Permanent isolated micrographia from traumatic basal ganglia injury.

Micrographia is a rare neurological finding in isolation. Most cases of isolated micrographia have been found in association with focal ischemia of the left basal ganglia. Here, we present a case of post-traumatic micrographia stemming from contusion to the left basal ganglia.

Síndrome de Susac. A propósito de las encefalitis autoinmunes / Susac's syndrome. A case of autoimmune encephalitis

No disponible

Management of Penetrating Brain Injury Caused by a Nail Gun: Three Case Reports and Literature Review.

BACKGROUND: Penetrating brain injury (PBI) caused by a nail gun is an extremely rare neurosurgical emergency that poses a challenge for neurosurgeons because of its rarity and complexity. CASE DESCRIPTION: Here we present 3 cases of PBI caused by a nail gun. In the first case, the nail entered through the right parietal bone and lodged in the right parietal lobe and basal ganglia. In the second case, the nail entered through the right occipital bone and lodged in the right occipital lobe. In the third case, the nail entered through the right parietal bone and lodged in the right frontal and parietal lobes. All patients underwent surgical removal of the nail. The first patient presented with reduced left-side strength, whereas the second and third patients were neurologically intact on presentation. CONCLUSIONS: PBI caused by a nail gun can present with differing clinical manifestations, and most cases require immediate surgery. A rational management strategy should provide a good postoperative prognosis with minimal neurologic deficits in these patients.

Utilidad del estudio metabólico cerebral con PET/TC 18F-fluorodeoxiglucosa para descartar estado vegetativo / The role of 18-F-fluorodeoxyglucose PET/CT in ruling out vegetative state

No disponible

Caso 24 / Case 24

Trata-se de apresentação da Análise da Imagem de lesões cutâneas e intracranianas reveladas pelo exame clínico direto e radiológico, em que características clínico-epidemiológicas e de exames complementares permitem a identificação de agente etiológico mais provável, e revela gravidade extrema de nosologia eminentemente brasileira, que requer alerta para seu diagnóstico precoce e tratamento adequado para impedir sequelas e morte precoce. (AU)

This is a presentation of the Image Analysis of cutaneous and intracranial lesions revealed by direct clinical and radiological examination, in which clinical-epidemiological and complementary features allow the identification of the most probable etiological agent, and reveals extreme severity of nosology in Brazil, which requires alertness for its early diagnosis and appropriate treatment to prevent sequelae and early death. (Au)

Severe Neonatal Anaemia, MRI Findings and Neurodevelopmental Outcome.

BACKGROUND AND OBJECTIVE: Severe neonatal anaemia can impair cerebral oxygen supply. Data on long-term outcomes following severe neonatal anaemia are scarce. METHODS: Clinical data and neurodevelopmental outcome of 49 (near) term infants with haemoglobin concentration after birth <6.0 mmol/l were retrospectively collected and analysed. In a subgroup of 28 patients, amplitude-integrated EEG was available and in 25 infants cerebral MRI was obtained. Infants were followed up at 14-35 months of age and assessed with the Griffiths Scale of Mental Development or Bayley Scale of Infant Development. RESULTS: Eighteen patients (37%) died during the neonatal period. In 25 patients MRI was performed. A predominant pattern of injury on MRI was seen in the basal ganglia and thalami in 7 patients (28%), whereas some form of white matter injury was present in 16 (64%) and a combination in 3 (12%). Follow-up data were available for 26 patients (84% of survivors). Formal assessment of neurodevelopmental outcome was performed in 20 of 31 (65%) infants who survived (median age: 19 months, range: 14-35). Sixteen infants (80%) had a developmental quotient appropriate for age in the first 2 years after birth. On motor outcome, 1 patient (5%) scored below average (Z-score -1.10). One patient developed cerebral palsy. CONCLUSION: Early neurodevelopmental outcome in surviving patients with severe neonatal anaemia was within the normal range in the majority of the survivors. MRI showed mild-to-moderate white matter injury in two thirds of the infants. Prospectively collected data with a longer follow-up period are needed.

The nature of facilitation and interference in the multilingual language system: insights from treatment in a case of trilingual aphasia.

The rehabilitation study described here sets out to test the premise of Abutalebi and Green's neurocognitive model--specifically, that language selection and control are components of overall cognitive control. We follow a trilingual woman (first language, L1: Amharic; second language, L2: English; third language, L3: French) with damage to the left frontal lobe and left basal ganglia who presented with cognitive control and naming deficits, through two periods of semantic treatment (French, followed by English) to alleviate naming deficits. The results showed that while the participant improved on trained items, she did not show within- or cross-language generalization. In addition, error patterns revealed a substantial increase of interference of the currently trained language into the nontrained language during each of the two treatment phases. These results are consistent with Abutalebi and Green's neurocognitive model and support the claim that language selection and control are components of overall cognitive control.

Encefalopatía tardía por monóxido de carbono de curso reversible en un paciente tratado con citicolina / Delayed-onset encephalopathy caused by carbon monoxide poisoning: Resolution in a patient treated with citicoline

No disponible

The effect of claustrum lesions on human consciousness and recovery of function.

Crick and Koch proposed that the claustrum plays a crucial role in consciousness. Their proposal was based on the structure and connectivity of the claustrum that suggested it had a role in coordinating a set of diverse brain functions. Given the few human studies investigating this claim, we decided to study the effects of claustrum lesions on consciousness in 171 combat veterans with penetrating traumatic brain injuries. Additionally, we studied the effects of claustrum lesions and loss of consciousness on long-term cognitive abilities. Claustrum damage was associated with the duration, but not frequency, of loss of consciousness, indicating that the claustrum may have an important role in regaining, but not maintaining, consciousness. Total brain volume loss, but not claustrum lesions, was associated with long-term recovery of neurobehavioral functions. Our findings constrain the current understanding of the neurobehavioral functions of the claustrum and its role in maintaining and regaining consciousness.

Basal ganglia contribution to rule expectancy and temporal predictability in speech.

The current work set out to answer three questions: (1) Are reported syntactic deficits in patients with structural damage to the basal ganglia (BG) in the cortico-striato-thalamo-cortical systems (CSTCS) the result of a syntax specific computational deficit or are they potentially a consequence of a generalized timing deficit? (2) Do BG patients suffer from a simple beat perception deficit in speech comparable to the one reported in music? (3) Can regular speech meter (i.e., a pattern of beats induced by the regular alteration of stressed and unstressed syllable accents) ameliorate the computation of syntactically marked information by making speech events temporally predictable and salient? The latter 'remediation' hypothesis would predict that when speech events (i.e., those that are syntactically marked) are metrically aligned to the syllabic accent structure, the computation of syntactic information is facilitated or in the case of patients ameliorated. During continuous EEG measurement nineteen patients with focal BG lesions and matched healthy controls listened to metrically regular and syntactically well-formed sentences and metrically well-formed sentences that either violated syntactic expectancy, metrical expectancy, or both. While healthy controls showed an expected P600 response in the event-related brain potential (ERP) to all expectancy violations, BG patients showed overall comparable P600 responses to all, but the metrical expectancy violation. These results confirm that (1) BG patients suffer from a simple beat perception deficit in speech and (2) regular speech meter ameliorates the computation of syntactically marked information in the speech signal. We propose that a domain general sensorimotor cerebello-thalamo-cortical system (CTCS), involved in event-based temporal processing, engages in the remediation of dysfunctional cortico-striato-thalamo-cortical timing that affects the timely computation of linguistic (i.e., syntax) information in the speech signal.

Modeling effects of cerebellar and basal ganglia lesions on adaptation and anticipation during sensorimotor synchronization.

This study addressed the role of subcortical brain structures in temporal adaptation and anticipation during sensorimotor synchronization. The performance of patients with cerebellar or basal ganglia lesions was compared with that of healthy control participants on tasks requiring the synchronization of drum strokes with adaptive and tempo-changing auditory pacing sequences. The precision of sensorimotor synchronization was generally lower in patients relative to controls (i.e., variability of asynchronies was higher in patients), although synchronization accuracy (mean asynchrony) was commensurate. A computational model of adaptation and anticipation (ADAM) was used to examine potential sources of individual differences in precision by estimating participants' use of error correction, temporal prediction, and the amount of variability associated with central timekeeping and peripheral motor processes. Parameter estimates based on ADAM indicate that impaired precision was attributable to increased variability of timekeeper and motor processes as well as to reduced temporal prediction in both patient groups. Adaptive processes related to continuously applied error correction were, by contrast, intact in patients. These findings highlight the importance of investigating how subcortical structures, including the cerebellum and basal ganglia, interact with a broader network of cortical regions to support temporal adaptation and anticipation during sensorimotor synchronization.

Single fetal demise in monochorionic pregnancies: incidence and patterns of cerebral injury.

OBJECTIVE: To evaluate the incidence, type and severity of cerebral injury in the surviving monochorionic (MC) cotwin after single fetal demise in twin pregnancies. METHODS: All MC pregnancies with single fetal demise that were evaluated at the Leiden University Medical Center between 2002 and 2013 were included. Perinatal characteristics, neonatal outcome and the presence of cerebral injury, observed on neuroimaging, were recorded for all cotwin survivors. RESULTS: A total of 49 MC pregnancies with single fetal demise, including one MC triplet, were included in the study (n = 50 cotwins). Median gestational age at occurrence of single fetal demise was 25 weeks and median interval between single fetal demise and live birth was 61 days, with a median gestational age at birth of 36 weeks. Severe cerebral injury was diagnosed in 13 (26%) of the 50 cotwins and was detected antenatally in 4/50 (8%) and postnatally in 9/50 (18%) cases. Cerebral injury was mostly due to hypoxic-ischemic injury resulting in cystic periventricular leukomalacia, middle cerebral artery infarction or injury to basal ganglia, thalamus and/or cortex. Risk factors associated with severe cerebral injury were advanced gestational age at the occurrence of single fetal demise (odds ratio (OR), 1.14 (95% CI, 1.01-1.29) for each week of gestation; P = 0.03), twin-twin transfusion syndrome developing prior to single fetal demise (OR, 5.0 (95% CI, 1.30-19.13); P = 0.02) and a lower gestational age at birth (OR, 0.83 (95% CI, 0.69-0.99) for each week of gestation; P = 0.04). CONCLUSIONS: Single fetal demise in MC pregnancies is associated with severe cerebral injury occurring in 1 in 4 surviving cotwins. Routine antenatal and postnatal neuroimaging, followed by standardized long-term follow-up, is mandatory.

Oculomotor disturbances in HIV-positive individuals treated with methadone.

INTRODUCTION: Methadone substitution is claimed to be the most effective way of pharmacological management of human immunodeficiency virus (HIV) positive patients addicted to opioids. Possible and clinically the most relevant drug interactions are those between methadone and antiretroviral agents [13,18,25,32]. HIV causes cognitive impairment by infiltrating the central nervous system (CNS) in the initial phase of infection. The consequence of this is damage to the hippocampus, caudate nucleus, and basal ganglia [2,26]. METHODS: Eighty-six patients from the substitution program group were examined. The trial was conducted twice: before and about 1.5 hours after the administration of a therapeutic dose of methadone. The antisaccades task (AT) and latency task (LT) were performed using a saccadometer diagnostic system. RESULTS: The statistical analysis showed that the mean duration of latency measured by AT in HIV(-) and HIV(+) subjects after the administration of a therapeutic dose of methadone was significantly increased (p=0.03 HIV(-); p=0.04 HIV(+)). There was a statistically significant increase in the mean latency after the administration of methadone in HIV(+) subjects when compared to the control group measured by LT (p=0.03). CONCLUSION: The statistical analysis confirms the change in the saccadic refixation parameters in patients addicted to opioids. Methadone influences saccadic dynamic parameters less in HIV(+) than in HIV(-) drug users. Oculomotor disturbances are probably related to the neurotropic effects of HIV leading to damage of the striatum, which plays an important role in psychomotor functions.

Differential expression of synaptic proteins in unilateral 6-OHDA lesioned rat model-A comparative proteomics approach.

Parkinson's disease (PD) is characterized as a movement disorder due to lesions in the basal ganglia. As the major input region of the basal ganglia, striatum plays a vital role in coordinating movements. It receives afferents from the cerebral cortex and projects afferents to the internal segment of the globus pallidus and substantia nigra pars reticulate. Additionally, accumulating evidences support a role for synaptic dysfunction in PD. Therefore, the present study explores the changes in protein abundance involved in synaptic disorders in unilateral lesioned 6-OHDA rat model. Based on (18) O/(16) O-labeling technique, striatal proteins were separated using online 2D-LC, and identified by nano-ESI-quadrupole-TOF. A total of 370 proteins were identified, including 76 significantly differentially expressed proteins. Twenty-two downregulated proteins were found in composition of vesicle, ten of which were involved in neuronal transmission and recycling across synapses. These include N-ethylmaleimide-sensitive fusion protein attachment receptor proteins (SNAP-25, syntaxin-1A, syntaxin-1B, VAMP2), synapsin-1, septin-5, clathrin heavy chain 1, AP-2 complex subunit beta, dynamin-1, and endophilin-A1. Moreover, MS result for syntaxin-1A was confirmed by Western blot analysis. Overall, these synaptic changes induced by neurotoxin may serve as a reference for understanding the functional mechanism of striatum in PD.

Disconnection of a basal ganglia circuit in juvenile songbirds attenuates the spectral differentiation of song syllables.

Similar to language acquisition by human infants, juvenile male zebra finches (Taeniopygia guttata) imitate an adult (tutor) song by transitioning from repetitive production of one or two undifferentiated protosyllables to the sequential production of a larger and spectrally heterogeneous set of syllables. The primary motor region that controls learned song is driven by a confluence of input from two premotor pathways: a posterior pathway that encodes the adult song syllables and an anterior pathway that includes a basal ganglia (BG)-thalamo-cortical circuit. Similar to mammalian motor-learning systems, the songbird BG circuit is thought to be necessary for shaping juvenile vocal behaviour (undifferentiated protosyllables) toward specific targets (the tutor's song syllables). Here, we tested the hypothesis that anterior pathway activity contributes to the process of protosyllable differentiation. Bilateral ablation of lateral magnocellular nucleus of the anterior nidopallium (LMAN) was used to disconnect BG circuitry at ages before protosyllable production and differentiation. Comparison to surgical controls revealed that protosyllables fail to differentiate in birds that received juvenile LMAN ablation--the adult songs of birds with >80% bilateral LMAN ablation consisted of only one or two syllables produced with the repetitive form and spectral structure that characterizes undifferentiated protosyllables in normal juveniles. Our findings support a role for BG circuitry in shaping juvenile vocal behaviour toward the acoustic structure of the tutor song and suggest that posterior pathway function remains in an immature "default" state when developmental interaction with the anterior pathway is reduced or eliminated.

[Forensic medical assessment of the role of the injury and pathology in the development of basal subarachnoidal hemorrhage].

The comparative analysis of clinical and pathomorphological forensic medical literature and the original investigations of basal subarachnoidal hemorrhage carried out by the author during 25 years provided a basis for morphological diagnostics of traumatic and non-traumatic subarachnoidal hemorrhage with special reference to variants of forensic medical assessment of the role of injuries and pathologies in the development of basal subarachnoidal hemorrhage.

Levodopa treatment of late onset extrapyramidal movements in a child after high voltage electrocution.

We present the case of a 12-year-old girl with abnormal extrapyramidal movements associated with basal ganglia lesions after electrical injury. After her injury, our patient initially did well and recovered from acute cardiovascular and hemodynamic instability, and the results of her neurological examination, head computed tomography scan, and electroencephalogram were normal on discharge from hospital. Two weeks after discharge, she developed extrapyramidal movements, and head magnetic resonance imaging showed areas of bilateral, symmetrical enhanced associated with signal intensity in the basal ganglia, hypoxic encephalopathy, and cerebral edema that may have occurred secondary to the cardiopulmonary arrest that she suffered immediately after her accident. The symptoms disappeared after low dose levodopa was instituted and have not recurred during the 15 months of treatment. Injury and death from electric current, although rare, are not uncommon and occur mostly as a result of accidental contact with a live wire. This is the first case report documenting the use of levodopa for extrapyramidal movements secondary to high-tension electrocution.

Adversive seizures associated with periodic lateralised epileptiform discharges (PLEDs) after left orbital contusion.

We report a patient who presented with adversive seizures associated with periodic lateralised epileptiform discharges (PLEDs), a month after head trauma. The PLEDs predominantly involving the left frontal contacts became more frequent at the onset of adversive seizures during EEG. Brain MRI demonstrated a contusion scar in the left orbital cortex with reduced diffusion, not only around this orbital lesion but also in the ipsilateral anteromedial thalamus. Single photon emission computed tomography revealed focal cerebral hyperperfusion in the left medial orbitofrontal region, basal ganglia, and thalamus. The abnormal metabolism involving the thalamus and striatum could be associated with the ipsilateral orbital contusion and might have been caused by cortical-subcortical, trans-synaptic hyperactivity. Further studies are warranted to determine the role of subcortical structures in the generation of PLEDs and adversive seizures. [Published with video sequences].

Isolated basal ganglia hemorrhage due to blast injury.

Bilateral traumatic hemorrhage of the basal ganglia is an extremely rare neuropathologic entity. Bilateral basal ganglia hemorrhage secondary to blast injury has not described before. We report a case with bilateral basal ganglia hemorrhage secondary to explosion.