[A neuropsychological study of triplets with a history of prematurity]. / Estudio neuropsicologico de trillizas con antecedentes de prematuridad.

INTRODUCTION AND AIMS: Prematurity has often been associated with a general intellectual deficit and with different structural brain disorders which can be revealed by volumetric measurements performed by magnetic resonance imaging (MRI). In turn, perinatal asphyxia, even when it is not accompanied by neurological disorders, is related to a deficit in specific neuropsychological functions. CASE REPORT: This study describes the case of three 13 year old female triplets, with a history of extreme prematurity and perinatal asphyxia, the long term effects of which are evaluated in terms of cognitive performance. We studied their performance in the neuropsychological functions of intelligence, memory, and visual perceptual, visual constructive, visual spatial and frontal functions. In two of the subjects, structural MRI and volumetric analysis of the hippocampuses were performed. In all the subjects, intelligence was found to be above average, the most notable result being the superior score in case 1. Verbal learning and the long term retention of verbal material were altered in case 3, where there was also a smaller hippocampal volume. CONCLUSIONS: In the context of a multiple birth, we have seen that extreme prematurity, accompanied by non severe perinatal asphyxia without hypoxic ischemic encephalopathy, can exert very diverse effects on neurocognitive development. It can be normal, and even superior, or show a deficit in some skill. In our case, the functions that were most liable to suffer these antecedents are long term memory and verbal learning. This disorder is accompanied by bilateral involvement of the hippocampus, which can be observed using MRI.

Estudio neuropsicológico de trillizas con antecedentes de prematuridad / A neuropsychological study of triplets with a history of prematurity

Introducción y objetivos. La prematuridad se ha asociado frecuentemente a un déficit intelectivo general y a distintas alteraciones cerebrales estructurales evidenciables por volumetría mediante resonancia magnética (RM). A su vez, la asfixia perinatal, aun cuando no se acompaña de alteraciones neurológicas, está relacionada con déficit en funciones neuropsicológicas específicas. Casos clínicos. El presente trabajo describe tres hermanas gemelas, de 13 años de edad, con antecedentes de prematuridad extrema y asfixia perinatal, cuyos efectos sobre el rendimiento cognitivo a largo plazo se evalúan. Estudiamos el rendimiento en las funciones neuropsicológicas de inteligencia, memoria, funciones visuoperceptivas, visuoconstructivas y visuoespaciales y frontales. En dos de los casos se realizó una RM estructural y un análisis volumétrico de los hipocampos. En los tres casos, la inteligencia estaba por encima de la media; destaca la puntuación `superior' en el caso 1. Aparece alterado el aprendizaje verbal y la retención a largo plazo de material verbal en el caso 3, el cual muestra, además, una reducción del volumen hipocampal. Conclusiones. En el contexto de un embarazo múltiple, hemos observado que la extrema prematuridad, acompañada de asfixia perinatal no grave, sin encefalopatía hipoxicoisquémica, puede tener unos efectos muy diversos sobre el desarrollo neurocognitivo. Éste puede ser normal, e incluso superior, o mostrar un déficit en alguna habilidad. En nuestro caso, las funciones más susceptibles a estos antecedentes son la memoria a largo plazo y el aprendizaje verbales. Esta afectación se acompaña de una alteración bilateral del hipocampo, que se puede observar a través de la RM (AU)

Introduction and aims. Prematurity has often been associated with a general intellectual deficit and with different structural brain disorders which can be revealed by volumetric measurements performed by magnetic resonance imaging (MRI). In turn, perinatal asphyxia, even when it is not accompanied by neurological disorders, is related to a deficit in specific neuropsychological functions. Case report. This study describes the case of three 13-year-old female triplets, with a history of extreme prematurity and perinatal asphyxia, the long-term effects of which are evaluated in terms of cognitive performance. We studied their performance in the neuropsychological functions of intelligence, memory, and visual-perceptual, visual-constructive, visual-spatial and frontal functions. In two of the subjects, structural MRI and volumetric analysis of the hippocampuses were performed. In all the subjects, intelligence was found to be above average, the most notable result being the ‘superior’ score in case 1. Verbal learning and the long-term retention of verbal material were altered in case 3, where there was also a smaller hippocampal volume. Conclusions. In the context of a multiple birth, we have seen that extreme prematurity, accompanied by nonsevere perinatal asphyxia without hypoxic-ischemic encephalopathy, can exert very diverse effects on neurocognitive development. It can be normal, and even superior, or show a deficit in some skill. In our case, the functions that were most liable to suffer these antecedents are long-term memory and verbal learning. This disorder is accompanied by bilateral involvement of the hippocampus, which can be observed using MRI (AU)

[Cerebral activation during Stroop's test in a case of early focal brain injury]. / Activación cerebral durante el test de Stroop en un caso de lesión cerebral focal temprana.

INTRODUCTION: Functional magnetic resonance imaging (fMRI) offers an important advantage over other functional neuroimaging techniques used with children because of its harmlessness. Previous studies conducted with adults with alexia suggested two ways the brain can reorganise reading after a brain injury affecting the left hemisphere, one contralateral and the other ipsilateral. CASE REPORT: We describe a study carried out using fMRI of a 10 year old girl with an injury to the left hemisphere caused by a fishing harpoon when she was 6 years old. As a result of the accident the girl presented a right hemiparesia. The girl s parents and teachers also reported difficulties in the acquisition of reading writing and arithmetic, as well as a certain degree of attentional deficit. An fMRI exploration was performed while the girl was doing the Stroop test. The structural MR images showed left hemisphere cortical lesions in the orbital and angular gyrus regions, in addition to the caudate and putamen nuclei, and in the inferior longitudinal bundle. The fRMI revealed a strong overactivation of the right dorsolateral frontal cortex, in the evaluation of interference, and activations of the right angular and bilateral supramarginal gyri, in the evaluation of word reading. CONCLUSION: The functional study suggests the existence of a reorganisation of reading that is both intra and inter hemispheric.

Activación cerebral durante el test de Stroop en un caso de lesión cerebral focal temprana / Cerebral activation during Stroop's test in a case of early focal brain injury

Introducción. La resonancia magnética funcional (RMf) presenta una gran ventaja frente a otras técnicas en estudios de neuroimagen funcional con niños debido a su inocuidad. Estudios previos de adultos con alexia sugieren dos vías de reorganización cerebral de la lectura tras una lesión cerebral del hemisferio izquierdo, una contralateral y la otra ipsilateral. Caso clínico. Describimos un estudio mediante RMf de una niña de 10 años con una lesión del hemisferio izquierdo causada por un arpón de pesca, lesión ocurrida a los 6 años de edad. Como consecuencia del accidente la niña presenta hemiparesia derecha. Los padres y profesores informaron también de dificultades en la adquisición de la lectoescritura y el cálculo, así como cierto déficit atencional. Se realizó una exploración mediante RMf mientras la niña ejecutaba la prueba de Stroop. Las imágenes de RM estructural demostraron lesiones corticales del hemisferio izquierdo en la región orbital y el giro angular, así como en los núcleos caudado y putamen y en el fascículo longitudinal inferior. La RMf reveló una fuerte sobreactivación del córtex frontal dorsolateral derecho, en la evaluación de la interferencia, y activaciones del giro angular derecho y supramarginal bilateral, en la evaluación de la lectura de palabras. Conclusión. El estudio funcional sugiere la existencia de una reorganización intra e interhemisférica de la lectura (AU)

Introduction. Functional magnetic resonance imaging (fMRI) offers an important advantage over other functional neuroimaging techniques used with children because of its harmlessness. Previous studies conducted with adults with alexia suggested two ways the brain can reorganise reading after a brain injury affecting the left hemisphere, one contralateral and the other ipsilateral. Case report. We describe a study carried out using fMRI of a 10-year-old girl with an injury to the left hemisphere caused by a fishing harpoon when she was 6 years old. As a result of the accident the girl presented a right hemiparesia. The girl’s parents and teachers also reported difficulties in the acquisition of reading-writing and arithmetic, as well as a certain degree of attentional deficit. An fMRI exploration was performed while the girl was doing the Stroop test. The structural MR images showed left hemisphere cortical lesions in the orbital and angular gyrus regions, in addition to the caudate and putamen nuclei, and in the inferior longitudinal bundle. The fRMI revealed a strong overactivation of the right dorsolateral frontal cortex, in the evaluation of interference, and activations of the right angular and bilateral supramarginal gyri, in the evaluation of word reading. Conclusion. The functional study suggests the existence of a reorganisation of reading that is both intra- and interhemispheric (AU)