Facial myokomias in brain stem tumors]

Four cases of brain-stem tumor were described, in which myokymias were electromyographically derived from the region of several cerebral nerves. An attempt is made to interpret the effects of twitching by reference to the electromyogram. Myokymias are a positive indication of organic brain stem damage. The use subtle techniques of electromyographic examination shows that this muscular hyperkinesis is not so infrequent a symptom as is generally believed.     

Attention and memory in children with brain tumors.

The Rey Auditory Verbal Learning Test was utilized to examine attention, learning, and memory abilities in 42 children with cerebellar (N = 18) and third ventricle tumors (N = 24). Children with cerebellar tumors exhibited significant auditory attentional impairments and displayed adequate encoding and retrieval across subsequent learning and memory trials. In contrast, children with third ventricle tumors exhibited average auditory attentional abilities, but they displayed mild encoding deficits across trials 2-5. Furthermore, the third ventricle group's compromised performance on the delayed recall trial and average performance on the delayed recognition trial is suggestive of underlying retrieval deficits.     

Disorders of higher mentae functions as first symptoms in patients with brain tumors]

It has been established that in 29 (or 36,25%) of examined patients with neoplasms of the brain in the left dominant hemisphere, disturbances in the psychic functions seem to be the first and most early symptoms of the disease. They develop slowly, progressively, or in the form of epileptic language equivalents (in 5% of examined patients). As early symptoms, disturbances in language indicate existance of a brain disease and give cause to suspect a neoplasm, in this way stating the necessity of further examination, and from the other side - in some cases show the localization of the process.     

An introduction to organic brain syndromes

Organic brain syndromes are of forensic interest for several reasons. First, patients with organic brain syndromes may require judicial determination of competence in any of a number of areas, e.g., testamentary capacity, need for financial guardianship, or competence to make medical decisions. Second, any patient whose mental state is of legal interest will need evaluation for contributing organic factors; uncovering these factors may have considerable medical and legal consequence. Third, the discovery of organic factors may be decisive in the outcome of a judicial proceeding, where “hard” biological data are often accorded more weight, and are thus more persuasive, than “soft” psychological data. This article provides an introductory overview of the organic brain syndromes. For each syndrome, the clinical features are described and are illustrated with a case vignette, the more common etiologies are presented, and selected aspects to the evaluation are highlighted. In addition, since the detectian of malingered mental illness is a key component in many forensic contexts, characteristics are described which help to distinguish actual from malingered mental illness.     

Verbal memory abilities of children with brain tumors.

Several critical neuroanatomical structures and pathways for memory performance are located in the third ventricle region. This led us to predict that verbal memory abilities would be more impaired in children treated for third ventricle tumors compared to those treated for cerebellar tumors. Archival data was obtained from 24 pediatric patients with third ventricle region tumors and 18 pediatric patients with cerebellar tumors. Neuroradiological verifications of tumor involvement and hydrocephalus severity (i.e., Evans Index) on preoperative scans and MRIs proximal to the time of the neuropsychological evaluation were conducted. The potential confounds of hydrocephalus severity, seizure medication, age, radiation treatment, and chemotherapy were addressed. Verbal IQ was comparable between tumor groups and in the Average range. The third ventricle region group performed significantly worse on list learning and delayed list recall compared to the cerebellar group. Their mean performance was in the clinically impaired range on both trials. The third ventricle region tumor group performed better than the cerebellar tumor group on Digit Span, a basic repetition, attention span task. These findings support the hypothesis that pediatric patients with third ventricle region brain tumors are more likely to be impaired on verbal recall tasks compared to pediatric patients with cerebellar brain tumors. In contrast, patients who were treated for cerebellar tumors were more impaired on the basic repetition, attention span task compared to patients who were treated for third ventricle tumors. Future studies should examine the specific neuroanatomical structures and pathways that are damaged and may influence differential cognitive impairments in children.     

The usefulness of the Western Aphasia Battery for differential diagnosis of Alzheimer dementia and focal stroke syndromes: preliminary evidence.

We assessed the usefulness of the Western Aphasia Battery for distinguishing the language disturbances caused by Alzheimer dementia (AD) from those caused by stroke. Using discriminant function analyses, the multiple variable "aphasia quotient--reading quotient--writing quotient" classified 29 (72.5%) of the 40 patients correctly. These 29 patients included 8 of 10 patients with left hemisphere infarction and fluent aphasia; 6 of 10 with AD; 5 of 10 patients with right hemisphere infarction; and all 10 of the neurologically normal control subjects. The patients with AD and those with right hemisphere stroke were the most difficult to classify using the aphasia battery.     

Aphasia in a polyglot

A Greek-born aphasic who had been able to speak four languages (Romanian, Russian, Greek, German) was tested quantitatively for verbal expression (standard interview indexes) and verbal reception (fifth part of the Token Test). The form of aphasia (qualitative aspect) was found to be identical for all four languages. Quantitatively, his performance in the four languages was different, with the languages used most during the past 20 years (Romanian and Russian) being less impaired. Nevertheless, verbal reception was equally impaired quantitatively in all four languages. Treatment with semantic-syntagmatic methods performed in Romanian had a beneficial effect on speech in the other languages as well. The authors feel that the expressive disturbance noted in aphasia reflects involvement of deep as well as of surface structures of language, but the receptive disturbance reflects involvement of the deep structures only. This may account for quantitative discrepancies in expression without discrepancy in reception among the four languages, as well as the qualitatively identical features of the disturbance in verbal expression and reception.     

Combination treatment of malignant brain tumors. Results of initial experiences

First experiences with the combined treatment of malignant gliomas (29 cases) are presented in connection with the results reported in literature. The cytostatic therapy has been carried out according to the modified Israel-Scheme of Heiss et al. Using the combined treatment (resection of tumor, radiotherapy and polychemotherapy) a prolongation of survival time to 55 till 80 weeks is noticeable. The patients observed in our study survived on an average 79,8 weeks (operation and chemotherapy) resp. 94,7 weeks (operation, radiotherapy and chemotherapy). Special problems of the cytostatic therapy of malignant brain tumors are considered, among others in relation to the blood-brain-barrier and the tumorcell-kinetics; a further optimation of therapy is necessary.     

Behavior and brain neurotransmitters: correlations in different strains of mice

Correlations of behavioral patterns in a social setting with catecholamines, serotonin, and several metabolites and precursors in three brain regions were examined in the DeFries H2, C1, and L1 strains of mice. In Experiment I, behavioral observations were recorded for two 15-min sessions in same-sex, same-strain pairs at about 65 days of age. In Experiment II, sex and strain groups were subdivided into 4% and 24% protein diet groups about 1 week before a second set of behavioral observations at about 120 days of age. Brain tissue content of neurotransmitters, precursors, and metabolites was determined by high-performance liquid chromatography after the second set of observations. Significant multivariate strain differences were shown for behavioral variables (both experiments) as well as concentrations of various neurochemicals. Strain H2 showed relatively high levels of locomotion, while rearing and social investigation were high in strain C1 and self-grooming in strain L1. Significant neurochemical differences were found in the following sets of variables: dopamine variables in the cortex, norepinephrine variables and serotonin variables in the combined diencephalon and midbrain, and norepinephrine and serotonin variables in the hindbrain. Effects of diet were found only on serotonin and tryptophan in the subcortical regions. Significant multivariate correlation with the behavioral variables was demonstrated for the catecholamines but not for serotonin. The results suggest that these strain differences in behavior may be mediated by catecholamine systems.     

Speed of Lexical Activation in Nonfluent Broca''s Aphasia and Fluent Wernicke''s Aphasia

Rapid, automatic access to lexical/semantic knowledge is critical in supporting the tight temporal constraints of on-line sentence comprehension. Based on findings of “abnormal” lexical priming in nonfluent aphasics, the question of disrupted automatic lexical activation has been the focus of many recent efforts to understand their impaired sentence comprehension capabilities. The picture that emerges from this literature is, however, unclear. Nonfluent Broca's aphasic patients showinconsistent,notabsent,lexical priming, and there is little consensus about the conditions under which they do and do not prime. The most parsimonious explanation for the variable findings from priming studies to date is that the primary disturbance in Broca's lexical activation has something to do withspeedof activation. Broca's aphasic patients prime when sufficient time is allowed for activation to spread among associates. To examine this “slowed activation” hypothesis, the time course of lexical activation was examined using a list priming paradigm. Temporal delays between successive words ranged from 300 to 2100 msec. One nonfluent Broca's aphasic patient and one fluent Wernicke's patient were tested. Both patients displayed abnormal priming patterns, though of different sorts. In contrast to elderly subjects, who prime at relatively short interstimulus intervals (ISIs) beginning at 500 msec, the Broca's aphasic subject showed reliable automatic priming but only at a long ISI of 1500 msec. That is, this subject retained the ability to access lexical information automatically if allowed sufficient time to do so, a finding that may help explain disrupted comprehension of normally rapid conversational speech. The Wernicke's aphasic subject, in contrast, showed normally rapid initial activation but continued to show priming over an abnormally long range of delays, from 300 msec through 1100 msec. This protracted priming suggests failure to dampen activation and might explain the semantic confusion exhibited by fluent Wernicke's patients.     

The functional correlations of dreams and transference]

The author discusses the old question about an exceptional position of the dream in psychoanalysis in a new way: he postulates the exceptional position of the dream in relation to the transference. Case material is given to illustrate how the dream report goes beyond the level of information insofar it is in itself equivalent to a specific ongoing of the transference process. In conclusion the relations between dream and transference are discussed in regard to a hypothetic functional unit.     

Psychiatric disorders and growth of brain tumors

In 49 of 365 clinical and patho-anatomical intracranial tumour cases the tumours were indicated in the anamnesis only by mental disturbances before acute signs of brain pressure appeared. With reference to the relations between the psychopathological syndromes and the types of locations of tumours attention is drawn to factors that may complicate the early detection of tumours.