Crossed right hemisphere syndrome following left thalamic stroke

Improved Visualization and Quantification of Net Water Uptake in Recent Small Subcortical Infarcts in the Thalamus Using Computed Tomography

Diagnosing recent small subcortical infarcts (RSSIs) via early computed tomography (CT) remains challenging. This study aimed to assess CT attenuation values (Hounsfield Units (HU)) and net water uptake (NWU) in RSSI and explore a postprocessing algorithm's potential to enhance thalamic RSSI detection. We examined non-contrast CT (NCCT) data from patients with confirmed thalamic RSSI on diffusion-weighted magnetic resonance imaging (DW-MRI) between January 2010 and October 2017. Co-registered DW-MRI and NCCT images enabled HU and NWU quantification in the infarct area compared to unaffected contralateral tissue. Results were categorized based on symptom onset to NCCT timing. Postprocessing using window optimization and frequency-selective non-linear blending (FSNLB) was applied, with interpretations by three blinded Neuroradiologists. The study included 34 patients (median age 70 years [IQR 63-76], 14 women). RSSI exhibited significantly reduced mean CT attenuation compared to unaffected thalamus (29.6 HU (±3.1) vs. 33.3 HU (±2.6); p < 0.01). Mean NWU in the infarct area increased from 6.4% (±7.2) at 0-6 h to 16.6% (±8.7) at 24-36 h post-symptom onset. Postprocessed NCCT using these HU values improved sensitivity for RSSI detection from 32% in unprocessed CT to 41% in FSNLB-optimized CT, with specificities ranging from 86% to 95%. In conclusion, CT attenuation values and NWU are discernible in thalamic RSSI up to 36 h post-symptom onset. Postprocessing techniques, particularly window optimization and FSNLB, moderately enhance RSSI detection.

Functional topography of the thalamocortical system in human

Various studies have indicated that the thalamus is involved in controlling both cortico-cortical information flow and cortical communication with the rest of the brain. Detailed anatomy and functional connectivity patterns of the thalamocortical system are essential to understanding the cortical organization and pathophysiology of a wide range of thalamus-related neurological and neuropsychiatric diseases. The current study used resting-state fMRI to investigate the topography of the human thalamocortical system from a functional perspective. The thalamus-related cortical networks were identified by performing independent component analysis on voxel-based thalamic functional connectivity maps across a large group of subjects. The resulting functional brain networks were very similar to well-established resting-state network maps. Using these brain network components in a spatial regression model with each thalamic voxel's functional connectivity map, we localized the thalamic subdivisions related to each brain network. For instance, the medial dorsal nucleus was shown to be associated with the default mode, the bilateral executive, the medial visual networks; and the pulvinar nucleus was involved in both the dorsal attention and the visual networks. These results revealed that a single nucleus may have functional connections with multiple cortical regions or even multiple functional networks, and may be potentially related to the function of mediation or modulation of multiple cortical networks. This observed organization of thalamocortical system provided a reference for studying the functions of thalamic sub-regions. The importance of intrinsic connectivity-based mapping of the thalamocortical relationship is discussed, as well as the applicability of the approach for future studies.

Crossed-brain representation of verbal and nonverbal functions

A 74-year-old, left-handed man presented with a rapidly evolving loss of strength in his right leg associated with difficulty in walking. MR images disclosed an extensive left hemisphere tumor. A neuropsychological examination revealed that language was broadly normal but that the patient presented with severe nonlinguistic abnormalities, including hemineglect (both somatic and spatial), constructional defects, and general spatial disturbances; symptoms were usually associated with right hemisphere pathologies. No ideomotor apraxia was found. The implications of crossed-brain representations of verbal and nonverbal functions are analyzed.

Laterality of seizure onset and the simple reaction time: revamping the Poffenberger's paradigm for seizure surgery

BACKGROUND

Crossed-uncrossed differentials (CUDs) are viewed as surrogates for interhemispheric transfer time (IHTT). Not uncommonly CUDs assume statistically significant negative values (inverted CUDs). This raises doubts of the accepted interpretation of CUDs, i.e. intra- and inter-hemispheric routings of signals in uncrossed and crossed responses, respectively.

METHOD

Based on the evidence supporting directionality in callosal traffic, data are provided indicating that callosal transfers exclusively involve non-dominant responses and such transfers are modality non-specific. The evidence also indicates that neural handedness corresponds to behavioral only in a statistical manner and the former remains unchanged regardless of the subject's life experience.

RESULTS

The neurally dominant side is the side that is directly connected to the major hemisphere (command center). The connection of the non-dominant side to the command center is via the corpus callosum; therefore, a delay occurs in the reaction time of all non-dominant effectors, corresponding to IHTT. Accordingly, negative CUDs indicate a mismatch of neural and behavioral (avowed) handedness of the subject. This group comprises a minority of 15-20% of the population.

CONCLUSION

Comparing the response time of symmetrically located effector is a robust way of lateralizing a person's major hemisphere. The latter is also the site of initiation of seizures, as the minor hemisphere is bereft of independent motor activity. Sensory signals arising from the nondominant side of the body traverse the callosum before reaching the major hemisphere. Searching for ipsilateral somatosensory evoked potentials provides another approach in lateralizing the non-dominant side of the body (ipsilateral to the major hemisphere). Practical uses of a conceptually revamped Poffenberger paradigm in neurosurgery are briefly reviewed.

Lower Left Thalamic Myo-Inositol Levels Associated with Greater Cognitive Impulsivity in Marijuana-Dependent Young Men: Preliminary Spectroscopic Evidence at 4T

The effects of chronic marijuana (MRJ) use on neurochemistry are not well characterized. Previously, altered global myo-Inositol (mI) concentrations and distribution in white matter were associated with impulsivity and mood symptoms in young MRJ-dependent men. The objective of this study was to retrospectively examine previously collected data, to investigate the potential regional specificity of metabolite levels in brain regions densely packed with cannabinoid receptors. Spectra were acquired at 4.0 Tesla using 2D J-resolved proton magnetic resonance spectroscopic imaging (MRSI) to quantify the entire J-coupled spectral surface of metabolites from voxels in regions of interest. For the current regional spectral analyses, a 2D-JMRSI grid was positioned over the central axial slice and shifted in the x and y dimensions to optimally position voxels over regions containing thalamus, temporal lobe, and parieto-occipital cortex. MRJ users exhibited significantly reduced mI levels in the left thalamus (lThal), relative to non-using participants, which were associated with elevated cognitive impulsivity. Other regional analyses did not reveal any significant group differences. The current findings indicate that reduced mI levels are regionally specific to the lThal in MRJ users. Furthermore, findings suggest that mI and the lThal uniquely contribute to elevated impulsivity.

Lateralization of cognitive functions in aphasia after right brain damage

PURPOSE

The lateralization of cognitive functions in crossed aphasia in dextrals (CAD) has been explored and compared mainly with cases of aphasia with left hemisphere damage. However, comparing the neuropsychological aspects of CAD and aphasia after right brain damage in left-handers (ARL) could potentially provide more insights into the effect of a shift in the laterality of handedness or language on other cognitive organization. Thus, this case study compared two cases of CAD and one case of ARL.

MATERIALS AND METHODS

The following neuropsychological measures were obtained from three aphasic patients with right brain damage (two cases of CAD and one case of ARL); language, oral and limb praxis, and nonverbal cognitive functions (visuospatial neglect and visuospatial construction).

RESULTS

All three patients showed impaired visuoconstructional abilities, whereas each patient showed a different level of performances for oral and limb praxis, and visuospatial neglect.

CONCLUSION

Based on the analysis of these three aphasic patients' performances, we highlighted the lateralization of language, handedness, oral and limb praxis, visuospatial neglect and visuospatial constructive ability in aphasic patients with right brain damage.

Cognitive, affective and behavioural disturbances following vascular thalamic lesions: a review

During the last decades, many studies have shown that the thalamus is crucially involved in language and cognition. We critically reviewed a study corpus of 465 patients with vascular thalamic lesions published in the literature since 1980. 42 out of 465 (9%) cases with isolated thalamic lesions allowed further neurocognitive analysis. On the neurolinguistic level, fluent output (=31/33; 93.9%), normal to mild impairment of repetition (=33/35; 94.3%), mild dysarthria (=8/9; 88.9%) and normal to mild impairment of auditory comprehension (=27/34; 79.4%) were most commonly found in the group of patients with left and bilateral thalamic lesions. The taxonomic label of thalamic aphasia applied to the majority of the patients with left thalamic damage (=7/11; 63.6%) and to one patient with bithalamic lesions (=1/1). On the neuropsychological level, almost 90% of the left thalamic and bithalamic patient group presented with amnestic problems, executive dysfunctions and behaviour and/or mood alterations. In addition, two thirds (2/3) of the patients with bilateral thalamic damage presented with a typical cluster of neurocognitive disturbances consisting of constructional apraxia, anosognosia, desorientation, global intellectual dysfunctioning, amnesia, and executive dysfunctions associated with behaviour and/or mood alterations. Our study supports the long-standing view of a 'lateralised linguistic thalamus' but restates the issue of a 'lateralised cognitive thalamus'. In addition, critical analysis of the available literature supports the view that aphasia following left or bithalamic damage constitutes a prototypical linguistic syndrome.

Spared and impaired olfactory abilities after thalamic lesions

Olfactory information reaches olfactory cortex without a thalamic relay. This neuroanatomical substrate has combined with functional findings to suggest that, in olfaction, the typical thalamic role in sensory processing has shifted to the olfactory bulb or olfactory cortex. With this in mind, we set out to ask whether the thalamus at all plays a significant functional role in human olfaction. We tested olfactory function in 17 patients with unilateral focal thalamic lesions and in age-matched healthy controls. We found that thalamic lesions did not significantly influence olfactory detection but significantly impaired olfactory identification, and only right lesions altered olfactory hedonics by reducing the pleasantness of pleasant odors. An auditory control revealed that this shift in pleasantness was olfactory specific. These olfactory impairments were evident in explicit measures of perception, as well as in patterns of sniffing. Whereas healthy subjects modulated their sniffs in accordance with odorant content, thalamic patients did not. We conclude that, although the thalamus is not in the path of olfactory information from periphery to cortex, it nevertheless plays a significant functional role in human olfaction.

Bimanual simultaneous movements and hemispheric dominance: Timing of events reveals hard-wired circuitry for action, speech, and imagination

The evidence that speech is the marker of hemisphere of action is overwhelming. Thus, contrary to the commonly accepted belief, the evidence indicates that both sides of the body are under the same command (major hemisphere) and that the nondominant side of the body is a callosum-width farther from the major hemisphere. Substantial controversy exists, however, as to the best method for determining the laterality of motor control in an individual case. According to the new understanding, ie, the one-way callosal traffic circuitry underpinning laterality of motor control, the larger excursions of effectors located opposite (contralateral to) the command center while performing bimanual simultaneous drawing tasks provides the best noninvasive and inexpensive approach for demonstrating the laterality of the major hemisphere of a person (who is able to perform such tasks). Here, it is documented pictorially that bimanual simultaneous drawing of geometrical designs or straight lines, as well as moving the arms simultaneously from side to side (or up and down) while noting the difference of speed of the two arms (represented by the distance between the two index fingers), both provide a reliable indication of the laterality of a person’s major hemisphere. In all these maneuvers the nondominant side of the body (even the diaphragms) lags behind the dominant side by an interval equal to the interhemispheric transfer time (IHTT). This lagging behind of the nondominant side of the body in bimanual simultaneous movements is the footprint of directionality of callosal traffic underpinning the laterality of motor control evidenced by worsening of the delay of the nondominant side following callosotomy (uncoupling). Here, the historical precedence of a novel understanding in motor control together with its neurological implications in daily life as well as in laterality of seizure onset are briefly addressed, pointing out the deleterious effects of Sir Isaac Newton’s influence in neurological research on interhemispheric connectivity by suggesting symmetrical representation of visual sense of space in the human brain.

Extinction of auditory stimuli in hemineglect: Space versus ear

Unilateral extinction of auditory stimuli, a key feature of the neglect syndrome, was investigated in 15 patients with right (11), left (3) or bilateral (1) hemispheric lesions using a verbal dichotic condition, in which each ear received simultaneously one word, and a interaural-time-difference (ITD) diotic condition, in which both ears received both words lateralised by means of ITD. Additional investigations included sound localisation, visuo-spatial attention and general cognitive status. Five patients presented a significant asymmetry in the ITD diotic test, due to a decrease of left hemispace reporting but no asymmetry was found in dichotic listening. Six other patients presented a significant asymmetry in the dichotic test due to a significant decrease of left or right ear reporting, but no asymmetry in diotic listening. Ten of the above patients presented mild to severe deficits in sound localisation and eight signs of visuo-spatial neglect (three with selective asymmetry in the diotic and five in the dichotic task). Four other patients presented a significant asymmetry in both the diotic and dichotic listening tasks. Three of them presented moderate deficits in localisation and all four moderate visuo-spatial neglect. Thus, extinction for left ear and left hemispace can double dissociate, suggesting distinct underlying neural processes. Furthermore, the co-occurrence with sound localisation disturbance and with visuo-spatial hemineglect speaks in favour of the involvement of multisensory attentional representations.

Crossed-uncrossed difference (CUD) in a new light: anatomy of the negative CUD in Poffenberger's paradigm

Crossed Uncrossed Differentials (CUDs) have long been used as surrogate for the interhemispheric transfer time (IHTT). Evidence is presented that macular vision is the province of the major hemisphere, wherein all commands are initiated regardless of the laterality of the effectors of such commands. Using clinical and time-resolved data it is shown also that the above arrangement (i.e. neural handedness) corresponds to the subject's behavioral avowed (avowed, self-declared) handedness only in a statistical sense; with a substantial minority of humanity displaying a disparity of neural and behavioral handedness. Evidence is provided that the negative CUD in previously reported studies was a reflection of such incongruity in those subjects studied. Thus, to lateralize the command center it is sufficient to determine the reaction time of two symmetrically located effectors on the body. The side with longer reaction time is ipsilateral to the major hemisphere, with the difference of the two sides commensurate to transcallosal IHTT.

Alterações cognitivas, comunicativas e emocionais após lesão hemisférica direita: em busca de uma caracterização da Síndrome do Hemisfério Direito

O conjunto de sinais e sintomas observados após um acometimento neurológico no hemisfério direito pode ser denominado de Síndrome do Hemisfério Direito &– SHD. Esse ensaio teórico tem por objetivo apresentar uma caracterização desse quadro neuropsicológico. A SHD é, então, caracterizada por déficits nas funções cognitivas atenção, percepção, memória, praxias e funções executivas, com a presença de anosognosia, heminegligência sensorial, prosopagnosia, alterações de memória visuo-espacial e de trabalho, dispraxia construtiva e disfunção executiva. Quanto às habilidades comunicativas, a SHD engloba alterações nos componentes discursivo, pragmático-inferencial, léxico-semântico e prosódico. Os déficits de processamento emocional incluem dificuldades de compreensão e produção de emoções a partir de expressões faciais ou emissões vocais e alterações neuropsiquiátricas. Há, no entanto, uma heterogeneidade na sua manifestação. Tendo em vista essa variabilidade de sinais e sintomas, mais estudos de caso e de grupo com indivíduos lesados de hemisfério direito devem ser conduzidos para um melhor entendimento da SHD.