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Kawakami N, Okada Y, Morihara K, Katsuse K, Kakinuma K, Matsubara S, Kanno S, Suzuki K. Long-lasting pure topographical disorientation due to heading disorientation following left retrosplenial infarction: A report of two cases. Brain Cogn 2024; 181:106211. [PMID: 39226866 DOI: 10.1016/j.bandc.2024.106211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2024] [Revised: 08/02/2024] [Accepted: 08/27/2024] [Indexed: 09/05/2024]
Abstract
Topographical disorientation is linked to lesions in the right hemisphere and typically resolves within a few months post-stroke. Persistent topographical disorientation is uncommon and frequently accompanied by impairments in visual memory, complicating the analysis of the underlying mechanisms. Herein, we report two cases of sustained pure topographical disorientation following cerebral hemorrhages in the left retrosplenial region. The patients exhibited disorientation in both familiar and unfamiliar settings, attributable to heading disorientation, a deficit in determining the directional relationship between one's current position and a target location or external frames. The patients struggled with reconstructing large-scale spatial frameworks and integrating new egocentric and allocentric perspectives upon changes in body orientation. There were no landmark agnosia, egocentric disorientation, or anterograde disorientation. Although mild verbal memory deficits were observed, no other cognitive impairments, including visual memory deficits, were detected. Our findings imply that lesions confined to the left retrosplenial region can induce enduring heading disorientation and suggest a significant role for this area in processing and integrating spatial information necessary for large-scale navigation. Clarifying the features of topographical disorientation will significantly impact the therapeutic approaches, enhancing the quality of life for affected patients by restoring their independence and mobility.
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Affiliation(s)
- Nobuko Kawakami
- Department of Behavioral Neurology and Cognitive Neuroscience, Graduate School of Medicine, Tohoku University, Japan.
| | - Yuri Okada
- Department of Neurology, Graduate School of Medicine, Tohoku University, Japan
| | - Keisuke Morihara
- Department of Neurology and Stroke Medicine, Graduate School of Medicine, Yokohama City University, Japan.
| | - Kazuto Katsuse
- Department of Behavioral Neurology and Cognitive Neuroscience, Graduate School of Medicine, Tohoku University, Japan; Department of Neurology, Graduate School of Medicine, The University of Tokyo, Japan
| | - Kazuo Kakinuma
- Department of Behavioral Neurology and Cognitive Neuroscience, Graduate School of Medicine, Tohoku University, Japan.
| | - Shiho Matsubara
- Department of Behavioral Neurology and Cognitive Neuroscience, Graduate School of Medicine, Tohoku University, Japan
| | - Shigenori Kanno
- Department of Behavioral Neurology and Cognitive Neuroscience, Graduate School of Medicine, Tohoku University, Japan.
| | - Kyoko Suzuki
- Department of Behavioral Neurology and Cognitive Neuroscience, Graduate School of Medicine, Tohoku University, Japan.
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Blondiaux E, Diamantaras A, Schumacher R, Blanke O, Müri R, Heydrich L. The neural correlates of topographical disorientation-a lesion analysis study. Ann Clin Transl Neurol 2024; 11:520-524. [PMID: 38234234 PMCID: PMC10863913 DOI: 10.1002/acn3.51967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 11/24/2023] [Accepted: 11/28/2023] [Indexed: 01/19/2024] Open
Abstract
Topographical disorientation refers to the selective inability to orient oneself in familiar surroundings. However, to date its neural correlates remain poorly understood. Here we use quantitative lesion analysis and a lesion network mapping approach in order to investigate seven patients with topographical disorientation. Our findings link not only the posterior parahippocampal gyrus (PHG) and retrosplenial cortex but also the lingual gyrus, the precuneus and the fusiform gyrus to topographical disorientation. We propose that topographical disorientation is due to the inability to integrate familiar landmarks within a framework of allocentric and egocentric orientation, supported by a neural network including the posterior PHG, the retrosplenial and the lingual cortex.
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Affiliation(s)
- Eva Blondiaux
- Laboratory of Cognitive NeuroscienceBrain‐Mind Institute, School of Life Sciences, Ecole Polytechnique Fédérale de LausanneLausanneSwitzerland
- Center for NeuroprostheticsSchool of Life Sciences, Ecole Polytechnique Fédérale de LausanneLausanneSwitzerland
| | - Andreas Diamantaras
- Department of NeurologyInselspital, Bern University Hospital, University of BernBernSwitzerland
- CORE Lab, Psychosomatic Competence Center, Department of NeurologyInselspital. Bern University Hospital, University of BernBernSwitzerland
| | - Rahel Schumacher
- Department of NeurologyInselspital, University Neurorehabilitation, Bern University Hospital, University of BernBernSwitzerland
| | - Olaf Blanke
- Laboratory of Cognitive NeuroscienceBrain‐Mind Institute, School of Life Sciences, Ecole Polytechnique Fédérale de LausanneLausanneSwitzerland
- Center for NeuroprostheticsSchool of Life Sciences, Ecole Polytechnique Fédérale de LausanneLausanneSwitzerland
- Department of NeurologyUniversity Hospital GenevaGenevaSwitzerland
| | - René Müri
- Department of NeurologyInselspital, Bern University Hospital, University of BernBernSwitzerland
- Department of NeurologyInselspital, University Neurorehabilitation, Bern University Hospital, University of BernBernSwitzerland
| | - Lukas Heydrich
- Department of NeurologyInselspital, Bern University Hospital, University of BernBernSwitzerland
- CORE Lab, Psychosomatic Competence Center, Department of NeurologyInselspital. Bern University Hospital, University of BernBernSwitzerland
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Zebhauser PT, Vernet M, Nischwitz S, Sämann PG, Brem AK. Neural correlates of transient topographical disorientation: an experimental EEG-MRI case study. J Neurol 2023; 270:6151-6154. [PMID: 37566233 PMCID: PMC10632213 DOI: 10.1007/s00415-023-11902-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 07/25/2023] [Indexed: 08/12/2023]
Affiliation(s)
- Paul Theo Zebhauser
- Department of Neurology, Klinikum Rechts der Isar der Technischen Universität, Munich, Germany
- Max Planck Institute of Psychiatry, Munich, Germany
| | - Marine Vernet
- IMPACT Team, Lyon Neuroscience Research Centre (CRNL), INSERM U1028, CNRS UMR5292, Université Claude Bernard Lyon 1, Lyon, France
| | | | | | - Anna-Katharine Brem
- Max Planck Institute of Psychiatry, Munich, Germany.
- Department of Old Age Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, SE5 8AF, UK.
- University Hospital of Old Age Psychiatry, University of Bern, 3008, Bern, Switzerland.
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Boukobza M, Ehmer C, Baud F, Laissy JP. "Unusual Pattern of Cerebral Microbleeds and Petechial Hemorrhages after Veno-Arterial Extracorporeal Membrane Oxygenation Support. A Report of 2 Cases". J Stroke Cerebrovasc Dis 2021; 30:105792. [PMID: 33866273 DOI: 10.1016/j.jstrokecerebrovasdis.2021.105792] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 02/15/2021] [Accepted: 03/24/2021] [Indexed: 10/21/2022] Open
Abstract
OBJECTIVE to report an unusual pattern of brain petechial hemorrhages in 2 patients after veno-arterial extracorporeal membrane oxygenation support (VA-ECMO) CASE 1: a 28-year-old man (Marfan disease) presented in the early post-operative period a multi-organ failure associated with a disseminated intravascular coagulation (DIC). He was placed on continuous veno-venous hemofiltration and VA-ECMO. He was weaned from ECMO 4 days later. He then developed bacterial pneumoniae leading to respiratory failure and requiring mechanical ventilation. MRI 30 days later showed widespread petechial hemorrhages in the subcortical and deep white matter (WM) (optic radiations, corpus callosum, predominantly in the splenium, internal and external capsules), caudate nuclei, basal ganglia, frontal and parietal cortex and in infratentorial structures. These hemorrhages were bilateral and almost symmetric and marked at the border zones of the carotid arteries territories. CASE 2: a 60-year-old man presented an out-of-hospital refractory hypothermic cardiac arrest. At arrival, cardiopulmonary resuscitation was continued; he presented bleeding at the puncture sites related to DIC and associated with multi-organ failure. VA-ECMO was implanted. After ECMO removal (day 7) he presented a severe spatial orientation deficit. MRI showed petechial hemorrhages in both hippocampi and microbleeds at the cerebral cortex and the juxta-cortical WM. Both patients had good functional outcome. CONCLUSION Two unusual presentations of brain hemorrhages in patients who underwent VA-ECMO are reported. If their specific cause remains unclear, there seems to be a relationship in time between DIC and microhemorrhages in these cases, even if in case 1 brain hemorrhages seem to have a multifactorial cause.
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Affiliation(s)
- Monique Boukobza
- Department of Radiology, Bichat Hospital, 46 rue Henri Huchard, 75018 -Paris, France; Assistance Publique-Hôpitaux de Paris.
| | - Carsten Ehmer
- Department of Radiology, Paris Assistance Publique-Hôpitaux de Paris, Bichat Hospital, 46 rue Henri Huchard, INSERM U1148, Paris 75018, France
| | - Frédéric Baud
- Medical and Toxicological Intensive Care Unit, Lariboisière - Saint Louis hospital, Paris, France ; Assistance Publique - Hôpitaux de Paris, Paris University, Paris, France.
| | - Jean-Pierre Laissy
- Department of Radiology, Bichat Hospital, 46 rue Henri Huchard, 75018 -Paris, France; Assistance Publique-Hôpitaux de Paris.
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Schöberl F, Zwergal A, Brandt T. Testing Navigation in Real Space: Contributions to Understanding the Physiology and Pathology of Human Navigation Control. Front Neural Circuits 2020; 14:6. [PMID: 32210769 PMCID: PMC7069479 DOI: 10.3389/fncir.2020.00006] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 02/14/2020] [Indexed: 12/18/2022] Open
Abstract
Successful navigation relies on the flexible and appropriate use of metric representations of space or topological knowledge of the environment. Spatial dimensions (2D vs. 3D), spatial scales (vista-scale vs. large-scale environments) and the abundance of visual landmarks critically affect navigation performance and behavior in healthy human subjects. Virtual reality (VR)-based navigation paradigms in stationary position have given insight into the major navigational strategies, namely egocentric (body-centered) and allocentric (world-centered), and the cerebral control of navigation. However, VR approaches are biased towards optic flow and visual landmark processing. This major limitation can be overcome to some extent by increasingly immersive and realistic VR set-ups (including large-screen projections, eye tracking and use of head-mounted camera systems). However, the highly immersive VR settings are difficult to apply particularly to older subjects and patients with neurological disorders because of cybersickness and difficulties with learning and conducting the tasks. Therefore, a need for the development of novel spatial tasks in real space exists, which allows a synchronous analysis of navigational behavior, strategy, visual explorations and navigation-induced brain activation patterns. This review summarizes recent findings from real space navigation studies in healthy subjects and patients with different cognitive and sensory neurological disorders. Advantages and limitations of real space navigation testing and different VR-based navigation paradigms are discussed in view of potential future applications in clinical neurology.
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Affiliation(s)
- Florian Schöberl
- Department of Neurology, University Hospital, Ludwig Maximilian University (LMU) of Munich, Munich, Germany.,German Center for Vertigo and Balance Disorders, DSGZ, LMU Munich, Munich, Germany
| | - Andreas Zwergal
- Department of Neurology, University Hospital, Ludwig Maximilian University (LMU) of Munich, Munich, Germany.,German Center for Vertigo and Balance Disorders, DSGZ, LMU Munich, Munich, Germany
| | - Thomas Brandt
- German Center for Vertigo and Balance Disorders, DSGZ, LMU Munich, Munich, Germany.,Clinical Neurosciences, LMU Munich, Munich, Germany
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Flanagin VL, Fisher P, Olcay B, Kohlbecher S, Brandt T. A bedside application-based assessment of spatial orientation and memory: approaches and lessons learned. J Neurol 2019; 266:126-138. [PMID: 31240446 PMCID: PMC6722154 DOI: 10.1007/s00415-019-09409-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 05/28/2019] [Accepted: 05/29/2019] [Indexed: 01/05/2023]
Abstract
Spatial orientation and memory deficits are an often overlooked and potentially powerful early marker for pathological cognitive decline. Pen-and-paper tests for spatial abilities often do not coincide with actual navigational performance due to differences in spatial perspective and scale. Mobile devices are becoming increasingly useful in a clinical setting, for patient monitoring, clinical decision-making, and information management. The same devices have positional information that may be useful for a scale appropriate point-of-care test for spatial ability. We created a test for spatial orientation and memory based on pointing within a single room using the sensors in mobile phone. The test consisted of a baseline pointing condition to which all other conditions were compared, a spatial memory condition with eyes-closed, and two body rotation conditions (real or mental) where spatial updating were assessed. We examined the effectiveness of the sensors from a mobile phone for measuring pointing errors in these conditions in a sample of healthy young individuals. We found that the sensors reliably produced appropriate azimuth and elevation pointing angles for all of the 15 targets presented across multiple participants and days. Within-subject variability was below 6° elevation and 10° azimuth for the control condition. The pointing error and variability increased with task difficulty and correlated with self-report tests of spatial ability. The lessons learned from the first tests are discussed as well as the outlook of this application as a scientific and clinical bedside device. Finally, the next version of the application is introduced as an open source application for further development.
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Affiliation(s)
| | - Paul Fisher
- Neuro-Cognitive-Psychology, Department of Psychology, LMU, Munich, Germany
| | - Berk Olcay
- Computer Aided Medical Procedures, Technical University Munich (TUM), Munich, Germany
| | - Stefan Kohlbecher
- German Centre for Vertigo and Balance Disorders (DSGZ), Munich, Germany
| | - Thomas Brandt
- German Centre for Vertigo and Balance Disorders (DSGZ), Munich, Germany
- Hertie, University Hospital, LMU Munich, Munich, Germany
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Irving S, Pradhan C, Dieterich M, Brandt T, Zwergal A, Schöberl F. Transient topographical disorientation due to right-sided hippocampal hemorrhage. Brain Behav 2018; 8:e01078. [PMID: 30141244 PMCID: PMC6160660 DOI: 10.1002/brb3.1078] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Accepted: 06/15/2018] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Topographical disorientation is defined as the inability to recognize familiar or unfamiliar environments. While its slowly progressive development is a common feature of neurodegenerative processes like Alzheimer's dementia, acute presentations are less frequent and mostly caused by strategic lesions within the cerebral navigation network. Depending on the lesion site, topographical disorientation can originate from deficits in landmark recognition and utilization for route planning (egocentric navigation deficit), or disturbance of an overarching cognitive map of the spatial environment (allocentric navigation deficit). However, objective measurements of spatial navigation performance over time are largely missing in patients with topographical disorientation. METHODS We here report a 55-year-old patient with acute topographical disorientation as the single symptom of right-sided hippocampal hemorrhage and present quantitative gaze-monitoring head camera-based analyses of his path-finding strategy and visual exploration behavior in a real space navigation paradigm. RESULTS The patient exhibited severe allocentric and also egocentric navigation deficits during the acute phase, shown by higher error rates at finding target items. In addition, he showed a more extensive use of search saccades toward, and fixations on, landmarks that could potentially serve as spatial cues. These deficits had been completely compensated for after four months, when the patient performed unremarkably in the real space navigation task, and used even more strongly allocentric path optimization strategies than age-matched controls. CONCLUSIONS This case report highlights the integral function and right-sided dominance of the hippocampal formation in the cerebral navigation network in humans. It shows that the cognitive map can be restored completely despite a residual hippocampal lesion, which illustrates the enormous plasticity of the cerebral navigation network in humans.
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Affiliation(s)
- Stephanie Irving
- German Center for Vertigo and Balance Disorders, DSGZ, Ludwig-Maximilians-University, Munich, Germany.,Graduate School of Systemic Neuroscience (GSN), Ludwig-Maximilians-University, Munich, Germany
| | - Cauchy Pradhan
- German Center for Vertigo and Balance Disorders, DSGZ, Ludwig-Maximilians-University, Munich, Germany
| | - Marianne Dieterich
- German Center for Vertigo and Balance Disorders, DSGZ, Ludwig-Maximilians-University, Munich, Germany.,Graduate School of Systemic Neuroscience (GSN), Ludwig-Maximilians-University, Munich, Germany.,Department of Neurology, Ludwig-Maximilians-University, Munich, Germany.,Munich Cluster of Systems Neurology, SyNergy, Munich, Germany
| | - Thomas Brandt
- German Center for Vertigo and Balance Disorders, DSGZ, Ludwig-Maximilians-University, Munich, Germany.,Graduate School of Systemic Neuroscience (GSN), Ludwig-Maximilians-University, Munich, Germany.,Clinical Neurosciences, Ludwig-Maximilians-University, Munich, Germany
| | - Andreas Zwergal
- German Center for Vertigo and Balance Disorders, DSGZ, Ludwig-Maximilians-University, Munich, Germany.,Department of Neurology, Ludwig-Maximilians-University, Munich, Germany
| | - Florian Schöberl
- German Center for Vertigo and Balance Disorders, DSGZ, Ludwig-Maximilians-University, Munich, Germany.,Department of Neurology, Ludwig-Maximilians-University, Munich, Germany
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