Neuropsychiatric outcomes following strokes involving the cerebellum: a retrospective cohort study.

Introduction: Given the wide-ranging involvement of cerebellar activity in motor, cognitive, and affective functions, clinical outcomes resulting from cerebellar damage can be hard to predict. Cerebellar vascular accidents are rare, comprising less than 5% of strokes, yet this rare patient population could provide essential information to guide our understanding of cerebellar function.

Methods: To gain insight into which domains are affected following cerebellar damage, we retrospectively examined neuropsychiatric performance following cerebellar vascular accidents in cases registered on a database of patients with focal brain injuries.

Hyperacute immune responses associate with immediate neuropathology and motor dysfunction in large vessel occlusions.

Objective: Despite successful endovascular therapy, a proportion of stroke patients exhibit long-term functional decline, regardless of the cortical reperfusion. Our objective was to evaluate the early activation of the adaptive immune response and its impact on neurological recovery in patients with large vessel occlusion (LVO).

Methods: Nineteen (13 females, 6 males) patients with acute LVO were enrolled in a single-arm prospective cohort study.

Large-scale lesion symptom mapping of depression identifies brain regions for risk and resilience.

Understanding neural circuits that support mood is a central goal of affective neuroscience, and improved understanding of the anatomy could inform more targeted interventions in mood disorders. Lesion studies provide a method of inferring the anatomical sites causally related to specific functions, including mood. Here, we performed a large-scale study evaluating the location of acquired, focal brain lesions in relation to symptoms of depression.

Neural correlates of recognition and naming of famous persons and landmarks: A special role for the left anterior temporal lobe.

The anterior temporal lobes (ATLs) have been shown to be crucial for recognition and naming of unique entities such as persons and places. In this chapter, we review previous research that identified the neural underpinnings of these processes, and discuss the convergence zone theory of conceptual knowledge and proper name retrieval. Lesion-deficit and neuroimaging studies have found that the temporal poles are essential for recognition and naming of unique persons and places.

Lateralized differences for verbal learning across trials in temporal lobe epilepsy are not affected by surgical intervention.

This research aimed to broaden understanding of learning verbal material in participants with left- and right-sided mesial temporal lobe epilepsy (MTLE). We modeled word list-learning to determine how anterior temporal lobe resection affects verbal learning. Verbal learning (across trials) was assessed using the first five trials of the Rey Auditory Verbal Learning Test (RAVLT) in 128 participants with MTLE.

Lesions in different prefrontal sectors are associated with different types of acquired personality disturbances.

"Frontal lobe syndrome" is a term often used to describe a diverse array of personality disturbances following frontal lobe damage. This study's guiding premise was that greater neuroanatomical specificity could be achieved by evaluating specific types of personality disturbances following acquired frontal lobe lesions. We hypothesized that three acquired personality disturbances would be associated with lesion involvement of distinct sectors of the prefrontal cortex (PFC): 1) emotional-social disturbance and ventromedial PFC, 2) hypoemotional disturbance and dorsomedial PFC, and 3) dysexecutive and dorsolateral PFC.

Post-stroke outcomes predicted from multivariate lesion-behaviour and lesion network mapping.

Clinicians and scientists alike have long sought to predict the course and severity of chronic post-stroke cognitive and motor outcomes, as the ability to do so would inform treatment and rehabilitation strategies. However, it remains difficult to make accurate predictions about chronic post-stroke outcomes due, in large part, to high inter-individual variability in recovery and a reliance on clinical heuristics rather than empirical methods. The neuroanatomical location of a stroke is a key variable associated with long-term outcomes, and because lesion location can be derived from routinely collected clinical neuroimaging data there is an opportunity to use this information to make empirically based predictions about post-stroke deficits.

Cognitive and Psychological Functioning in Chiari Malformation Type I Before and After Surgical Decompression - A Prospective Cohort Study.

Background: Chiari Malformation Type I (CM-I) is defined as cerebellar tonsil displacement more than 5 mm below the foramen magnum. This displacement can alter cerebrospinal fluid flow at the cervicomedullary junction resulting in Valsalva-induced headaches and syringomyelia and compress the brainstem resulting in bulbar symptoms. However, little is known about cognitive and psychological changes in CM-I.

Assessing the Effects of Healthy and Neuropathological Aging on Personality with the Iowa Scales of Personality Change.

Personality changes in older adults with brain disease may be confounded by effects of normal aging. In this cross-sectional study, ratings with the Iowa Scales of Personality Change for 62 healthy older adults (OA-H, aged 60+) were compared to matched older adults with brain diseases (OA-BD). OA-H did not show any significant personality changes from middle age to older adulthood.

Multivariate Lesion-Behavior Mapping of General Cognitive Ability and Its Psychometric Constituents.

General cognitive ability, or general intelligence (g), is central to cognitive science, yet the processes that constitute it remain unknown, in good part because most prior work has relied on correlational methods. Large-scale behavioral and neuroanatomical data from neurologic patients with focal brain lesions can be leveraged to advance our understanding of the key mechanisms of g, as this approach allows inference on the independence of cognitive processes along with elucidation of their respective neuroanatomical substrates. We analyzed behavioral and neuroanatomical data from 402 humans (212 males; 190 females) with chronic, focal brain lesions.

Acquired Personality Disturbances After Meningioma Resection Are Strongly Associated With Impaired Quality of Life.

Background: Some patients experience long-term declines in quality of life following meningioma resection, but associated factors are not well understood.

Objective: To investigate whether long-term declines in quality of life (specifically impaired adaptive functioning) after meningioma resection are associated with specific personality disturbances that often develop with lesions in ventromedial prefrontal cortex (vmPFC).

Methods: We studied 38 patients who underwent resection of meningioma, 18 of whom had vmPFC lesions and 20 with lesions elsewhere (non-vmPFC).

"Frontal lobe syndrome"? Subtypes of acquired personality disturbances in patients with focal brain damage.

Conceptualizations of the nature of acquired personality disturbances after brain damage, especially to prefrontal cortex, have progressed from clinical observations of a large, disparate set of disturbances to theories concerning neuroanatomically-based subgroups with prefrontal damage. However, hypothesized subtypes have not yet been studied systematically. Based on our previous investigations of acquired personality disturbances, we hypothesized five subtypes of acquired personality disturbances: Executive Disturbances, Disturbed Social Behavior, Emotional Dysregulation, Hypo-emotionality/De-Energization, and Distress, as well as an undisturbed group.

The safety and efficacy of propofol as a replacement for amobarbital in intracarotid Wada testing of presurgical patients with epilepsy.

Objective: The intracarotid sodium amytal procedure (the "Wada test") has for many years been the gold standard for language and memory lateralization and remains an important part of presurgical analysis for patients with medically intractable seizures. Due to shortages in the key sedative (amobarbital), neuropsychologists have turned to alternatives such as propofol. Our aim was to investigate the safety and efficacy of propofol relative to amobarbital in the Wada test.

Neural correlates of improvements in personality and behavior following a neurological event.

Research on changes in personality and behavior following brain damage has focused largely on negative outcomes, such as increased irritability, moodiness, and social inappropriateness. However, clinical observations suggest that some patients may actually show positive personality and behavioral changes following a neurological event. In the current work, we investigated neuroanatomical correlates of positive personality and behavioral changes following a discrete neurological event (e.

The cognitive and behavioral effects of meningioma lesions involving the ventromedial prefrontal cortex.

OBJECT Anterior skull base meningiomas are frequently associated with changes in personality and behavior. Although such meningiomas often damage the ventromedial prefrontal cortex (vmPFC), which is important for higher cognition, the cognitive and behavioral effects of these meningiomas remain poorly understood. Using detailed neuropsychological assessments in a large series of patients, this study examined the cognitive and behavioral effects of meningioma lesions involving the vmPFC.

The left temporal pole is a heteromodal hub for retrieving proper names.

The left temporal pole (LTP) has been posited to be a heteromodal hub for retrieving proper names for semantically unique entities. Previous investigations have demonstrated that LTP is important for retrieving names for famous faces and unique landmarks. However, whether such a relationship would hold for unique entities apprehended through stimulus modalities other than vision has not been well established, and such evidence is critical to adjudicate claims about the "heteromodal" nature of the LTP.

Benefit of the doubt: a new view of the role of the prefrontal cortex in executive functioning and decision making.

The False Tagging Theory (FTT) is a neuroanatomical model of belief and doubt processes that proposes a single, unique function for the prefrontal cortex. Here, we review evidence pertaining to the FTT, the implications of the FTT regarding fractionation of the prefrontal cortex, and the potential benefits of the FTT for new neuroanatomical conceptualizations of executive functions. The FTT provides a parsimonious account that may help overcome theoretical problems with prefrontal cortex mediated executive control such as the homunculus critique.

A neuropsychological test of belief and doubt: damage to ventromedial prefrontal cortex increases credulity for misleading advertising.

We have proposed the False Tagging Theory (FTT) as a neurobiological model of belief and doubt processes. The theory posits that the prefrontal cortex is critical for normative doubt toward properly comprehended ideas or cognitions. Such doubt is important for advantageous decisions, for example in the financial and consumer purchasing realms.

Dimensions of personality disturbance after focal brain damage: investigation with the Iowa Scales of Personality Change.

This study employed a multistep, rational-empirical approach to identify dimensions of personality disturbance in brain-damaged individuals: (a) Five dimensions were hypothesized based on empirical literature and conceptual grounds; (b) principal components analysis was performed on the Iowa Scales of Personality Change (ISPC) to determine the pattern of covariance among 30 personality characteristics; (c) when discrepancies existed between principal components analysis results and conceptually based dimensions, empirical findings and clinical considerations were weighed to determine assignment of ISPC scales to dimensions; (d) the fit of data to the refined dimensions was assessed by examination of intercorrelations; (e) differential predictions concerning the relationship of dimensions to ventromedial prefrontal cortex (vmPFC) damage were tested. This process resulted in the specification of five dimensions: Disturbed Social Behavior, Executive/Decision-Making Deficits, Diminished Motivation/Hypo-Emotionality, Irascibility, and Distress. In accord with predictions, the 28 participants with vmPFC lesions, compared to 96 participants with focal lesions elsewhere in the brain, had significantly more Disturbed Social Behavior and Executive/Decision-Making Deficits and tended to have more Diminished Motivation/Hypo-Emotionality.

Further lesion evidence for the neural basis of conceptual knowledge for persons and other concrete entities.

The neural underpinnings of conceptual knowledge have been studied intensively, but many unanswered questions remain. In a previous study examining recognition of persons, animals, and tools in 116 participants with unilateral brain lesions, we found no instance of a patient who manifested defective recognition in all three categories. We reasoned that the spatial distribution of the lesion loci critical for the appearance of recognition defects for these different categories explained why this 'three-way' defect could not be found in patients with unilateral lesions, and we proposed that only a suitable bilateral lesion would be likely to produce such a combined defect.

Neuroanatomical correlates of the Benton Facial Recognition Test and Judgment of Line Orientation Test.

Two of the most successful and widely used tests developed by Arthur Benton and colleagues are the Facial Recognition Test (FRT) and Judgment of Line Orientation Test (JLO), which probe visuoperceptual and visuospatial functions typically associated with right hemisphere structures, especially parietal, occipitoparietal, and occipitotemporal structures. Taking advantage of a large database of focal lesion patients (the Iowa Neurological Patient Registry), we used a new lesion-deficit mapping technique to investigate the neuroanatomical correlates of FRT and JLO performance. For the FRT, there were 201 patients with relevant data; of these, 38 were impaired on the FRT, and failure was most strongly associated with lesions in the right posterior-inferior parietal and right ventral occipitotemporal (fusiform gyrus) areas.

Naming dynamic and static actions: neuropsychological evidence.

There has been considerable interest in identifying the neural correlates of action naming, but the bulk of previous work on this topic has utilized static stimuli. Recent research comparing the visual processing of dynamic versus static actions suggests that these two types of stimuli engage largely overlapping neural systems, raising the possibility that the higher-order processing requirements for naming dynamic and static actions might not be very different. To explore this issue in greater depth, we developed the Dynamic Action Naming Test (DANT), which consists of 158 video clips 3-5s in length, for each of which the participant is asked to produce the most appropriate verb.

Is the prefrontal cortex important for fluid intelligence? A neuropsychological study using Matrix Reasoning.

Patients with prefrontal damage and severe defects in decision making and emotional regulation often have a remarkable absence of intellectual impairment, as measured by conventional IQ tests such as the WAIS/WAIS-R. This enigma might be explained by shortcomings in the tests, which tend to emphasize measures of "crystallized" (e.g.

Effects of intraoperative hypothermia on neuropsychological outcomes after intracranial aneurysm surgery.

Objective: Subarachnoid hemorrhage and surgical obliteration of ruptured intracranial aneurysms are frequently associated with neurological and neuropsychological abnormalities. We reported that intraoperative cooling did not improve neurological outcome in good-grade surgical subarachnoid hemorrhage patients, as assessed by the Glasgow Outcome Scale score or other neurological and functional measures (National Institutes of Health Stroke Scale, Rankin Disability Scale, Barthel Activities of Daily Living). We now report the results of neuropsychological testing in these patients.

Detecting poor effort and malingering with an expanded version of the Auditory Verbal Learning Test (AVLTX): validation with clinical samples.

Three studies describe the development and validation of a new procedure (AVLTX) to detect inadequate effort or malingering by adding 60-min delayed recall/recognition trials and identifying "impaired" memory performances that are highly inconsistent with performances of brain-damaged (BD) individuals. In Study I, AVLTX performances of 25 probable malingerers (PMs) were compared with those of 43BD and 40 psychiatric patients (PSYs). Seven inconsistencies were identified and converted to scaled inconsistency scores, yielding the exaggeration index (EI).