Lesion localization
Michael Y. Wang, Andrea L. Strayer, Odette A. Harris, Cathy M. Rosenberg, Praveen V. Mummaneni in Handbook of Neurosurgery, Neurology, and Spinal Medicine for Nurses and Advanced Practice Health Professionals, 2017
The brain is a complex organ. With our current understanding of its intricate layout, we are only able to understand general functions relative to specific structures. The concept of lesion localization in the brain has its basis in our understanding the basic anatomic structures, how they communicate with one another, and which structures they neighbor. The foundations of clinical neurology and neurosurgery that allow us to localize a lesion include anatomy and physiology, the patient history, the neurologic examination, and then use of this information to identify where in the nervous system the lesion is and then provide a differential diagnosis of what the pathology is. This information allows the clinician to formulate a plan to try and confirm the diagnosis, develop a treatment plan, and provide a prognosis. Nurses and advanced health-care providers can enhance their ability to care for neurologically compromised patients by knowing where in the brain their patient’s lesion lies. This information allows for a better understanding of the patient’s presenting symptoms and the expected clinical exam findings. A comprehensive treatment plan can then be tailored and executed. A brain lesion can include a variety of diagnoses that pertain to an area of dysfunction anatomically or physiologically. This could include aneurysm, vascular malformation, tumor, infection, inflammation, hemorrhage, demyelination, traumatic lesion, or congenital cyst.
Epilepsy and Sleep Disorders
John W. Scadding, Nicholas A. Losseff in Clinical Neurology, 2011
It is a rare condition, accounting for perhaps 1 per cent of all new cases of epilepsy, although because of its poor outcome it may represent as many as 10 per cent of cases of severe epilepsy. Lennox–Gastaut syndrome is frequently associated with learning difficulties and neuropsychiatric disturbances. In about half of the cases, no definite aetiological factor can be identified. A past history of West syndrome is the most common identifiable cause, being present in 30–40 per cent of children. Other causes include brain damage at birth, infections, tumour and severe head trauma. The condition typically has its onset between ages three and five years, although it may start at as early an age as one year or as late as eight years of age (rarely even older). Patients are at high risk of developing status epilepticus, either tonic–clonic or non-convulsive. The prognosis of Lennox–Gastaut syndrome is poor, both with regard to seizure control (seizures persisting in 60–80 per cent of patients) and mental development. Cognitive and behavioural problems are very common, and it is unusual for patients ever to lead independent lives.
Gerstmann Syndrome (Dysgraphia, Dyscalculia, Finger Agnosia, and Left-Right Disorientation)
Alexander R. Toftness in Incredible Consequences of Brain Injury, 2023
Damage to a part of the brain called the angular gyrus, located near where the parietal and temporal lobes meet, appears to be enough to produce this syndrome. However, there are reports of people developing some of the symptoms even with brain damage in different areas (Bhattacharyya et al., 2014). For example, dyscalculia can be a symptom of damage to many different brain locations, including frontal, temporal, parietal, and subcortical structures, although the angular gyrus is probably the most frequently implicated (e.g., Grafman et al., 1982; Willmes, 2008). Importantly, Gerstmann syndrome is commonly associated with damage to the dominant hemisphere of a person's brain (Tucha et al., 1997). In right-handed people, the left side of the brain is usually dominant, and because most people are right-handed, Gerstmann syndrome is usually associated with damage to the left half of the brain. Therefore, Gerstmann syndrome is most frequently associated with left-sided damage of the angular gyrus… but there are exceptions to all of this (Lebrun, 2005). In fact, there are a lot of exceptions to the guidelines of this syndrome, which brings us to an important question.
Ganglion Cell Topography Indicates Pre- or Postnatal Damage to the Retro-Geniculate Visual System, Predicts Visual Field Function and May Identify Cerebral Visual Impairment in Children – A Multiple Case Study
Published in Neuro-Ophthalmology, 2019
Lena Jacobson, Finn Lennartsson, Maria Nilsson
With the help of new diagnostic tools, it has now become possible to more precisely describe the connection between the primary retro-geniculate lesion and the secondary loss of retinal ganglion cells. The primary brain lesion can be depicted with magnetic resonance imaging (MRI). Optic coherence tomography (OCT) can analyse the retinal nerve fibre layer (RNFL). In 2005 Mehta and Plant5 used OCT and reported RNFL thinning in two adult patients who presented with homonymous visual field defects due to presumed prenatal occipital stroke. Jindahra et al. (2009)6 demonstrated thinning of the RNFL in the human retina in individuals with homonymous hemianopia, in both “congenital” and adult acquired cases. The extent and exact location of the underlying brain pathology were not described. Park et al. (2012)7 defined the pattern of brain pathology in adult stroke patients using MRI to describe the lesion side and vascular territory. They then used OCT to study the RNFL and demonstrated topographical correlations between the thinning of the RNFL and the nature of the brain lesion. They also quantified the degree of visual field loss. Their study therefore covered neuroradiology, RNFL structure and visual field function.
Multidisciplinary approach to degenerative cervical myelopathy
Published in Expert Review of Neurotherapeutics, 2020
Ali Moghaddamjou, Jamie R.F. Wilson, Allan R. Martin, Harry Gebhard, Michael G. Fehlings
DCM has a broad differential diagnosis that requires a clinician with neurological expertise to decipher. This includes radiculopathy, polyradiculopathy, stroke, inflammation (e.g. multiple sclerosis, transverse myelitis), tumor, Chiari malformation, diabetic neuropathy, peripheral nerve entrapment (e.g. carpal tunnel), and amyotrophic lateral sclerosis (ALS). The diagnosis can typically be made based on the clinical and imaging criteria discussed above, but the possibility of a brain lesion should always be considered and ruled out by a complete neurological examination combined with brain imaging, when necessary. As a result, input from a neurologist, physiatrist, or spine surgeon is necessary to help confirm the diagnosis. In some cases, it is useful for the neurologist or physiatrist to perform electromyography (EMG), nerve conduction studies, and other electrophysiology tests (e.g. somatosensory evoked potentials) to rule out alternative diagnoses. Unfortunately, these tests have poor sensitivity to diagnose cervical myelopathy, but a promising new technique called contact heat evoked potentials (CHEPs) may overcome these limitations [44].
Patterns of vestibular function in patients with dizziness after COVID-19 vaccination; dual tertiary referral center study
Published in Acta Oto-Laryngologica, 2022
Joonsik Yoon, Min Seok Song, Sang-Yeon Lee, Moo Kyun Park, Jun Ho Lee, Seung Ha Oh, Min Young Lee, Myung-Whan Suh
While every patient had test results suggesting peripheral vestibular functional weakness, 56% of patients’ vestibular function test results showed central vestibulopathy signs (Table 4). The most common sign was periodic nystagmus: nystagmus that comes and goes within the same day. Five patients showed periodic nystagmus. Four out of five patients had the onset of dizziness within a day after vaccination. Among them, periodic (intermittent) positional nystagmus was observed in two patients. Periodic spontaneous nystagmus was observed in one patient. Periodic alternating nystagmus (nystagmus with different directions each time) was observed in one patient. No patients showed rhythmic nystagmus. Periodic alternating nystagmus sustained for 45 days. Patients complained of intermittent dizziness attacks with a duration of less than an hour, recurring about three times a day. Two patients consulted the Department of Neurology for a differential diagnosis. Imaging analyses, such as MRI or single photon emission computed tomography, were performed on nine patients, and a brain lesion was detected in one patient.
Related Knowledge Centers
- Acquired Brain Injury
- Birth
- Birth Defect
- Brain Cell
- Primary & Secondary Brain Injury
- Traumatic Brain Injury
- Injury
- Head Injury
- Genetic Disorder
- Primary & Secondary Brain Injury
- Focal & Diffuse Brain Injury