Serious and reversible levetiracetam-induced psychiatric symptoms after resection of frontal low-grade glioma: two case histories.

Levetiracetam may induce serious behavioral disturbances, especially after surgical resection of frontal lobe low-grade glioma. Two patients, treated with levetiracetam, developed serious psychiatric complications postoperatively which completely resolved after switching to valproate. We aim to create awareness for this serious but reversible adverse effect of levetiracetam in this specific patient category.

Scan patterns during the processing of facial identity in prosopagnosia.

The scan patterns of ocular fixations made by prosopagnosic patients while they attempt to identify faces may provide insights into how they process the information in faces. Contrasts between their scanning of upright versus inverted faces may index the presence of a hypothesized orientation-dependent expert mechanism for processing faces, while contrasts between their scanning of familiar versus novel faces may index the influence of residual facial memories on their search for meaningful facial information. We recorded the eye movements of two prosopagnosics while they viewed faces. One patient, with acquired prosopagnosia from a right occipitotemporal lesion, showed degraded orientation effects but still with a normal distribution of fixations to more salient facial features. However, the dynamics of his global scan patterns were more chaotic for novel faces, suggesting degradation of an internal facial schema, and consistent with other evidence of impaired face configuration perception in this patient. His global scan patterns for famous faces differed from novel faces, suggesting the influence of residual facial memories, as indexed previously by his relatively good imagery for famous faces. The other patient, with a developmental prosopagnosia, showed anomalous orientation effects, abnormal distribution of fixations to less salient regions, and chaotic global scan patterns, in keeping with a more severe loss of face-expert mechanisms. The effects of fame on her scanning were weaker than those in the first subject and non-existent in her global scan patterns. We conclude that scan patterns in prosopagnosia can both reflect the loss of orientation-dependent expert mechanisms and index the covert influence of residual facial memories. In these two subjects the scanning data were consistent with other results from tests of configuration perception, imagery, and covert recognition.

Utilidad de las altas dosis de quimioterapia en tumores del SNC en niños / Usefulness of high-dose chemotherapy in children with CNS tumors

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Hemihyperaesthesia and hyperresponsiveness resembling central pain syndrome in a dog with a forebrain oligodendroglioma.

A 4-year-old male Boxer was presented with neurological signs referable to a right forebrain lesion that was confirmed with computed tomography. Whilst characteristic signs of a unilateral forebrain lesion were observed, the dominant and striking finding was a right-sided hemisensory disturbance characterised by hyperaesthesia and hyperresponsiveness. Necropsy revealed a gelatinous mass confined to the right forebrain that was identified histologically as an oligodendroglioma. The lesion was centred on the internal capsule and involved ventral frontal and temporal lobes and the ventrolateral thalamus, including lateral and medial parts of the ventrocaudal nuclear region (ventrobasilar complex) of the thalamus. On clinical and neuroanatomical grounds, the case exhibited features in common with central pain syndrome in human patients with thalamic lesions. These included a somatosensory disorder of hyperaesthesia affecting an entire side of the head and body, behavioural manifestations consistent with spontaneous pain and a lesion involving the ventrobasilar complex. Of interest, the hemisensory abnormality was ipsilateral to the lesion, contrasting with central pain in humans, in which clinical signs are contralateral to analogous lesions. It is suggested that species-specific differences in spinal cord organisation of pain pathways, particularly the greater bilateral projection of nociceptive afferents to thalamic relay nuclei in carnivores, may account for this disparity. Notably, central pain is rare in human patients with brain tumours, even those affecting the thalamus, and this may also be the case in dogs.

Gyratory epilepsy in a patient with a thalamic neoplasm.

A patient with a right thalamic oligodendroglioma developed seizures characterized by circling behavior, speech arrest, and secondarily generalized seizures. Gyratory epilepsy is relatively uncommon and may either represent a benign form of primary generalized epilepsy or occur secondary to a focal cortical lesion. Thalamic stimulation has been shown experimentally to induce circling movements, but no other clinical cases with a thalamic lesion have been described.

[Preoperative nutritional status of neurosurgery patients]. / Präoperativer Ernährungszustand neurochirurgischer Patienten.

In a prospective trial anthropometric and biochemical data of 24 neurosurgical patients with primary intracranial tumors were measured to assess preoperative malnutrition in this special group of patients. In spite of starving because of invasive diagnostic procedures, high-dose dexamethasone therapy of peritumoral edema, and changes in food intake because of psychical alterations and repeated vomiting resulting from elevated intracranial pressure no abnormalities were found in the data measured. The authors conclude that in general preoperative malnutrition is absent in neurosurgical patients and preoperative nutrition to improve postoperative outcome is not indicated in this group.