Writing, calculating, and finger recognition in the region of the angular gyrus: a cortical stimulation study of Gerstmann syndrome

2003 ◽  
Vol 99 (4) ◽  
pp. 716-727 ◽  
Author(s):  
Franck-Emmanuel Roux ◽  
Sergio Boetto ◽  
Oumar Sacko ◽  
François Chollet ◽  
Michel Trémoulet
Keyword(s):  
Brain Mapping ◽  
Right Hemisphere ◽  
Color Naming ◽  
Angular Gyrus ◽  
Cortical Mapping ◽  
Object Naming ◽  
Content Type ◽  
Finger Recognition ◽  
Naming Tasks ◽  
Fine Print

Object. In an attempt to gain a better understanding of the cerebral functions represented in the angular gyrus and to spare them during surgery, the authors studied patients with brain tumors located close to the angular gyrus and mapped cortical sites by using electrostimulation. Methods. Before undergoing tumor removal, six right-handed patients (five with left and one with right hemisphere tumors) were studied using cortical mapping with the aid of calculating, writing, finger-recognition, and color-naming tasks in addition to standard reading and object-naming tasks (for a total of 36 brain mapping studies). Strict conditions of functional site validation were applied to include only those cortical sites that produced repetitive interferences in the function tested. Preoperatively, four of the patients exhibited discrete symptoms related to Gerstmann syndrome while performing very specific tasks, whereas the other two patients presented with no symptoms of the syndrome. No patient had significant language or apraxic deficits. Distinct or shared cortical sites producing interferences in calculating, finger recognition, and writing were repeatedly found in the angular gyrus. Object- or color-naming sites and reading-interference sites were also found in or close to the angular gyrus; although frequently demonstrated, these latter results were variable and unpredictable in the group of patients studied. Finger agnosia and acalculia sites were also found elsewhere, such as in the supramarginal gyrus or close to the intraparietal sulcus. Mechanisms involved in acalculia, agraphia, or finger agnosia (either complete interferences or hesitations) during stimulation were various, from an aphasia-like form (for instance, the patient did not understand the numbers or words given for calculating or writing tasks) to an apparently pure interference in the function tested (patients understood the numbers, but were unable to perform a simple addition). Conclusions. Symptoms of Gerstmann syndrome can be found during direct brain mapping in the angular gyrus region. In this series of patients, sites producing interferences in writing, calculating, and finger recognition were demonstrated in the angular gyrus, which may or may not have been associated with object-naming, color-naming, or reading sites.

Category-specific cortical mapping: color-naming areas

2006 ◽  
Vol 104 (1) ◽  
pp. 27-37 ◽  
Author(s):  
Franck-Emmanuel Roux ◽  
Vincent Lubrano ◽  
Valérie Lauwers-Cances ◽  
Christopher R. Mascott ◽  
Jean-François Démonet
Keyword(s):  
Electrical Stimulation ◽  
Naming Task ◽  
Color Naming ◽  
Individual Variability ◽  
Cortical Mapping ◽  
Object Naming ◽  
Cortical Areas ◽  
Language Deficit ◽  
Language Areas ◽  
Naming Tasks

Object It has been hypothesized that a certain degree of specialization exists within language areas, depending on some specific lexical repertories or categories. To spare hypothetical category-specific cortical areas and to gain a better understanding of their organization, the authors studied patients who had undergone electrical stimulation mapping for brain tumors and they compared an object-naming task with a category-specific task (color naming). Methods Thirty-six patients with no significant preoperative language deficit were prospectively studied during a 2-year period. Along with a reading task, both object- and color-naming tasks were used in brain mapping. During color naming, patients were asked to identify 11 visually presented basic colors. The modality specificity of the colornaming sites found was subsequently tested by asking patients to retrieve the color attributes of objects. High individual variability was observed in language organization among patients and in the tasks performed. Significant interferences in color naming were found in traditional language regions—that is, Broca (p < 0.003) and Wernicke centers (p = 0.05)—although some color-naming areas were occasionally situated outside of these regions. Color-naming interferences were exclusively localized in small cortical areas (< 1 cm2). Anatomical segregation of the different naming categories was apparent in 10 patients; in all, 13 color-specific naming areas (that is, sites evoking no object-naming interference) were detected in the dominant-hemisphere F3 and the supramarginal, angular, and posterior parts of the temporal gyri. Nevertheless, no specific brain region was found to be consistently involved in color naming (p > 0.05). At five sites, although visually presented color-naming tasks were impaired by stimulation, auditory color naming (for example, “What color is grass?”) was performed with no difficulty, showing that modality-specific areas can be found during naming. Conclusions Within language areas, a relative specialization of cortical language areas for color naming can be found during electrical stimulation mapping.

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.

Microvascular bypass surgery

1976 ◽  
Vol 44 (6) ◽  
pp. 712-714 ◽  
Author(s):  
Norman Chater ◽  
Robert Spetzler ◽  
Kent Tonnemacher ◽  
Charles B. Wilson
Keyword(s):  
Frontal Lobe ◽  
Temporal Lobe ◽  
Bypass Surgery ◽  
Angular Gyrus ◽  
Anatomical Studies ◽  
Content Type ◽  
Cortical Areas ◽  
Cortical Vessel ◽  
Suitable Location ◽  
Fine Print

✓ Microvascular anatomical studies were performed to ascertain the most suitable cortical vessel for extracranial-intracranial arterial bypass (EIAB). The three most commonly used cortical areas (the tip of the frontal lobe, the tip of the temporal lobe, and the area at the angular gyrus) were examined in detail. Because of their accessibility and size, the cortical arteries in the area of the angular gyrus offer the most suitable location for creating an EIAB.

Discordance between functional magnetic resonance imaging during silent speech tasks and intraoperative speech arrest

2005 ◽  
Vol 103 (2) ◽  
pp. 267-274 ◽  
Author(s):  
Nicole Petrovich ◽  
Andrei I. Holodny ◽  
Viviane Tabar ◽  
Denise D. Correa ◽  
Joy Hirsch ◽  
...  
Keyword(s):  
Magnetic Resonance ◽  
Inferior Frontal Gyrus ◽  
Hemispheric Dominance ◽  
Cortical Mapping ◽  
Precentral Gyrus ◽  
Functional Magnetic Resonance ◽  
Content Type ◽  
Neurosurgical Planning ◽  
Silent Speech ◽  
Fine Print

Object. The goal of this study was to investigate discordance between the location of speech arrest during awake cortical mapping, a common intraoperative indicator of hemispheric dominance, and silent speech functional magnetic resonance (fMR) imaging maps of frontal language function. Methods. Twenty-one cases were reviewed retrospectively. Images of silent speech fMR imaging activation were coregistered to anatomical MR images obtained for neuronavigation. These were compared with the intraoperative cortical photographs and the behavioral results of electrocorticography during awake craniotomy. An fMR imaging control study of three healthy volunteers was then conducted to characterize the differences between silent and vocalized speech fMR imaging protocols used for neurosurgical planning. Conclusions. Results of fMR imaging showed consistent and predominant activation of the inferior frontal gyrus (IFG) during silent speech tasks. During intraoperative mapping, however, 16 patients arrested in the precentral gyrus (PRG), well posterior to the fMR imaging activity. Of those 16, 14 arrested only in the PRG and not in the IFG as silent speech fMR imaging predicted. The control fMR imaging study showed that vocalized speech fMR imaging shifts the location of the fMR imaging prediction to include the motor strip and may be more appropriate for neurosurgical planning.

Intracranial navigation by using low-field intraoperative magnetic resonance imaging: preliminary experience

2002 ◽  
Vol 97 (5) ◽  
pp. 1115-1124 ◽  
Author(s):  
Andrew A. Kanner ◽  
Michael A. Vogelbaum ◽  
Marc R. Mayberg ◽  
Joseph P. Weisenberger ◽  
Gene H. Barnett
Keyword(s):  
Magnetic Resonance ◽  
Imaging System ◽  
Intraoperative Imaging ◽  
Tumor Resection ◽  
Cortical Mapping ◽  
Subtotal Resection ◽  
Neurosurgical Procedures ◽  
Content Type ◽  
Low Field ◽  
Fine Print

Object. Intracranial navigation by using intraoperative magnetic resonance (iMR) imaging allows the surgeon to reassess anatomical relationships in near—real time during brain tumor surgery. The authors report their initial experience with a novel neuronavigation system coupled to a low-field iMR imaging system. Methods. Between October 2000 and December 2001, 70 neurosurgical procedures were performed using the mobile 0.12-tesla PoleStar N-10 iMR imaging system. The cases included 38 craniotomies, 15 brain biopsies, nine transsphenoidal approaches, and one drainage of a subdural hematoma. Tumor resection was performed using the awake method in seven of 38 cases. Of the craniotomies, image-confirmed complete or radical tumor resection was achieved in 28 cases, subtotal resection in eight cases, and open biopsies in two cases. Tumor resection was controlled with the use of image guidance until the final intraoperative images demonstrated that there was no residual tumor or that no critical brain tissue was at risk of compromise. In each stereotactic biopsy the location of the biopsy needle could be verified by intraoperative imaging and diagnostic tissue was obtained. Complications included a case of aseptic meningitis after a biopsy and one case of temporary intraoperative failure of the anesthesia machine. Awake craniotomies were performed successfully with no permanent neurological complications. Conclusions. Intraoperative MR image—based neuronavigation is feasible when using the Odin PoleStar N-10 system for tumor resections that require multiple other surgical adjuncts including awake procedures, cortical mapping, monitoring of somatosensory evoked potentials, or electrocorticography. Use of the system for brain biopsies offers the opportunity of immediate verification of the needle tip location. Standard neurosurgical drills, microscopes, and other equipment can be used safely in conjunction with this iMR imaging system.

Cortical stimulation mapping of language cortex by using a verb generation task: effects of learning and comparison to mapping based on object naming

2002 ◽  
Vol 97 (1) ◽  
pp. 33-38 ◽  
Author(s):  
Jeffrey G. Ojemann ◽  
George A. Ojemann ◽  
Ettore Lettich
Keyword(s):  
Functional Neuroimaging ◽  
Cortical Stimulation ◽  
Object Naming ◽  
Generation Task ◽  
Content Type ◽  
Cortical Stimulation Mapping ◽  
Verb Generation ◽  
Language Areas ◽  
Language Cortex ◽  
Fine Print

Object. Cortical stimulation mapping has traditionally relied on disruption of object naming to define essential language areas. In this study, the authors reviewed the use of a different language task, verb generation, in mapping language. This task has greater use in brain imaging studies and may be used to test aspects of language different from those of object naming. Methods. In 14 patients, cortical stimulation mapping performed using a verb generation task provided a map of language areas in the frontal and temporoparietal cortices. These verb generation maps often overlapped object naming ones and, in many patients, different areas of cortex were found to be involved in the two functions. In three patients, stimulation mapping was performed during the initial performance of the verb generation task and also during learned performance of the task. Parallel to findings of published neuroimaging studies, a larger area of stimulated cortex led to disruption of verb generation in response to stimulation during novel task performance than during learned performance. Conclusions. Results of cortical stimulation mapping closely resemble those of functional neuroimaging when both implement the verb generation task. The precise map of the temporoparietal language cortex depends on the task used for mapping.

Awake craniotomy with brain mapping as the routine surgical approach to treating patients with supratentorial intraaxial tumors: a prospective trial of 200 cases

1999 ◽  
Vol 90 (1) ◽  
pp. 35-41 ◽  
Author(s):  
Michael D. Taylor ◽  
Mark Bernstein
Keyword(s):  
Intensive Care ◽  
Surgical Approach ◽  
Brain Mapping ◽  
Prospective Trial ◽  
Awake Craniotomy ◽  
Neurological Deficits ◽  
Total Hospital ◽  
Content Type ◽  
Total Hospital Stay ◽  
Fine Print

Object. Awake craniotomy was performed as the standard surgical approach to supratentorial intraaxial tumors, regardless of the involvement of eloquent cortex, in a prospective trial of 200 patients surgically treated by the same surgeon at a single institution.Methods. Patient presentations, comorbid conditions, tumor locations, and the histological characteristics of lesions were recorded. Brain mapping was possible in 195 (97.5%) of 200 patients. The total number of patients sustaining complications was 33 for an overall complication rate of 16.5%. There were two deaths in this series, for a mortality rate of 1%. New postoperative neurological deficits were seen in 13% of the patients, but these were permanent in only 4.5% of them. Complication rates were higher in patients who had gliomas or preoperative neurological deficits and in those who had undergone prior radiation therapy or surgery. No patient who entered the operating room neurologically intact sustained a permanent neurological deficit postoperatively. Of the most recent 50 patients treated, three (6%) required a stay in the intensive care unit, and the median total hospital stay was 1 day.Conclusions. Use of awake craniotomy can result in a considerable reduction in resource utilization without compromising patient care by minimizing intensive care time and total hospital stay. Awake craniotomy is a practical and effective standard surgical approach to supratentorial tumors with a low complication rate, and provides an excellent alternative to craniotomy performed with the patient in the state of general anesthesia because it allows the opportunity for brain mapping and avoids general anesthesia.

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.

A waitlist control-group study of cognitive, mood, and quality of life outcome after posteroventral pallidotomy in Parkinson disease

2003 ◽  
Vol 99 (1) ◽  
pp. 78-88 ◽  
Author(s):  
Jason A. R. Carr ◽  
Christopher R. Honey ◽  
Marci Sinden ◽  
Anthony G. Phillips ◽  
Jeffrey S. Martzke
Keyword(s):  
Quality Of Life ◽  
Social Functioning ◽  
Bodily Pain ◽  
Color Naming ◽  
Motor Functioning ◽  
Content Type ◽  
Posteroventral Pallidotomy ◽  
Fine Print

Object. The aim of this study was to examine neuropsychological outcome from unilateral posteroventral pallidotomy (PVP) in Parkinson disease while controlling for confounding factors such as test practice and disease progression. Methods. Participants underwent baseline and 2-month follow-up assessments of cognition, quality of life, mood, and motor functioning. The surgery group (22 patients) underwent PVP (15 left, seven right) after baseline assessment. The waitlist group (14 patients) underwent PVP after follow up. At follow up, the left PVP group exhibited a decline on verbal measures of learning, fluency, working memory, and speeded color naming. The incidence of significant decline on these measures after left PVP ranged from 50 to 86%. The right PVP group did not exhibit a significant cognitive decline, but fluency did decline in 71% of patients who underwent right PVP. Participants who underwent PVP reported better bodily pain and social functioning at follow up than participants in the waitlist group. Improved bodily pain was evident for 62% of the surgery group, and social functioning improved for 19%. Surgery did not alter reported physical functioning or mood. Dyskinesia improved after surgery, but there were no improvements in “on-state” manual dexterity or handwriting. Conclusions. Most patients who underwent left PVP exhibited declines in learning, fluency, working memory, and speeded color naming. Accounting for retesting effects altered the magnitude of these declines by up to one quarter of a standard deviation, but did not increase the breadth of postsurgical neuropsychological decline beyond that typically reported in the literature. It was found that PVP improved dyskinesia, bodily pain, and social functioning, but did not lead to improvement on other objective and self-reported measures of motor functioning.

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