As is the case for naming or reading interference sites, writing interference sites could be extremely localized (1 cm2 in diameter). In this group of patients, writing interference sites found in Broca areas were associated with other sites of language interference, whereas writing-specific interference sites were found twice in the dominant middle frontal gyrus. Conclusions. In this series, we found that writing interference sites could be detected by direct cortical stimulation in dominant inferior and middle frontal gyri regardless of whether they were associated with naming or reading interference sites. Writing disorders elicited by direct stimulation in the frontal lobes are varied and probably depend on the functional status of the stimulated cortical area.

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