Degree of language lateralization determines susceptibility to unilateral brain lesions.

Language is considered a function of either the left or, in exceptional cases, the right side of the brain. Functional imaging studies show, however, that in the general population a graded continuum from left hemispheric to right hemispheric language lateralization exists. To determine the functional relevance of lateralization differences, we suppressed language regions using transcranial magnetic stimulation (TMS) in healthy human subjects who differed in lateralization of language-related brain activation. Language disruption correlated with both the degree and side of lateralization. Subjects with weak lateralization (more bilaterality) were less affected by either left- or right-side TMS than were subjects with strong lateralization to one hemisphere. Thus in some people, language processing seems to be distributed evenly between the hemispheres, allowing for ready compensation after a unilateral lesion.

Assessment of hemispheric language lateralization: a comparison between fMRI and fTCD.

The cerebral blood flow velocity (CBFV) in the basal arteries during a word-generation task was assessed by functional transcranial Doppler ultrasonography (fTCD) and by functional magnetic resonance imaging (fMRI). The study investigates how event-related CBFV modulations in the middle cerebral artery (MCA) relate to regional cerebral blood flow (rCBF) changes. Both fMRI and fTCD were used in 13 subjects (7 men, 6 women, aged 21 to 44 years). The maximum difference of relative CBFV changes between the left and right MCA during the word-generation task was used as the language laterality index (LIfTCD). For the fMRI examination during the nearly identical language task, the corresponding index was defined by LIfMRI = 100(N(L) - N(R))/(N(L) + N(R)), where N(L) and N(R) refer to the numbers of voxels activated in the left and right hemisphere, respectively. The evoked CBFV changes expressed by LIfTCD and the corresponding laterality index, LIfMRI, estimated by fMRI showed a close linear relation (regression analysis: r = 0.95, p < 0.0001). The results of this study demonstrate that language-related velocity changes in the MCAs relate to rCBF increases in a linear fashion. Since the laterality indices assessed by fMRI and fTCD are in such close agreement both techniques can therefore be used in a complementary way.

Transient ischemic attacks caused by trumpet playing.

We report a young musician who experienced transient ischemic attacks during trumpet playing. Cardiovascular examination revealed a patent foramen ovale; Doppler ultrasound of the middle cerebral arteries detected microembolic signals with increased rates during trumpet playing and Valsalva maneuver. After operative occlusion of the foramen ovale, the symptoms disappeared and no microembolic signals could be detected.

Objective assessment of progression in Huntington's disease: a 3-year follow-up study.

Objective measures to assess progression of Huntington's disease (HD) are desirable. The authors have previously found that patients with HD with higher Unified Huntington's Disease Rating Scale (UHDRS) motor scores exhibited higher variability of isometric grip forces while grasping an object. Therefore, the authors assessed grip force variability during this task in 10 HD patients with a 3-year follow-up. Grip force variability increased in all patients at the follow-up. Thus, grip force variability during grasping might be an objective and quantitative measure to assess motor deficits associated with the progression of HD.

D-amphetamine does not improve outcome of somatosensory training.

BACKGROUND: D-amphetamine has been shown to affect early stages of stroke recovery, and may have a beneficial effect on functions when administered later after stroke. OBJECTIVE: To test D-amphetamine effects on skill acquisition after the acute or subacute stages of stroke, when lesion-related structural changes have consolidated. METHODS: Sixteen healthy subjects were treated with D-amphetamine during a 4-week training of tactile frequency discrimination in a placebo-controlled, double-blind design. RESULTS: All subjects improved significantly in tactile temporal acuity. However, improvement did not differ in subjects treated with or without D-amphetamine. CONCLUSION: No beneficial effect of D-amphetamine on somatosensory training improvements was found in healthy subjects.

Language and spatial attention can lateralize to the same hemisphere in healthy humans.

BACKGROUND: Disorders of language classically occur after left brain lesions, and disorders of spatial attention after right brain lesions. It is unclear whether the hemispheric dissociation of functions is a fixed pattern of brain organization. OBJECTIVE: The authors determined whether lateralization of language and lateralization of spatial attention also dissociate in people with atypical (i.e., right hemispheric) language dominance. METHODS: The authors selected 10 subjects with typical, i.e., left hemispheric, and 10 with atypical, i.e., right hemispheric, language representation on a random basis from a sample of 326 healthy volunteers examined with functional transcranial Doppler sonography (fTCD) for language dominance. In these subjects, hemispheric lateralization of cerebral perfusion during a line bisection task was determined with fTCD. RESULTS: The authors found a dissociation between dominance for language and spatial attention in all but four subjects. In the latter subjects, there was a significant lateralization to the right hemisphere for both tasks. The four subjects showed normal intellectual, linguistic, and spatial performance, with normal EEG and MRI scans of the brain. CONCLUSION: Even in the absence of brain pathology, the same hemisphere can be dominant in control of both language and spatial attention.

Successive activation of both cerebral hemispheres during cued word generation.

Most humans have a left hemispheric dominance for language. However, during diagnostic language testing there also is activation of the right hemisphere, which is probably related to attention. To investigate further the role of attention during language production we monitored cerebral blood flow velocities in the middle cerebral arteries by continuous bilateral transcranial Doppler ultrasonography (TCD) in nine right-handed subjects. During cued word generation, a successive activation of the right hemisphere in the preparatory phase, and of the left hemisphere during word searching was demonstrated. These findings indicate that attentional processes precede verbal activation and that the two procedures can be separated by comparative blood flow velocity measurement.

Cortical tuning: a function of anticipated stimulus intensity.

We investigated the activation of the brain during anticipation of tactile stimuli by continuous cerebral blood flow velocity (CBFV) monitoring with bilateral transcranial Doppler sonography. A forced choice paradigm was performed where a first group of subjects (n=16) was expecting suprathreshold and a second group (n=19) was anticipating threshold tactile stimuli to the index finger after a cueing tone. During the anticipation of suprathreshold stimuli the CBFV always exhibited a significantly stronger increase in the right hemisphere than in the left, even when stimuli were anticipated at the right index finger. Conversely when stimuli at perception threshold were expected, the respective contralateral hemisphere showed a significantly stronger perfusion increase. These data show that preparatory activation of the brain during stimulus anticipation is dependant on the expected stimulus intensity.

AVERAGE: a Windows program for automated analysis of event related cerebral blood flow.

Functional transcranial Doppler sonography (fTCD) is used to measure changes in brain perfusion during different states of brain activity by evaluating flow velocities within the major brain arteries. We developed a computer program called AVERAGE which can be used with various TCD devices and allows for subtle quantitative off-line analysis of Doppler flow signals. AVERAGE supports data transformation, heart beat analysis, noise reduction, trigger signal and marker modification, artifact analysis and artifact rejection, as well as data reduction. Perfusion differences and their time course within two different arteries can be analyzed by parametric and non parametric statistical methods. This is important, for instance, in studies on hemispherical dominance during mental task processing. Each data processing step is supported by graphical output. If investigated bilaterally with interhemispheric analysis even minimal activations can reliably be detected and quantified with a sensitivity known from positron emission tomography approaches.

Immunohistology of temporal arteritis: phenotyping of infiltrating cells and deposits of complement components.

Deposition of complement factors, immunoglobulins and infiltrating cells was evaluated by immunohistochemical staining in 30 temporal artery biopsy specimens from patients suffering from temporal arteritis and/or polymyalgia rheumatica and in controls. In the temporal arteritis group infiltrating cells, classic complement, alternative complement and lytic complex activation were detected. In specimens from patients suffering from only polymyalgia rheumatica there was unexpected evidence of classic complement and lytic complex activation. We conclude that immuno-histochemistry provides support for the concept of temporal arteritis and polymyalgia being based on the same pathological process.

Persistent unihemispheric perceptual impairments in humans following focal seizures.

Perception has been linked to a highly coordinated activation of cortical regions whose functional organization and performance is subject to plastic changes. We tested whether chronic repetitive disturbances of the brain by focal epileptic activity have a long-standing detrimental effect on the perceptual performance in the affected hemisphere. Nine patients were examined who had a history of complex partial seizures but no structural cerebral damage on magnetic resonance imaging and no evidence of ongoing epileptic activity on scalp electroencephalography and who had clinically been without seizures for at least 3 days. The side of primary epileptic involvement was determined by seizure semiology (n = 2), focal electroencephalographic slowing (n = 3) or focal abnormality during single photon emission topography (SPECT) (n = 4). The computer controlled psychometric assessment of the somesthetic frequency discrimination revealed that the perception in the hand corresponding to the affected hemisphere was impaired relative to the contralateral hand (P < 0.01), and to the performance of a group of normal controls (P < 0.01). We conclude that mechanisms related to focal epileptic activity can result in regional perceptual decrements even when there is no clinical or surface-electroencephalographic evidence of epileptic discharges. This in turn suggests that somatosensory testing may be of help in localizing, or at least lateralizing an epileptic focus.

Cortical reorganization in human amputees and mislocalization of painful stimuli to the phantom limb.

In human arm amputees, a significant relationship was found between the amount of reorganization in the primary somato-sensory cortex, and the amount of body surface from which painful stimuli evoked sensations that were perceived to be emanating from the now missing extremity, i.e. the phantom limb. This mislocalization could be evoked almost equally from stimulation of either side of the body. Based on these findings obtained by magnetic source imaging and psychophysical testing in eight amputees, it is concluded that the extent of the generally known cortical reorganization contralateral to the amputation is an indicator of more widespread plastic changes in the brain involving bilateral pathways.

Cortical asymmetries of the human somatosensory hand representation in right- and left-handers.

Hemispheric asymmetry is known for higher brain functions like language and attention. We tested whether such an asymmetry also exists in the representation of elementary sensory functions. Magnetic source imaging was used to compare the cortical somatosensory hand representation in seven right- and five left-handed individuals. In all right-handers the representation of the dominant hand was larger than the contralateral one in the corresponding hemispheres. In contrast, only two out of five left-handers revealed a larger representation of the dominant left hand compared to the right one. In agreement with previous findings on the lateralization of language and attention, there is a strong correlation between handedness and the extent of the cortical hand representation in right-, but not in left-handers. We conclude that a profound functional hemispheric asymmetry also exists in primary sensory cortices.

Functional reorganization of the human primary somatosensory cortex after acute pain demonstrated by magnetoencephalography.

The somatosensory system is capable of functional reorganization following peripheral denervation or training. Studies on human amputees with phantom limb pain provided evidence that these reorganizational changes are modulated through nociceptive input. In the present study we used magnetoencephalographic recordings of six healthy volunteers to assess whether acute pain by itself causes a reorganization of the primary somatosensory cortex. After the induction of an intense experimental pain at the thenar of the left hand by intradermal injection of capsaicin, the extent of the cortical hand representation and the distance between the hand representation and the localization of the lip decreased. A likely mechanism for this acute reorganization is that pain induced hyperresponsiveness of the left thenar to tactile input from neighboring body sites.

Regional cerebral blood flow in endogenous psychoses, measured by 99mTc HMPAO-SPECT.

The aim of this pilot study was to determine the sensitivity of HMPAO-Single Photon Emission Computed Tomography (SPECT), a new technique for determining cerebral blood flow. 7 RDC-schizophrenics, 5 schizoaffectives and 6 depressives were investigated after remission of the psychosis. It appeared that in the schizophrenics the blood flow was significantly reduced in the left anterior region in the infraventricular and ventricular section when compared with the depressives. This finding is discussed here. Apparently, HMPAO-SPECT is another valuable technique for investigating cerebral blood flow.

[Preliminary results of 99mTc-HMPAO-SPECT studies in endogenous psychoses]. / Vorläufige Ergebnisse von 99mTc-HMPAO-SPECT-Untersuchungen bei endogenen Psychosen.

18 psychopharmacologically treated patients (7 schizophrenics, 5 schizoaffectives, 6 depressives) were studied using 99mTc-HMPAO-SPECT of the brain. The regional cerebral blood flow was measured in three transversal sections (infra-/supraventricular, ventricular) within 6 regions of interest (ROI) respectively (one frontal, one parietal and one occipital in each hemisphere). Corresponding ROIs of the same section in each hemisphere were compared. In the schizophrenics there was a significantly reduced perfusion in the left frontal region of the infraventricular and ventricular section (p less than 0.02) compared with the data of the depressives. The schizoaffectives took an intermediate place. Since the patients were treated with psychopharmaca, the result must be interpreted cautiously. However, our findings seem to be in accordance with post-mortem-, CT- and PET-studies presented in the literature. Our results suggest that 99mTc-HMPAO-SPECT may be helpful in finding cerebral abnormalities in endogenous psychoses.

[Stroke patients in general practice. Preventing recurrent infarct]. / Schlaganfall-Patienten in der Hausarztpraxis. Dem Reinsult vorbeugen.

Stroke patients have a high recurrence risk of 4-14% per year--depending on individual etiology. The best way of preventing a repeat insult and protecting the patient's remaining quality of life is to rigorously apply all available secondary prophylactic possibilities. These include measures aimed at modifying a health-endangering lifestyle, as well as medical treatment of all risk-enhancing illnesses. The present article offers an overview of the major confirmed and modifiable risk factors for stroke (arterial hypertension, smoking, atrial fibrillation, diabetes mellitus, overweight, hyper-cholesterolemia, thrombophilia, immoderate use of alcohol, lack of exercise, use of contraceptives, migraine), and outlines therapeutic strategies for secondary prevention.