Efforts for the Correct Comprehension of Deceitful and Ironic Communicative Intentions in Schizophrenia: A Functional Magnetic Resonance Imaging Study on the Role of the Left Middle Temporal Gyrus.

Deficits in social cognition and more specifically in communication have an important impact on the real-life functioning of people with schizophrenia (SZ). In particular, patients have severe problems in communicative-pragmatics, for example, in correctly inferring the speaker's communicative intention in everyday conversational interactions. This limit is associated with morphological and functional alteration of the left middle temporal gyrus (L-MTG), a cerebral area involved in various communicative processes, in particular in the distinction of ironic communicative intention from sincere and deceitful ones. We performed an fMRI study on 20 patients with SZ and 20 matched healthy controls (HCs) while performing a pragmatic task testing the comprehension of sincere, deceitful, and ironic communicative intentions. We considered the L-MTG as the region of interest. SZ patients showed difficulties in the correct comprehension of all types of communicative intentions and, when correctly answering to the task, they exhibited a higher activation of the L-MTG, as compared to HC, under all experimental conditions. This greater involvement of the L-MTG in the group of patients could depend on different factors, such as the increasing inferential effort required in correctly understanding the speaker's communicative intentions, and the higher integrative semantic processes involved in sentence processing. Future studies with a larger sample size and functional connectivity analysis are needed to study deeper the specific role of the L-MTG in pragmatic processes in SZ, also in relation to other brain areas.

A distinct MR imaging phenotype in amyotrophic lateral sclerosis: correlation between T1 magnetization transfer contrast hyperintensity along the corticospinal tract and diffusion tensor imaging analysis.

BACKGROUND AND PURPOSE: In the search for a diagnostic marker in ALS, we focused our attention on the hyperintense signal intensity in T1 MTC MR images along the CST, detected in some patients and not found in other patients with ALS and in control subjects. The aim of this study was to investigate the relationship between the hyperintense signal intensity in T1 MTC images and white matter damage. To this purpose, we studied potential heterogeneities in DTI values within our patients by using TBSS without a priori anatomic information. MATERIALS AND METHODS: In 43 patients with ALS and 43 healthy control subjects, the presence or absence of T1 MTC hyperintense signal intensity was evaluated. With a DTI analysis with a TBSS approach, differences in FA distribution between the 2 groups (patients with T1 MTC hyperintense signal intensity and patients without it) compared with each other and with control subjects were investigated. RESULTS: We found regional differences in white matter FA between patients with T1 MTC hyperintense signal intensity (37.2%) and patients without it. Patients with T1 MTC abnormal signal intensity showed lower FA strictly limited to the motor network and the posterior aspect of the body of the CC without extramotor FA reductions, whereas patients without this sign showed FA reductions in several confluent regions within and outside the CST and in the whole CC. CONCLUSIONS: T1 MTC hyperintense signal intensity in the CST and posterior CC, when present, is specific for ALS and represents, among patients with ALS, a possible distinct phenotype of presentation of the disease with prominent UMN involvement.

Deep brain stimulation of the subthalamic nucleus: clinical effectiveness and safety.

The authors report the data relative to the clinical effectiveness of bilateral deep brain stimulation of the subthalamic nucleus in 16 patients with PD 3 months after the surgery. The comparison of the Unified PD Rating Scale scores in the different conditions of medication and stimulation, and the lack of significant surgical complications, confirm the effectiveness and the safety of the subthalamic nucleus deep brain stimulation for the treatment of advanced PD.

Supratentorial cavernous angiomas and epileptic seizures: preoperative course and postoperative outcome.

OBJECTIVE: Patients operated on for supratentorial cavernous angiomas were studied to define the incidence and the course of seizures in their clinical history. Electroclinical and neuroradiological data were correlated with the location of cavernomas. The impact of lesionectomy on the outcome of seizures was evaluated. METHODS: Preoperative clinical data on the history of the seizures, semeiology, incidence, severity, and response to antiepileptic drugs were analyzed. The location of the cavernomas, revealed by magnetic resonance imaging, was correlated with electroencephalographic and clinical data. Postoperative clinical and neuroradiological data were evaluated, with particular consideration to the outcome of the seizures, antiepileptic drug withdrawal, and the completeness of the lesion excision. RESULTS: A higher incidence of severe epilepsy was observed in the patients with mesiotemporal and cortical angiomas. In most of the patients (78.7%), a good concordance between the site of the lesion and the electroclinical data was found. The complete removal of the lesion led to a favorable outcome, with discontinuation of antiepileptic drugs achieved in one-quarter of the patients. CONCLUSION: A high percentage of patients with cortical cavernomas had epileptic seizures. They often presented with chronic intractable epilepsy (44.7% in our series). In cases of good concordance between the electroclinical data and the location of the angioma, complete lesionectomy led to the disappearance of seizures. Removal of the hemosiderin ring did not correlate with better outcome. Preoperative ictal scalp recordings to assess the topographic relationship between the cavernoma and the epileptic seizures could improve outcome, which suggests different surgical strategies (lesionectomy versus enlarged resection) in patients without a clear-cut concordance between the site of the lesion and the ictal semeiology.

Dumbbell-shaped spinal epidural cavernous angioma. Case report.

Cavernous angiomas are common lesions of the CNS characterized by abnormally dilated blood vessels lined by a thin endothelium, closely clustered together and not separated by normal neural tissue. They are more frequently found intracranially. In the spine, a common location is the vertebral bodies. Intradural extramedullary and intramedullary cavernous angiomas are less frequent lesions, while purely epidural locations are uncommon. Spinal dumbbell-shaped epidural cavernous angiomas are exceedingly rare, and only six cases have been reported in the literature. We describe one additional case whose MRI appearance was indistinguishable from that of a neurinoma, which is a much more common lesion. Surgical treatment is advised and complete radiological evaluation is necessary to rule out concomitant localizations in other organs.

Radiologic demonstration of syringobulbia. Report of 8 cases.

Out of 75 syringomyelia cases, 8 had a syringobulbic extension. The cavity was demonstrated by magnetic resonance imaging (3 cases), syringography (3 cases), ventriculography (2 cases), and myelo-CT (2 cases). The cavities could be separated into 2 groups. In the first (5 cases) the cavity extended from the floor of the fourth ventricle, anterolaterally (3 cases) or anteriorly in the midline (2 cases). The communication with the fourth ventricle was usually wide. In the second group (3 cases), the syringobulbic cavity was located anteriorly; 2 of the 3 had no communication with the fourth ventricle and had an exceptional cranial extension (syringocephalia). In selected cases, invasive studies may help to recognize the connections of the cavities, and thus be useful in planning the surgical treatment.