Cognitive and affective Theory of Mind double dissociation after parietal and temporal lobe tumors

Extensive neuroimaging literature suggests that understanding others' thoughts and emotions engages a wide network encompassing parietal, temporal and medial frontal brain areas. However, the causal role played by these regions in social inferential abilities is still unclear. Moreover very little is known about ToM deficits in brain tumours and whether potential anatomical substrates are comparable to those identified in fMRI literature. This study evaluated the performance of 105 tumour patients, before and immediately after brain surgery, on a cartoon-based non-verbal task evaluating Cognitive (Intention Attribution) and Affective (Emotion Attribution) ToM, as well as a non-social control condition (Causal Inference). Across multiple analyses, we found converging evidence of a double dissociation between patients with right superior parietal damage, selectively impaired in Intention Attribution, and those with right antero-medial temporal lesion, exhibiting deficits only in Emotion attribution. Instead, patients with damage to the frontal cortex were impaired in all kinds of inferential processes, including those from the non-social control conditions. Overall, our data provides novel reliable causal evidence of segregation between different aspects of the ToM network from both the cognitive and also the anatomical point of view.

Penetrating keratoplasty for the management of a severe idiopathic lipid keratopathy

An 83-year-old female presented with progressive bilateral lipid keratopathy (LK) during the last 12 years. There was no history of previous ocular disease or trauma. Slit lamp examination of the left eye revealed a diffuse LK obscuring the visual axis and a temporal epithelial papillomatous lesion with superficial neovascularization (Figure A), while Best Corrected Visual Acuity (BCVA) was 20/200 with eccentric fixation. An uneventful Penetrating Keratoplasty (PKP) combined with excision of the temporal lesion was performed.

Hemorrhages Seen on Brain Images After Mild Traumatic Brain Injury May Increase the Risk of Post-concussion Syndrome

Background and Aim: Mild Traumatic Brain Injury (mTBI) mostly develops the symptoms that may persist for over three months known as Post-Concussion Syndrome (PCS). However, the PCS potential risk for mTBI victims is not well-identified. Here, we investigated the putative risk factors of PCS. Methods and Materials/Patients: In a cross-sectional study, we collected (HIS) the demographic, clinical, and radiological data using the hospital information system in 388 mTBI patients who passed at least 3 months since the onset of their injury and referred to Poursina hospital from March 2017 to December 2018. The patients were examined to diagnose PCS by a general physician using the phone interview via the Rivermead Post-concussion Symptoms Questionnaire (RPQ). The subjects were separated into groups with and without PCS. Data were analyzed by parametric t-test, Chi-square test and multiple logistic regression. Results: One-hundred ninety one out of 388 mTBI patients consented to complete the RPQ and around 59% of cases experienced PCS. There was no significant difference in the demographic variables and past medical history between groups. However, the previous psychological disease was particularly associated with PCS (P>0.043). Length of hospitalization, functional outcome during discharge, and post-resuscitation consciousness did not show any significant association with PCS (P<0.05). Interestingly, initial abnormal brain scan, fronto-temporal lesion, and accompanied hematoma (hemorrhages) were identified as risk factors of mTBI-induced PCS. The risk of PCS was found to increase by 7.2 times in mTBI patients demonstrated as an abnormality in their initial brain scans (P<0.001). A directly proportional relationship was found between the occurrence of the syndrome and the fronto-temporal lesion (P<0.017). Accompanied hematoma enhanced the risk of PCS by 2.6 times (P<0.04). Conclusion: This study emphasized the significance of early brain scan data for the prediction of PCS and the necessity of proper follow-up care for the at-risk population. The reported data from this study might be applied as an objective trajectory to measure PCS in those who simulated PCS for the litigation.

Primary Mucinous Adenocarcinoma: The Critical Role of Morphology in a Rare Neoplasm

Objectives Primary mucinous adenocarcinoma of the skin is a rare clinical entity derived primarily from sweat glands with reported sites mainly arising from the head and neck region. Difficulty then arises with distinguishing between these primary neoplasms and those with similar morphology in the breast and/or gastrointestinal tract. Presentation of Case We report a case of an 85-year-old female with a past medical history of endometrial cancer presenting to clinic with a slow-growing right temporal lesion that was excised and diagnosed as primary mucinous adenocarcinoma. Further clinical workup and imaging revealed an oral lesion diagnosed as squamous cell carcinoma after excision along with an enhancing right breast mass with biopsy and excision showing an invasive ductal carcinoma with papillary and micropapillary features. This unusual presentation of more than two malignancies provides a challenge to differentiate between primary versus metastatic disease, especially with a rare malignancy that is present. Discussion A review of the literature on primary mucinous adenocarcinoma of the skin is presented, discussing epidemiology, clinical presentation, morphology, and immunohistochemistry sets historically studied to aid in diagnosis, with our case relying on morphology to finalize our diagnosis. Conclusion This unusual case highlights the difficulty in differentiating between primary versus metastatic mucinous adenocarcinoma yet highlights the value of morphology to aid in arriving at a diagnosis to help guide correct clinical treatment and follow-up.

Exoscope-Guided (VITOM 3D) Single-Stage Removal of Supratentorial Cavernous Angioma and Hemangioblastoma: 3-Dimensional Operative Video

This video shows an exoscope-guided single-stage resection with 3-dimensional technology of a supratentorial cavernoma and a supratentorial hemangioblastoma during the same surgical procedure. The patient is a 42-yr-old man with a history of generalized tonico-clonic seizures. Contrast-enhanced magnetic resonance (MR) revealed the presence of a left frontal cavernoma and a left T1 non-enhancing hypointese temporal lesion (hemangioblastoma). The operation was carried out in the lateral position with the sole use of a 3D-exoscope (VITOM-3D, Karl Storz GmbH&Co, Tuttlingen, Germany). The operating room set-up included the surgeons standing at the head of the patients with the operating and navigator screens in the front of them and the exoscope arm entering from the left side. As recently highlighted, the 3D-exoscope carries several advantages: (1) it allows neurosurgeons to operate in a confortable and stable position; (2) it is less space-occupying in comparison to the microscope; (3) the optics and 3D-screen offer an optimal stereoscopic view in comparison to the 2D-exoscope, important for both surgical and training purposes; (4) although sharing with the endoscope, the image quality and confortable surgeon's position, there is no conflict between the surgical instruments and the scope in the surgical field. The adopted strategy enabled a complete resection of both lesions. The postoperative course was uneventful and the patient was seizure-free; the antiepileptic drugs were discontinued 3 mo after surgery. The 3D-exoscope represents a promising surgical tool, which may become part of the neurosurgical armamentarium. Nevertheless, the conceivable capability to improve neurosurgical results will have to be explored. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The patient has consented to the submission of the surgical video for submission to the journal.

Focal Bone Marrow Lesions: A Complication of Ultrasound Diathermy

Ultrasound diathermy is widely used for the treatment of musculoskeletal disorders and other soft tissue injuries. Its use as a therapeutic modality is believed to be safe, with very few reported complications. Here, we report two patients who developed focal bone marrow abnormalities after receiving ultrasound diathermy. Both patients’ magnetic resonance (MR) evaluations revealed linear subchondral bone lesions of the superolateral humeral head similar to those in osteonecrosis. The patients’ symptoms subsequently improved, and available follow-up MR evaluation revealed near complete resolution of bone lesions. These findings suggest that ultrasound diathermy, and its interaction with bone tissue through thermal mechanisms, can cause focal bone marrow abnormalities. Furthermore, the bone marrow abnormalities seem to be transient, resolving upon cessation of ultrasound diathermy, therefore osteonecrosis should be differentiated from this temporal lesion.

Minimally Invasive Transpalpebral Endoscopic-Assisted Amygdalohippocampectomy

BACKGROUND: Although anterior temporal lobectomy may be a definitive surgical treatment for epileptic patients with mesial temporal sclerosis, it often results in verbal, visual, and cognitive dysfunction. Studies have consistently reported the advantages of selective procedures compared with a standard anterior temporal lobectomy, mainly in terms of neuropsychological outcomes. OBJECTIVE: To describe a new technique to perform a selective amygdalohippocampectomy (SAH) through a transpalpebral approach with endoscopic assistance. METHODS: A mini fronto-orbitozygomatic craniotomy through an eyelid incision was performed in 8 patients. Both a microscope and neuroendoscope were used in the surgeries. An anterior SAH was performed in 5 patients who had the diagnosis of temporal lobe epilepsy with mesial temporal sclerosis. One patient had a mesial temporal lesion suggesting a ganglioglioma. Two patients presented mesial temporal cavernomas with seizures originating from the temporal lobe. RESULTS: The anterior approach allowed removal of the amygdala and hippocampus. The image-guided system and postoperative evaluation confirmed that the amygdala may be accessed and completely removed through this route. The hippocampus was partially resected. All patients have discontinued medication with no more epileptic seizures. The patients with cavernomas and ganglioglioma also had their lesions completely removed. One-year follow-up has shown no visible scars. CONCLUSION: The anterior route for SAH is a rational and direct approach to the mesial temporal lobe. Anterior SAH is a safe, less invasive procedure that provides early identification of critical vascular and neural structures in the basal cisterns. The transpalpebral approach provides a satisfactory cosmetic outcome.