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.
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.
Chapter 5 Mind-bending pain
Lawrence Goldie, Jane Desmarais in Psychotherapy and the Treatment of Cancer Patients, 2013
After treatment of breast cancer or a brain tumour, the patient may be left disabled, complaining and unpacified. A brain tumour may be removed with little prospect of recurrence but along with the tumour the patient may lose his or her capacity to work and live independently. In my opinion, the decision to operate knowing the consequences requires serious discussion and consideration by many people. The known precedents need to be made clear to the patients and their relatives. The predictions, and the unreliability of predictions, of impaired mental capacity, for example, should be discussed. Sometimes treatment other than complete removal of the brain tumour may be considered, to limit the brain damage and loss of faculties. Having the necessary facilities, organised and focused on caring for the severely damaged patient, is important. I have described instances where the cancer ‘cure’ — removal of a brain tumour — has also removed the mind in its completeness and produced a peculiarly distressing situation for the families of patients. My involvement was invariably requested after the damage was done, when the situation was irretrievable. The anger on the part of relatives that I mentioned towards the damaged patient, could, with preparation, be avoided. It is not only a person, the patient, that is lost, but the family's relationship to the patient is also damaged. The person they knew has been taken away, and those who took him away have no remedy and no recompense.
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].
Neuroanatomical and behavioural factors associated with the effectiveness of two weekly sessions of prism adaptation in the treatment of unilateral neglect
Published in Neuropsychological Rehabilitation, 2020
Maria Gutierrez-Herrera, Simone Eger, Ingo Keller, Joachim Hermsdörfer, Styrmir Saevarsson
Brain lesions were confirmed in all 19 patients by means of MRI (magnetic resonance imaging) and structural CT (computed tomography) scans. MRI scans were available for nine patients and CT scans for 10. Using the MRIcron software (Rorden, Karnath, & Bonilha, 2007), a trained researcher blinded to patients’ neuropsychological performance delineated the lesion borders on a slice-by-slice basis, either directly onto the T2-weighted fluid-attenuated inversion recovery image (FLAIR; 5 mm slice thickness) or onto the CT scan (2.5 mm slice thickness). In order to examine a three-dimensional lesion, the resulting two-dimensional map was then converted into a volume of interest. Subsequently, both the anatomical scan and the lesion volume were normalised to a standard brain template created from older adults using the Clinical Toolbox (Rorden, Bonilha, Fridriksson, Bender, & Karnath, 2012) running under SPM8 (Statistical Parametric Mapping Software package; http://www.fil.ion.ucl.ac.uk/spm). This toolbox provides age-specific templates oriented in MNI space for both CT and MRI scans (Rorden et al., 2012). If available, high-resolution T1-weighted anatomical scans were coregistered with the MRI scans during the normalisation process. The amount of lesion overlap among all patients is shown in Figure 2.
The prognostic and predictive significance of serum thiols and disulfide levels in advanced non-small cell lung cancer
Published in The Aging Male, 2020
Fatih Karatas, Murat Acat, Suleyman Sahin, Fatih Inci, Gulsah Karatas, Salim Neselioglu, Ismail Haskul, Ozcan Erel
In staging of patients with NSCLC, Positron Emission Tomography (PET) and contrast-enhanced brain Magnetic Resonance Imaging (MRI) were used as standard; the presence of metastases in lesions, detected in PET or by clinical findings, were histopathologically confirmed, or ruled out through Computed tomography-guided tru-cut needle biopsies. In brain MRI, malignant-looking brain lesions which were thought to be non-primary brain tumors or multiple parenchymal lesions compatible with metastasis were considered as metastasis, whereas solitary lesions were pathologically diagnosed as metastasis from excision material. Survival information was obtained through the database for population registration and tracking system of our country. The control group consisted of demographically-matched volunteers who were selected from the subjects applying to our hospital for general health screening. The exclusion criteria for both groups were defined as follows: any history of a presence of a second primary cancer, an uncontrolled severe symptomatic cardiovascular or metabolic disease, having organ dysfunction such as liver, kidney, and thyroid, patients unable to feed orally, any presence of rheumatic disorder, use of anti-inflammatory or immunosuppressive drugs (i.e. non-steroidal anti-inflammatory drugs, corticosteroids, anti-tumor necrosis factor alpha, or colchicine), and receiving hormone replacement therapies.
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