The "steroid dementia syndrome": a possible model of human glucocorticoid neurotoxicity.

Glucocorticoid medications cause neurotoxicity in animals under certain circumstances, but it is not known if this occurs in humans. We present the case of a 10-year-old boy with no prior psychiatric history and no prior exposure to glucocorticoid medication who received a single 5-week course of glucocorticoids for an acute asthma flare. Beginning during steroid treatment, and persisting for over 3 years after stopping treatment, he showed a significant decline from his pre-morbid academic performance and estimated IQ, verified by longitudinally administered testing and school records.

Anterior and middle cranial fossa in traumatic brain injury: relevant neuroanatomy and neuropathology in the study of neuropsychological outcome.

The frontal and temporal lobe regions of the brain have a high vulnerability to injury as a consequence of cerebral trauma. One reason for this selective vulnerability is how the frontal and temporal regions are situated in the anterior and cranial fossa of the skull. These concavities of the skull base cup the frontal and temporal lobes which create surface areas of contact between the dura, brain, and skull where mechanical deformation injures the brain.

Diffusion tensor imaging of white matter in the superior temporal gyrus and temporal stem in autism.

Recent MRI studies have indicated that regions of the temporal lobe including the superior temporal gyrus (STG) and the temporal stem (TS) appear to be abnormal in autism. In this study, diffusion tensor imaging (DTI) measurements of white matter in the STG and the TS were compared in 43 autism and 34 control subjects. DTI measures of mean diffusivity, fractional anisotropy, axial diffusivity, and radial diffusivity were compared between groups.

Autopsy-confirmed Alzheimer's disease versus clinically diagnosed Alzheimer's disease in the Cache County Study on Memory and Aging: a comparison of quantitative MRI and neuropsychological findings.

Atrophy of specific, regional, and generalized brain structures occurs as a result of the Alzheimer's disease (AD) process. Comparing AD patients with histopathological confirmation of the disease at autopsy to those without autopsy but who were clinically diagnosed using the same antemortem criteria will provide further evidence of the utility and accuracy of neuropsychological assessments at the time of diagnosis, as well as the efficacy of quantitative magnetic resonance imaging (qMRI) in demonstrating gross neuropathological changes associated with the disease. The Cache County Study of Aging provides a unique opportunity to determine how closely AD subjects with only the clinical diagnosis match similarly diagnosed AD subjects but with postmortem confirmation of the disease.

A retrospective fetal ultrasound study of brain size in autism.

Background: Despite evidence of possible abnormalities during fetal development, no study to date has attempted to investigate fetal brain growth in autism. Fetal head circumference (HC) and biparietal diameter (BPD) are highly correlated with fetal brain volume and are measured on fetal ultrasounds.

Methods: We used retrospective fetal ultrasound data to examine fetal head and body size during midgestation in children later diagnosed with autism.

Objective documentation of traumatic brain injury subsequent to mild head trauma: multimodal brain imaging with MEG, SPECT, and MRI.

Objective: To determine to what extent magnetic resonance imaging (MRI), single photon emission computed tomography (SPECT), and magnetoencephalography (MEG) can provide objective evidence of brain injury in adult patients with persistent (>1 year) postconcussive symptoms following mild blunt head trauma.

Design: A retrospective and blind review of imaging data with respect to the presence of specific somatic, psychiatric, and cognitive complaints.

Setting/participants: Thirty complete data sets (with MRI, SPECT, MEG, and neuropsychological testing results) were collected between 1994 and 2000 from the MEG programs at the Albuquerque VAMC and the University of Utah.

Superior temporal gyrus, language function, and autism.

Deficits in language are a core feature of autism. The superior temporal gyrus (STG) is involved in auditory processing, including language, but also has been implicated as a critical structure in social cognition. It was hypothesized that subjects with autism would display different size-function relationships between the STG and intellectual-language-based abilities when compared to controls.

Social outcomes in childhood brain disorder: a heuristic integration of social neuroscience and developmental psychology.

The authors propose a heuristic model of the social outcomes of childhood brain disorder that draws on models and methods from both the emerging field of social cognitive neuroscience and the study of social competence in developmental psychology/psychopathology. The heuristic model characterizes the relationships between social adjustment, peer interactions and relationships, social problem solving and communication, social-affective and cognitive-executive processes, and their neural substrates. The model is illustrated by research on a specific form of childhood brain disorder, traumatic brain injury.

Hippocampus, amygdala, and basal ganglia morphometrics in children after moderate-to-severe traumatic brain injury.

While closed head injury frequently results in damage to the frontal and temporal lobes, damage to deep cortical structures, such as the hippocampus, amygdala, and basal ganglia, has also been reported. Five deep central structures (hippocampus, amygdala, globus pallidus, putamen, and caudate) were examined in 16 children (eight males, eight females; aged 9-16y), imaged 1 to 10 years after moderate-to-severe traumatic brain injury (TBI), and in 16 individually-matched uninjured children. Analysis revealed significant volume loss in the hippocampus, amydala, and globus pallidus of the TBI group.

Quantitative temporal lobe differences: autism distinguished from controls using classification and regression tree analysis.

The temporal lobe is thought to be abnormal in autism, yet standard volumetric analyses are often unrevealing when age, sex, IQ, and head size are controlled. Quantification of temporal lobe structures were obtained in male subjects with autism and controls, where subjects with head circumference (HC) defined macrocephaly were excluded, so that volume differences were not just related to the higher prevalence of macrocephaly in autism. Various statistical methods were applied to the analysis including a classification and regression tree (CART) method, a non-parametric technique that helps define patterns of relationships that may be meaningful in distinguishing temporal lobe differences between subjects with autism and age and IQ matched controls.

A motion to exclude and the 'fixed' versus 'flexible' battery in 'forensic' neuropsychology: challenges to the practice of clinical neuropsychology.

Two recent publications in Archives of Clinical Neuropsychology (ACN) have been used by defense attorneys as the centerpiece for an argument that only a 'fixed' battery approach, exemplified by the Halstead-Reitan battery (HRB), satisfies the Daubert criteria for admissibility; and therefore, the HRB represents the only method of forensic neuropsychological assessment that should be admitted into evidence. Since this case has important implications for the practice of clinical neuropsychology in the United States, this 'Motion to Exclude' and its rationale are presented, which demonstrates how the legal profession uses neuropsychological literature. The critical issues of this argument for clinical neuropsychological practice are reviewed.

Diffusion tensor imaging of the corpus callosum in Autism.

The corpus callosum is the largest commissural white matter pathway that connects the hemispheres of the human brain. In this study, diffusion tensor imaging (DTI) was performed on subject groups with high-functioning autism and controls matched for age, handedness, IQ, and head size. DTI and volumetric measurements of the total corpus callosum and subregions (genu, body and splenium) were made and compared between groups.

Head circumference and height in autism: a study by the Collaborative Program of Excellence in Autism.

Data from 10 sites of the NICHD/NIDCD Collaborative Programs of Excellence in Autism were combined to study the distribution of head circumference and relationship to demographic and clinical variables. Three hundred thirty-eight probands with autism-spectrum disorder (ASD) including 208 probands with autism were studied along with 147 parents, 149 siblings, and typically developing controls. ASDs were diagnosed, and head circumference and clinical variables measured in a standardized manner across all sites.

Diffusion tensor imaging in the corpus callosum in children after moderate to severe traumatic brain injury.

Diffusion tensor imaging (DTI) is a recent imaging technique that assesses the microstructure of the cerebral white matter (WM) based on anisotropic diffusion (i.e., water molecules move faster in parallel to nerve fibers than perpendicular to them).

Day-of-injury computerized tomography, rehabilitation status, and development of cerebral atrophy in persons with traumatic brain injury.

Objective: To compare day-of-injury (DOI) computerized tomography (CT) findings with acute injury severity markers, disability at acute hospital admission and discharge from inpatient rehabilitation, injury severity markers, and degree of postacute cerebral atrophy on magnetic resonance imaging (MRI).

Design: Retrospective chart review of 240 consecutive traumatic brain injury (TBI) admissions (mean age 31.7 +/- 15.

Vulnerability of the anterior commissure in moderate to severe pediatric traumatic brain injury.

In relation to the adult brain, the immature brain might be more vulnerable to damage during and following traumatic brain injury, particularly in white-matter tracts. Given well-established evidence of corpus callosum atrophy, we hypothesized that anterior commissure volume (using quantitative magnetic resonance imaging [MRI]) in this structure would be decreased in children with moderate to severe traumatic brain injury relative to typically developing children. Second, given the purported role of the anterior commissure in interhemispheric axon conveyance between temporal lobes, we hypothesized that temporal lobe white matter, temporal lesion volume, and injury severity (Glasgow Coma Scale score) would be predictive of decreased anterior commissure cross-sectional volume in patients with traumatic brain injury.

Post-traumatic amnesia predicts long-term cerebral atrophy in traumatic brain injury.

Primary Objective: To examine post-traumatic amnesia (PTA) and its relation to long-term cerebral atrophy in persons with traumatic brain injury (TBI) using objective indicators of PTA duration and Quantitative Magnetic Resonance Imaging (QMRI). It was hypothesized that longer PTA would predict later generalized atrophy (increased ventricle-to-brain ratio (VBR)). As a guide in assessing patients with TBI, this study determined the probability of developing chronic cerebral atrophy based on PTA duration.

Prevalence of white matter hyperintensities in a young healthy population.

Background And Purpose: White matter hyperintensities (WMHs) are bright objects observed in the white matter on brain magnetic resonance (MR) imaging. WMHs are often reported as "normal" findings but may represent pathological changes. The prevalence of WMHs appears to increase with increasing age although both the typical timing and clinical significance of their appearance among medically and neurologically healthy persons remains unclear.

Population-based study of medical comorbidity in early dementia and "cognitive impairment, no dementia (CIND)": association with functional and cognitive impairment: The Cache County Study.

Objective: Authors investigated medical comorbidity in persons with dementia and "Cognitive Impairment, No Dementia" (CIND).

Methods: The Cache County Study is an ongoing population-based study of the epidemiology of dementia, the risk factors for conversion from CIND to dementia, and the progression of dementia. As part of the study's first incidence wave, persons with dementia (N=149), CIND (N=225), or without cognitive impairment (N=321) were identified and studied.

Neurobehavioral sequelae of child sexual abuse.

This study examined intellectual and memory functioning in a sample of sexually abused children compared to demographically and age-matched controls. The severity of abuse and other pertinent factors were also examined in relation to cognitive performance. Elevated levels of psychopathology were present in the abused children, as well as diminished performance on tasks influenced by attention/concentration.

Measuring medical complexity during inpatient rehabilitation after traumatic brain injury.

Objective: To compare the performance of 3 severity of illness (SOI) indices--the Comprehensive Severity Index (CSI), All Patient Refined Diagnosis Related Groups Severity of Illness, case-mix group (CMG)--and 5 well-known neurologic parameters, as measures of medical complexity.

Design: Retrospective chart review.

Setting: Inpatient rehabilitation center within a level I trauma center.

Clinical rating of cortical atrophy and cognitive correlates following traumatic brain injury.

We report on the utility of using a rapid, easy-to-use, visually based semi-quantitative neuroimaging atrophy rating scale in individuals with traumatic brain injury (TBI) and normal control subjects. Magnetic resonance (MR) scans were rated using a standardized semi-quantitative MR rating method. A four-point scale was used to rate each scan for atrophy in frontal, temporal, and parietal areas.

Memory and learning in children with 22q11.2 deletion syndrome: evidence for ventral and dorsal stream disruption?

This study examined memory functioning in children and adolescents with 22q11.2 Deletion Syndrome (DS; velocardiofacial syndrome). An overall verbal better than nonverbal memory pattern was evident on the Test of Memory and Learning (TOMAL), with children with 22q11.

Macrocephaly, corpus callosum morphology, and autism.

Although the cause of autism is undetermined, a general consensus has been that some type of early aberrant neural development underlies the disorder. Given the increased prevalence of macrocephaly in autism, one theory of abnormal neural development implicates early brain growth resulting in larger brain and head size in autism. Surface area measurements of the midsagittal section of the corpus callosum can be used as an index of neural development and white-matter integrity because the corpus callosum is the major white-matter structure that interconnects the two cerebral hemispheres.