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Neurological problems
Published in Catherine Nelson-Piercy, Handbook of Obstetric Medicine, 2020
Secondary epilepsy may be encountered in pregnancy in patients who have the following: Previous surgery to the cerebral hemispheres.Intracranial mass lesions (cavernomas present with seizures or intracranial bleeding. Meningiomas and arteriovenous malformations [AVMs] enlarge during pregnancy. This should always be considered if the first seizure occurs in pregnancy).Antiphospholipid syndrome (see Chapter 8).
Cry and response
Published in Anthony Korner, Communicative Exchange, Psychotherapy and the Resonant Self, 2020
In this section, a brief outline is given of some developments in understanding brain structure linked to vocal production. The contribution of Broca’s area, in the left frontal lobe to verbal vocalization, and that of Wernicke’s area, in the left temporal lobe, to receptive functions in verbal language are well recognized. These findings contributed to the view of the left cerebral hemisphere as dominant for language. More recently there has been recognition of the prominent role of the right cerebral hemisphere in relation to attention (McGilchrist, 2009, 2012) and early development (Schore, 1994, 2012), reflecting a current reappraisal of left hemispheric dominance.
The nervous system and the eye
Published in C. Simon Herrington, Muir's Textbook of Pathology, 2020
James A.R. Nicoll, William Stewart, Fiona Roberts
Anatomically, the cerebral hemispheres are divided into frontal, parietal, temporal and occipital lobes, with each lobe ascribed stereotypical functions (see below). However, there is asymmetry in representation of certain brain functions, with verbal, linguistic and analytical functions classically localized to the ‘dominant’ hemisphere whereas visual, spatial and perceptual skills are localized to the ‘non-dominant’ hemisphere. The left cerebral hemisphere is typically the dominant hemisphere in right-handed and most left-handed individuals.
Infant-Type Hemispheric Glioma in a Chinese Girl: A Newly Defined Entity
Published in Fetal and Pediatric Pathology, 2023
Yuan Fang, Yi-zhen Wang, Xia Wei, Shao-mei Li, Lian Chen
As a newly defined entity by the fifth WHO classification of tumors of the central nervous system, the infant-type hemispheric glioma harbors specific driving gene changes, such as ALK, NTRK1/2/3, ROS1 and MET [1]. There are very few case reports of this tumor [4–7]. Two recent multi-centric studies [2,3] involving large-scale cohorts of 29 and 82 cases, respectively, served as important references for the new WHO classification to incorporate the infant-type hemispheric gliomas as a novel independent entity [1]. According to the reports of Guerreiro et al. [2] and Clarke et al. [3], infant-type hemispheric gliomas account for 19.3% (29/150) of all pediatric gliomas in the age group under four years, and 34.0% (82/241) of infantile gliomas. The median age of onset was 2.8–7.2 months, and there was no obvious gender difference in incidence, albeit with a male to female ratio of 0.93:1. As the name implies, its anatomical location is exclusively in the cerebral hemisphere. The reported clinical symptoms are heterogeneous, including vomiting, seizures, altered mental status, cardiopulmonary arrest, and deviation of the head and the gaze to one side with increased head circumference [4–7]. Neuroimaging showed high or mixed density of space occupying masses, with a maximum diameter of 6–10.2 cm [4,5]. The present case was a four-month-old female infant who presented with increased head circumference, and a massive cystic solid space occupying lesion in the left cerebral hemisphere, which were consistent with the previous reports.
Effects of diagonally aligned sitting training with a tilted surface on sitting balance for low sitting performance in the early phase after stroke: a randomised controlled trial
Published in Disability and Rehabilitation, 2021
Kazuhiro Fukata, Kazu Amimoto, Masahide Inoue, Daisuke Sekine, Mamiko Inoue, Yuji Fujino, Shigeru Makita, Hidetoshi Takahashi
We recruited patients with cerebral infarction or haemorrhage in the cerebral hemisphere who had hemiparesis or hemiplegia and attended the inpatient stroke rehabilitation program at the stroke centre. A physician confirmed the diagnosis by computed tomography or magnetic resonance imaging. Patients who were medically stable and able to remain seated in a wheelchair for over 60 min were screened using the following inclusion criteria: (1) first stroke; (2) <60 days from stroke onset; (3) >20 years old; (4) sitting quietly sub-score of function in sitting test (FIST) [22] of 1 (physical assistance needed to maintain sitting), 2 (unable to maintain sitting without using upper extremities for support or assistance), or 3 (able to sit independently but may need verbal cues or excessive time) points; (5) unable to perform static standing independently without use of the upper limbs or a leg brace; (6) stable neurological symptoms and general condition; (7) no history of orthopaedic disease or neurological disorder (Parkinson’s disease or syndrome, spinocerebellar degeneration, or multiple sclerosis); (8) no dementia or psychiatric disorder; and (9) able to understand instructions. All subjects provided written informed consent before study participation. The Ethics Committees of our hospital (approval number: 16–288) and our university approved the study design (approval number: 17055).
Avoiding complacency when treating uncontrolled seizures: why and how?
Published in Expert Review of Neurotherapeutics, 2020
Ushtar Amin, Selim R. Benbadis
Hemispherectomy, the complete removal of a cerebral hemisphere, or hemispherotomy, the functional disconnection of a cerebral hemisphere, are other palliative surgeries that are used in patients with refractory epilepsy due to unilateral diffuse hemispheric pathology [49]. This surgery is typically used in children and has, less so, been performed in adults, with favorable results reported [50]. Complications may include moderate deficits in motor function, language, and cognition [50]. Rassmusen’s encephalitis is an example of a hemispheric syndrome where there is unilateral inflammation of the cerebral cortex, refractory epilepsy, and progressive neurological and cognitive decline [51]. Hemimegalencephaly is another example of a hemispheric syndrome due to a congenital malformation of cortical development resulting in enlargement of all or parts of one cerebral hemisphere. Patients present with intractable seizures, contralateral weakness, hemianopia, and cognitive delay [49]. Unfortunately, ASMs are of limited benefit in these syndromes and functional hemispherectomy is the only solution for seizure control and possibly even seizure freedom. Although hemispherectomy surgery is very successful in achieving seizure freedom (54%-90% of patients), there is very little literature in regards to overall post-surgical outcomes as the procedure is rarely performed [49]. Patients with bitemporal epilepsy with a side predominance can also benefit from palliative resective surgery.