胼胝体梗死所致的发作性拮抗性失用

目的 探讨胼胝体梗死引起拮抗性失用的特点和机制.方法 对1例表现为发作性拮抗性失用的患者,分别进行神经心理、头颅磁共振、颈CT血管成像检查.结果 神经心理检查提示为拮抗性失用,头MRI示右侧胼胝体梗死,予抗血小板,改善脑循环治疗后发作减少.结论 胼胝体梗死可以引起发作性拮抗性失用为特征的神经心理症状.

Abstract：

Objectives To report the clinical features and treatment in a case with paroxysmal diagonistic ideomotor apraxia after ischemic infarction of the corpus callosum.Methods The neuropsychological tests,brain MRI,the TCD and carotid duplex sonography were carried out in the patient who is right handed and had had presentation of paroxysmal diagonistic ideomotor apraxia for ten days.Results Neuropsychological tests confirmed the diagnosis of paroxysmal diagonistic apraxia in this patient.MRI showed ischemic infarction in the right corpus callosum.The symptomsin the patient were improved after the treatment with aspirin for three months.Conclusion The infarction of corpus callosum may induce paroxysmal diagonistic apraxia.     

以失用为主要表现的胼胝体梗死

目的探讨胼胝体梗死的临床表现、病因及鉴别诊断特点。方法对2005年7月收治的1例53岁男性胼胝体梗死患者的临床表现、影像学特点、病因机制及其治疗过程进行回顾分析。结果临床主要表现为发作性黑蒙、言语不利,既往有高血压、糖尿病、脑梗死、吸烟、饮酒史,体格检查以失用为主要表现。头部MRI检查可见左侧脑室旁、胼胝体梗死,右侧基底节、脑桥陈旧性腔隙性梗死;脑血管造影检查显示为多发性血管狭窄,其中以左侧大脑中动脉、右侧颈内动脉及基底动脉最为严重。经颈内动脉内膜剥离术及颈内动脉支架植入术治疗,临床症状缓解。结论失用可以是胼胝体梗死的主要表现,其病因是在脑动脉粥样硬化基础上的血流动力学改变,患者预后良好。     

Facial emotion recognition in agenesis of the corpus callosum

Background

Impaired social functioning is a common symptom of individuals with developmental disruptions in callosal connectivity. Among these developmental conditions, agenesis of the corpus callosum provides the most extreme and clearly identifiable example of callosal disconnection. To date, deficits in nonliteral language comprehension, humor, theory of mind, and social reasoning have been documented in agenesis of the corpus callosum. Here, we examined a basic social ability as yet not investigated in this population: recognition of facial emotion and its association with social gaze.

Methods

Nine individuals with callosal agenesis and nine matched controls completed four tasks involving emotional faces: emotion recognition from upright and inverted faces, gender recognition, and passive viewing. Eye-tracking data were collected concurrently on all four tasks and analyzed according to designated facial regions of interest.

Results

Individuals with callosal agenesis exhibited impairments in recognizing emotions from upright faces, in particular lower accuracy for fear and anger, and these impairments were directly associated with diminished attention to the eye region. The callosal agenesis group exhibited greater consistency in emotion recognition across conditions (upright vs. inverted), with poorest performance for fear identification in both conditions. The callosal agenesis group also had atypical facial scanning (lower fractional dwell time in the eye region) during gender naming and passive viewing of faces, but they did not differ from controls on gender naming performance. The pattern of results did not differ when taking into account full-scale intelligence quotient or presence of autism spectrum symptoms.

Conclusions

Agenesis of the corpus callosum results in a pattern of atypical facial scanning characterized by diminished attention to the eyes. This pattern suggests that reduced callosal connectivity may contribute to the development and maintenance of emotion processing deficits involving reduced attention to others'' eyes.     

Crossed aphasia in a patient with congenital lesion in the right hemisphere

Abstract

A phonologically based treatment was implemented to train oral picture naming in four aphasic subjects with severe word-retrieval deficits. An initial assessment based on current cognitive neuropsychological models of naming indicated different levels of phonological and/or semantic deficits underlying naming failure across the subjects. Using a single-subject multiple baseline design across behaviours and subjects, the effects of treatment were evaluated by daily probing of both trained and untrained items across lexical tasks: oral naming, oral reading, and written naming. Results indicated successful acquisition of trained naming targets for the four subjects, and varied patterns of response generalization to naming of untrained phonologically and semantically related pictures, and to oral reading and written naming for the same words. Baseline levels of oral reading performance were noted to predict success in oral naming treatment. Differences in generalization patterns across tasks are discussed with regard to the varying functional levels of breakdown noted across subjects. This investigation demonstrates the utility of cognitive models in guiding the development of appropriate treatment strategies and generalization measures, and the importance of incorporating single-subject experimental designs in documenting changes associated with treatment.     

胼胝体动静脉畸形

本文报告１９例胼胝体动静脉畸形（ＡＶＭ），２０个病灶（１例多发）。其中，膝部３个，体部２个，压部１５个，所有病人都有蛛网膜下腔出血，而以癫痫大发作为首症状者仅１例，以胼周动脉为主要供血动脉，大脑后动脉分支亦参与供血，除１例行供血动脉结扎术外，其余１９个ＡＶＭ均采用显微外科手术完整切除，无死亡，手术疗效满意。     

Surface lesions of corpus callosum

Summary Surface lesions of the corpus callosum, apparently hitherto unrecorded in the literature, are described. They were found in 17 cases among 168 consecutively examined brains. There was no correlation with clinical symptoms, or with general autopsy findings. Their morphology and relationship to neighboring structures suggest that they represent a form of physical trauma to the corpus callosum, but the exact mechanism of their production is not clear.Supported by US Public Health Grant NB6239 from the National Institute of Neurological Diseases and Blindness.     

Less developed corpus callosum in dyslexic subjects--a structural MRI study

BACKGROUND: Based on previous studies and due to the characteristics of dyslexia as an auditory phonological decoding disorder, we predicted that the shape of the posterior corpus callosum (CC) would differ between dyslexic and control subjects. METHOD: Twenty right-handed boys with developmental dyslexia were selected from a carefully screened general population sample (mean age 11 years) and compared to a matched control group. The CC contour was manually traced on the aligned midsagittal MR slice and total callosal area and its subregions were compared between the groups. A statistical shape analysis and subsequent CC classification was performed using a recently developed shape model method. RESULTS: The shape analysis revealed shorter CC shape in the dyslexic group, localised in the posterior midbody/isthmus region. This region contains interhemispheric fibers from primary and secondary auditory cortices. A shape length difference larger than a fixed threshold in the posterior midbody region could correctly discriminate between control and dyslexic subject in 78% of the cases, where a dyslexic CC was shorter in this region than a control CC. However, there were no significant group differences with respect to overall CC area or subregions. CONCLUSION: A clear shape difference in the posterior midbody of the CC was found between dyslexic and control subjects. This fits with recent other studies that have reported a strong growth factor in this CC region during the late childhood years, coinciding with literacy acquisition. Our results show that the dyslexic group has not undergone the same growth pattern as the normal reading group.     

Abnormalities of the corpus callosum in non-psychotic high-risk offspring of schizophrenia patients

Alterations in the structure of the corpus callosum (CC) have been observed in schizophrenia. Offspring of schizophrenia parents have 10-15 times higher risk for developing schizophrenia. We examined CC volume in offspring at genetic high-risk (HR) subjects. Since the sub-regions of the CC are topographically mapped to cortical brain regions, we hypothesized that HR subjects may show a decrement in total volume and differential volume decreases in sub-regions of the CC. The offspring of schizophrenia parents (HR; n = 70; 36 males) and healthy volunteers with no family or personal history of psychotic disorders (healthy controls (HC); n = 73; 37 males) matched for age, gender and education were selected for the study. Magnetic resonance images were collected using a GE 1.5 T scanner and processed using FreeSurfer image analysis software. The CC was divided into five neuroanatomically based partitions. The volume of total CC and the five sub-regions were measured blind to clinical information. With covariation for intracranial volume, HR subjects had significantly reduced total CC, more prominently observed in the anterior splenium. An age-related increase in CC volume was found in the anterior and posterior splenium of healthy controls but not in HR subjects. The volume reduction was greater in male than female HR subjects. The volume reduction in the CC may reflect a reduction in axonal fibers crossing the hemispheres and/or myelination between the left and right temporo-parietal cortices. The absence of an age-related volume increase suggests an abnormal developmental trajectory that may underlie susceptibility to schizophrenia.     

1例外伤性胼胝体出血报告

1病例资料 患者,女性,64岁,农民,因外伤后头痛、呕吐、左侧肢体无力1d余入院。患者入院前1d不慎摔倒,当时后枕部着地,随即出现头痛,为后枕部及右侧头部胀痛,伴恶心、呕吐,呕吐呈非喷射性,呕吐物为胃内容物,自行站起后又多次摔倒,后行走约1km回家,到家后仍头痛,频繁呕吐,     

Hyperlexia and ambient echolalia in a case of cerebral infarction of the left anterior cingulate cortex and corpus callosum

We report the case of a 69-year-old woman with cerebral infarction in the left anterior cingulate cortex and corpus callosum. She showed hyperlexia, which was a distinctive reading phenomenon, as well as ambient echolalia. Clinical features also included complex disorders such as visual groping, compulsive manipulation of tools, and callosal disconnection syndrome. She read words written on the cover of a book and repeated words emanating from unrelated conversations around her or from hospital announcements. The combination of these two features due to a focal lesion has never been reported previously. The supplementary motor area may control the execution of established subroutines according to external and internal inputs. Hyperlexia as well as the compulsive manipulation of tools could be interpreted as faulty inhibition of preexisting essentially intact motor subroutines by damage to the anterior cingulate cortex reciprocally interconnected with the supplementary motor area.     

“蝴蝶状”胼胝体胶质瘤的显微手术治疗

目的探讨MRI表现呈典型“蝴蝶状”改变的胼胝体胶质瘤的临床特点,以及不同部位肿瘤的显微手术切除方法及其预后。方法收集整理2003年至2008年期间,于我院住院并显微手术治疗的35例MRI表现呈“蝴蝶状”胼胝体胶质瘤患者的临床资料进行回顾性分析。结果手术全切27例,次全切8例。术后癫痫发作2例,瘫痪1例,死亡1例,31例术后恢复良好。30例随访6个月至5年,平均生存期16个月。结论通过MRI术前精确定位,对不同部位的“蝴蝶状”胼胝体胶质瘤选择恰当的手术人路,显微镜下行全切或次全切是可行的,大多数病例能取得良好的临床效果。     

Crossed aphasia. Report of a rare case in a glioblastoma patient

A rare case of a right-handed (on the Edinburgh Inventory) woman who developed aphasia at the clinical onset of a right hemisphere glioblastoma (GBM) is reported. She showed Wernicke aphasia and left spatial neglect. The integrity of the left hemisphere was assessed by Magnetic Resonance Imaging (MRI). A few aspects of hemispheric specialization for language, praxias and spatial abilities are briefly discussed.

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Sommario Viene descritto il caso di una donna destrimane che manifestò disturbi afasici all'esordio clinico di un glioblastoma emisferico destro. La paziente presentava afasia di Wernicke ed eminattenzione spaziale sinistra. L'integrità dell'emisfero sinistro fu documentata con la Risonanza Magnetica. Alcuni aspetti della specializzazione emisferica per le funzioni linguistiche, prassiche e spaziali vengono brevemente discussi.

     

胼胝体动静脉畸形的血管内治疗的疗效分析

目的探讨胼胝体动静脉畸形的临床、影像学特点及血管内治疗的临床疗效。方法回顾性分析2017年12月至2020年12月接受血管内治疗的6例胼胝体动静脉畸形的临床资料。结果6例均有脑室出血,伴蛛网膜下腔出血2例,伴胼胝体血肿3例。Spetzler-Martin分级Ⅰ级1例,Ⅱ 级3例,Ⅲ级2例。1例仅由胼周动脉供血,5例合并存在胼周动脉及大脑后动脉分支供血;6例均向大脑内静脉的深部引流,其中1例合并存在上矢状窦引流。术后即刻造影显示大部分栓塞3例,完全栓塞3例。围手术期未发生颅内出血,1例出现拔管困难而体内留管,1例因脑积水行脑室-腹腔分流,2例术后出现短时记忆下降。DSA随访71~292 d,平均（178.3±76.15）d;1例畸形复发,行立体定向放疗;1例畸形团少量残留,复查造影显示畸形团无进展;其余4例畸形团均消失。出院后半年,6例改良Rankin量表评分0~1分。结论胼胝体动静脉畸形临床少见,但出血风险较高,因此需要积极干预。由于胼胝体的特殊解剖位置,血管内治疗具有良好的适应证。术前充分评估并选择合适的栓塞方案是一种非常安全和有效的治疗手段。     

Comprehension of humor in primary agenesis of the corpus callosum

Individuals with agenesis of the corpus callosum (ACC) can, in some cases, perform normally on standardized intelligence tests. Nevertheless, recent studies suggest that individuals with ACC and normal IQ scores have deficits in domains of fluid and social intelligence. Anecdotal reports from families suggest diminished appreciation of the subtleties of social interactions, and deficits in the comprehension of jokes and stories. In this research, both the cartoon and narrative joke subtests of a humor test (developed by Brownell et al. [Brownell, H., Michel, D., Powelson, J., & Gardner, H. (1983). Surprise but not coherence: sensitivity to verbal humor in right-hemisphere patients. Brain and language, 18(1), 20-27] and Bihrle et al. [Bihrle, A. M., Brownell, H. H., Powelson, J. A., & Gardner, H. (1986). Comprehension of humorous and non-humorous materials by left and right brain-damaged patients. Brain and Cognition, 5(4), 399-411]) were given to 16 adults with complete ACC (all with IQs>80) and 31 controls of similar age and IQ. Individuals with ACC performed worse than controls on the narrative joke subtest (p<.025) when VIQ was controlled. However, on the cartoon subtest the two groups were not significantly different. Covarying age, forms of IQ, narrative memory, set-switching, and literal language comprehension did not substantially alter the group difference. However, covarying comprehension of nonliteral language and proverbs eliminated the difference, suggesting a common origin for the comprehension of jokes, nonliteral language, and proverbs, most likely related to capacity for understanding second-order meanings.     

Case study: A patient with agenesis of the corpus callosum with minimal associated neuropsychological impairment

This is a case study of an 88-year-old man who presented with agenesis of the corpus callosum and colpocephaly. Symptomatically, he reported a sudden onset of mild, intermittent left hand apraxia, but denied any previous manifestations consistent with this type of brain malformation. The patient underwent neuroimaging, evaluation by neurology, and comprehensive neuropsychological testing to determine the nature of any other associated impairments. Test results indicated that he was, with a few exceptions, neuropsychologically normal. He performed well on tests that are highly sensitive to acquired brain dysfunction. His most notable deficit was failed performance in the simultaneous and coordinated use of both hands in using tactile and proprioceptive feedback on the Tactual Performance Test. This case is discussed in terms of plasticity of the developing brain, including compensatory mechanisms, highlighting the variability in clinical outcome in the context of congenital brain malformation. This case study illustrates the strong influence of cerebral plasticity as well as a possible circumscribed manifestation of interhemispheric disconnection.     

Crossed aphasia with left spatial neglect and visual imperception: a case report

A 64-year-old right-handed woman with no left-handers in the family developed aphasia associated with moderate left hemiparesis and dense left homonymous hemianopia following rupture of a right middle cerebral artery aneurysm and subsequent selective surgery confined to the right hemisphere. Severe left spatial neglect and constructional apraxia were also present. The patient was an achondroplasic dwarf whose previous medical and neurological history was otherwise unremarkable. Computed tomography of the brain showed a large right temporo-insulofrontoparietal lesion. Language and nonverbal cognitive functions were assessed after 2 and 6 months, and then four years later. A reportedly overall language disruption in the acute period evolved into Wernicke's aphasia and then into a mild form of conduction aphasia. The associated left spatial neglect eventually shrank to a minimum. The patient never had clinically detectable visual agnosia, but on specific tests of visual recognition and perception some impairment was found four years after onset. The left hemiparesis disappeared in time while the left hemianopia persisted. This case is a convincing example of an entirely righthanded person in whom both linguistic and visuospatial functions are represented in the right hemisphere. Received: 12 May 2002 / Accepted in revised form: 18 November 2002 Correspondence to L.A. Vignolo     

Myelinated and unmyelinated axons of the corpus callosum differ in vulnerability and functional recovery following traumatic brain injury

Traumatic axonal injury (TAI), a common feature of traumatic brain injury, is associated with postinjury morbidity and mortality. However, TAI is not uniformly expressed in all axonal populations, with fiber caliber and anatomical location influencing specific TAI pathology. To study differential axonal vulnerability to brain injury, axonal excitability and integrity were assessed in the corpus callosum following fluid percussion injury in the rat. In brain slice electrophysiological recordings, compound action potentials (CAPs) were evoked in the corpus callosum, and injury effects were quantified separately for CAP waveform components generated by myelinated axons (N1 wave) and by unmyelinated axons (N2 wave). Ultrastructural analyses were also conducted of TAI-induced morphological changes in these axonal populations. The two populations of axons differed in response to brain injury, and in their functional recovery, during the first week postinjury. Amplitudes of N1 and N2 were significantly depressed at 3 h, 1 day, and 3 days survival. N1 amplitudes exhibited a recovery to control levels by 7 days postinjury. In contrast, N2 amplitudes were persistently suppressed through 7 days postinjury. Strength-duration properties of evoked CAPs further differentiated the effects of injury in these axonal populations, with N2 exhibiting an elevated strength-duration time constant postinjury. Ultrastructural observations revealed degeneration of myelinated axons consistent with diffuse injury sequelae, as well as previously undocumented pathology within the unmyelinated fiber population. Collectively, these findings demonstrate differential vulnerabilities of axons to brain injury and suggest that damage to unmyelinated fibers may play a significant role in morbidity associated with brain injury.     

The morphology of the corpus callosum in schizophrenia: An MRI study

40 schizophrenic patients and 17 normal controls underwent magnetic resonance imaging (MRI) of the brain. All subjects were consenting males. The size and form of the corpus callosum in the mid-sagittal cut of MRI were evaluated. This study revealed that the mean size of the anterior region of the corpus callosum was significantly greater in schizophrenics than in controls. The elongated anterior corpus callosum, which did not correlate with age, duration of illness, birth complications or any measures of brain areas in the midsagittal cut, was regarded as a primary change. Schizophrenics with the elongated corpus callosum seemed to have an unfavorable prognosis, because the large corpus callosum suggested poor heterosexual relations, reduced number of hospitalizations, low academic grades and mild anxiety-depression syndrome. A smooth and even corpus callosum seen in schizophrenics was likely a change dependent on duration of illness.     

Agenesis of corpus callosum: prenatal diagnosis and prognosis

Introduction Agenesis of corpus callosum (ACC) is commonly diagnosed prenatally. When isolated, it appears to carry a good prognosis but studies are often retrospective and follow-up short. We report a prospective study of 17 children (11 boys, 6 girls) with prenatally diagnosed isolated ACC.Methods Neuropsychological evaluation was performed each year and results at the ages of 2, 4, and 6 years were compared.Results Febrile seizures occurred in 3 patients. Median intellectual quotient (IQ) was within the normal range (80–109) and nonrelated to partial or complete ACC, sex, or febrile seizures. Lower median IQ was significantly related to low cultural status. With age, the number of children with IQ in the lower range (80–89) increased and slowness, attentional troubles, and instability appeared.Conclusion This study demonstrates that if outcome of isolated ACC is favorable, a long follow-up is necessary: with age, IQ in the lower range and behavioral troubles are linked to difficulties in school.