Right Hemisphere Language Dominance in a Right-Handed Patient with Late-Onset Seizures

Right hemisphere language dominance is rare in right-handed individuals and usually the result of language transfer associated with early left hemisphere pathology. We studied a 33-year-old right-handed man, with a normal MRI scan, who developed left frontal lobe seizures at age 15 years. Language lateralization testing by intracarotid amobarbital injection and dichotic listening showed the patient to be strongly right hemisphere language dominant. The clinical features of this patient do not fit the profile of pathology-induced language transfer, but instead suggest that he was right hemisphere language dominant before developing seizures. This case underscores the importance of language lateralization testing in patients who are candidates for seizure surgery, even if they are strongly right-handed and have late-onset seizures, features usually associated with left hemisphere language dominance. One implication is that the incidence of right hemisphere language dominance in the right-handed population may be underestimated.     

Spontaneous Anterior Cerebral Artery Dissection Presenting with Simultaneous Subarachnoid Hemorrhage and Cerebral Infarction in a Patient with Multiple Extracranial Arterial Dissections

Simultaneous subarachnoid hemorrhage and infarction is a quite rare presentation in a patient with a spontaneous dissecting aneurysm of the anterior cerebral artery. Identifying relevant radiographic features and serial angiographic surveillance as well as mode of clinical manifestation, either hemorrhage or infarction, could sufficiently determine appropriate treatment. Enlargement of ruptured aneurysm and progressing arterial stenosis around the aneurysm indicates impending risk of subsequent stroke. In this setting, prompt treatment with stent-assisted endovascular embolization can be a reliable alternative to direct surgery. When multiple arterial dissections are coexistent, management strategy often became complicated. However, satisfactory clinical results can be obtained by acknowledging responsible arterial site with careful radiographic inspection and antiplatelet medication.     

Paroxysmal Staring and Masticatory Automatisms During Postural Hypotension in a Patient with Multiple System Atrophy

Summary: Purpose: We studied a 51-year-old man with multiple system atrophy and autonomic insufficiency. He had repeated episodes of loss of contact, staring, and masticatory automatisms.
Methods: Blood pressure during these events documented a systolic pressure of 60 mm Hg. Cardiovascular reflex tests provided evidence of autonomic failure. Head computed tomography (CT) revealed moderate, diffuse cortical and cerebellar atrophy.
Results: These events were strictly related to blood pressure decreases and could be reproduced consistently by having the patient sit up after a meal. Ictal polygraphic recordings showed EEG changes consistent with anoxia, preceded by sudden hypotension with fixed heart rate.
Conclusions: Cerebral anoxia during a syncopal attack may therefore precipitate transient, sudden neurologic dysfunction that closely mimics complex partial seizures. Masticatory automatisms may represent a release phenomenon resulting from inactivation of neocortical structures by cerebral anoxia or reticular disconnection.     

多发性硬化患者脑脊液一氧化氮水平的检测及意义

目的探讨多发性硬化患者脑脊液(CSF)一氧化氮(NO)含量变化.方法采用硝酸还原酶法检测43例多发性硬化(MS)患者、25例吉兰-巴雷综合症(GBS)患者及39例对照者CSF的NO水平,同时进行其生化和细胞学成分及寡克隆IgG区带(IgG-OB)分析.结果MS组CSF的NO水平明显高于对照组(P＜0.01).结论硝酸还原酶法能快速、准确地检测CSF的NO含量;NO参与了MS的免疫发病机制,并在一定程度上反映机体细胞免疫的状态.     

不同侧别脑损伤患者失算症的特点分析

目的 比较脑损伤组与对照组的数字加工和计算测验（Number Processing and Calculation,NPC）成绩, 探讨不同侧别脑损伤患者失算症的特点。 方法 对40例脑损伤患者（左脑20例,右脑9例,双侧11例）和48例正常对照者进行NPC测验,对所 得数据进行统计分析。 结果 脑损伤组NPC测验的数字序列、数字理解、数字编码转换、计算成绩和总分均明显低于对照组 （P <0.01）。左脑损伤组的数字编码转换、计算成绩和总分低于右脑损伤组（P <0.05）。双侧脑损伤组 分别与左脑损伤组、右脑损伤组的成绩间差异无统计学意义（P >0.05） 结论 脑损伤患者的数字加工和计算能力较正常人下降。左脑损伤患者的受损表现与言语能力密切 相关。右脑损伤患者的受损表现与视空间等非言语认知能力有联系。     

Task and Stimulus Demands Influence Letter-case-Specific Priming in the Right Cerebral Hemisphere

A greater tendency to complete single-completion word stems (e.g. “BEY”) to form previously read whole words (e.g. “BEYOND”) was found when test stems were presented in the same letter case as their previously encoded words, compared with the different letter case, but only when stems were presented directly to the right hemisphere (i.e. in the left visual field) and not when they were presented directly to the left hemisphere (i.e. in the right visual field). This finding with single-completion stems was robust (i.e. observed for both lowercase and uppercase stems) when the initial encoding task was perceptually demanding, but it was test-case dependent (i.e. observed for uppercase but not lowercase stems) when the initial encoding task was not perceptually demanding. Results and theory help to explain why letter-case-specific priming in right-hemisphere test presentations is typically test-case dependent when priming is measured using perceptual identification at test, but is consistently robust when priming is measured using multiple-completion word stems (e.g.“BEA”) at test. Demands from both the stimuli and tasks affect the relative contributions of abstract and specific subsystems to the processing of visual forms.     

Progressive Cerebral Ischemia and Intracerebral Hemorrhage after Indirect Revascularization for a Patient with Cerebral Proliferative Angiopathy

We previously reported a patient with cerebral proliferative angiopathy (CPA) who showed cerebral ischemia in resting and acetazolamide-stressed N-isopropyl-p-[¹²³I] iodoamphetamine single-photon emission computed tomography (¹²³I-IMP-SPECT). At onset, the patient was treated conservatively. However, during the 2 years following initial onset, his hemiparesis and aphasia had gradually aggravated and his IQ scores were markedly decreased. MRI revealed progressive vascular proliferation and brain atrophy. ¹²³I-IMP-SPECT showed more severely impaired cerebral blood flow (CBF) and cerebrovascular reactivity over the affected hemisphere. We performed an indirect revascularization to augment CBF; however, his neurological deficits were not improved and new arteriovenous shunts via extracranial-intracranial bypass were developed, followed by an asymptomatic small intracerebral hemorrhage.There are no reports on CPA patients who have shown cerebral hemorrhage after indirect revascularization. Treatments for CPA are still challenging and controversial. Cases with severe stenosis of the proximal arteries may benefit from indirect revascularization. But indirect bypass should not be indicated for such patients without main arterial stenosis, even if they have persistent ischemia.     

Cerebral blood flow and oxygenation during head-up tilt in patients with multiple system atrophy and healthy control subjects

To assess cerebral hemodynamics in patients with multiple system atrophy (MSA), cerebral blood flow and oxygenation were evaluated in 7 MSA patients and 9 healthy controls during a head-up tilt test (HUT) by means of transcranial Doppler ultrasonography and near-infrared spectrophotometry. In the MSA patients examined, the perfusion pressure reduction during HUT was marked, but severe reduction in blood flow velocity was prevented because of a decrease in cerebrovascular resistance. The MSA patients showed no severe reduction in cerebral oxygenation during HUT. These findings indicate that our MSA patients exhibited a compensatory cerebral vasodilatation response to orthostatic hypotension.     

支架成形术治疗颅内动脉狭窄：6个月随访研究

目的 观察血管内支架成形术治疗颅内动脉狭窄的安全性及短期疗效，尤其是对认知功能的影响。方法 观察52例症状性颅内动脉狭窄患者血管内支架成形术前后的经颅多普勒超声（TCD）改变、简易精神状态评估量表（MMSE）评分及P300的变化。结果 52例患者进行了颅内动脉支架成形术，其中大脑中动脉水平段24例，椎动脉28例。治疗前责任病变血管的狭窄率为78％±10%，治疗后的狭窄率为7％±5%。在治疗后随访的1、3及6个月，MMSE明显提高而P300明显缩短；而且随随访时间延长P300及MMSE变化越明显；随访期间患者没有短暂性脑缺血发作（TIA）及症状性脑梗死发生；经TCD随访，没有发现再狭窄。结论 血管内支架成形术能有效缓解颅内动脉狭窄并能改善短期认知功能，且是安全的。其长期效果有待进一步临床观察。     

Extra-Axial Medulloblastoma in the Cerebellar Hemisphere

Extra-axial medulloblastoma is a rare phenomenon. We report a case in a 5-year-old boy who presented with nausea, vomiting, and gait disturbance. He was treated with total removal of the tumor. This is the first case of an extra-axially located medulloblastoma occurring in the cerebellar hemisphere posteriolateral to the cerebellopontine angle in Korea. Although the extra-axial occurrence of medulloblastoma is rare, it should be considered in the differential diagnosis of extra-axial lesions of the posterior fossa in children.     

Multiple Sclerosis and Peripheral Multifocal Demyelinating Neuropathies Occurring in a Same Patient

The co-occurrence of multiple sclerosis and peripheral demyelinating neuropathy is rare. It has been disputed whether these are pathologically related or coincidental findings. We report a 36-year-old woman who presented with diplopia, right facial palsy and left-sided weakness. Brain magnetic resonance imaging showed a lesion indicative of central demyelinating disease. Nerve conduction studies revealed peripheral multifocal demyelinating neuropathies. We suggest that the central and the peripheral lesions may be continua of a demyelinating process.     

Ipsilesional Bias and Processing Speed are Important Predictors of Functional Dependency in the Neglect Phenomenon After a Right Hemisphere Stroke

Visuospatial neglect (VSN) predicts unfavorable functional outcome in stroke patients. This study examined the relative importance of different core symptoms of VSN as predictors of functional dependency. A consecutive series of 105 right hemisphere stroke patients were tested early after stroke on three basic symptoms of VSN (omissions, asymmetry of omissions and ipsilesional bias of attention) and on two symptoms related to VSN (processing speed and repetitive target detections in visual search). Neurological deficits were also assessed. Functional outcome was measured 3 months and 2 years after stroke with the modified Rankin Scale. Univariate analyses revealed significant relationships with functional outcome for both core and related symptoms of VSN and for neurological deficits. Area under the curve statistics and stepwise logistic regressions showed that the most important predictors assessed early after stroke were presence of ipsilesional bias for dependency at 3 months and visual processing speed for dependency at 2 years after stroke. These results show that valuable prognostic information regarding dependency after right hemisphere stroke can be obtained by assessing fundamental sub-components of VSN early after stroke. The development of standardized clinical methods for investigation of sub-components, such as a right capture of attention and processing speed, is essential.     

社区水平的多学科综合管理对脑梗死患者二级预防效果研究

目的 研究社区水平的多学科综合管理对恢复期脑梗死患者的二级预防效果。      

False Lateralization of Seizure Perceived by a Patient with Infarction of the Right Parietal Lobe Who Showed the Neglect Syndrome

Summary: A 66–year-old right-handed man developed seizures characterized by an electric sensation and convulsive movements involving the left arm, which sometimes secondarily generalized. The patient, however, reported that the seizures occurred in his right arm. Neurological examination showed many features of left hemineglect, including allesthesia, secondary to acute infarction of the right parietal lobe. Although allesthetic response was not documented during the seizure, it is likely that sensory symptoms of the seizures were localized inappropriately or that he had false memory for lateralization of seizures. In this case, the neglect syndrome caused by infarction of the right parietal lobe extended to symptoms of the seizure itself.     

苯妥英治疗急性脑梗塞的疗效及其对脑循环动力学的影响

用随机对照方法静脉滴注苯妥英治疗急性脑梗塞２５例，观察神经功能缺失改变及首剂苯妥英静滴前后的脑循环动力学改变，结果显示，用苯妥英治疗后，脑梗塞患者神经功能缺失明显改善，总有效率达９２％，显效率达６８％，与未用苯妥英组比较差异显著（Ｐ＜０．０５）；治疗期间未见明显毒副作用。静滴苯妥英２５０ｍｇ后，颈动脉系统血流速度及血流量增加，外周小血管阻力下降，但无统计学差异。而静滴苯妥英５００ｍｇ，则可显著增加颈动脉系统血流速度及血流量（ｐ＜０．０１），降低外周小血管阻力（Ｐ＜０．０１）。提示苯妥英对缺血性脑组织有一定保护作用。