Norman Geschwind and the use of history in the (re)birth of behavioral neurology

Assessing Kurt Goldstein's lasting influence in the neuropsychology of language versus his use of aphasic symptoms as diagnostic insights into brain injuries

In the history of the neurological relationship between human behavior and brain function in Europe and North America, various perspectives on brain localization and holistic functioning have been addressed. One of the founding figures of modern neuropsychology, Professor Hans-Lukas Teuber (1916-1977) of the Massachusetts Institute of Technology, reminded the scholarly community of its negligence of preceding traditions in day-to-day research endeavors. Teuber particularly emphasized that during the development of the aphasiology field (1950s-1960s) even major figures, such as the German-American neurologist Kurt Goldstein (1878-1965), had been neglected in the scientific community's collective memory. This happened despite Goldstein's contributions to cortical blindness, vicarious brain functioning, and neurorehabilitation. The outcome of the debates regarding the neurology of language had to be incompletely relearned in later decades. Neuropsychological concerns regarding the relationship between cortical localizationism and functional holism have made recourse to Goldstein's work necessary for reviving historical answers for current conundrums. It is therefore opportune to review Goldstein's work in the light of the history of aphasiology. Contemporary scholarship has once more drawn research attention to the works of Goldstein along with Norman Geschwind (1926-1984) and his pupils. It has also resurrected the underlying research of Carl Wernicke (1848-1905). This review article explores deep and lasting questions regarding the positioning of Goldstein's holism among the contemporary holistic perspectives. It does so by firstly discussing Wernicke's traditional model of distributed localizationism. Secondly, it describes Goldstein's previous work in the German brain sciences. Thirdly, it examines his aphasiological contributions on both sides of the Atlantic. Fourthly, it addresses the advancement of a dynamic localizational perspective by Geschwind and his pupils. This article intends to render a historical analysis fruitful for those exploring modern-day problems in the neurology of aphasia and clinical speech neuropsychology.

Radiomic white matter parameters of functional integrity of the corticospinal tract in high-grade glioma

Tractography has become a widely available tool for the planning of neurosurgical operations as well as for neuroscientific research. The absence of patient interaction makes it easily applicable. However, it leaves uncertainty about the functional relevance of the identified bundles. We retrospectively analyzed the correlation of white matter markers with their clinical function in 24 right-handed patients who underwent first surgery for high-grade glioma. Morphological affection of the corticospinal tract (CST) and grade of paresis were assessed before surgery. Tractography was performed manually with MRTrix3 and automatically with TractSeg. Median and mean fractional anisotropy (FA) from manual tractography showed a significant correlation with CST affection (p = 0.008) and paresis (p = 0.015, p = 0.026). CST affection correlated further most with energy, and surface-volume ratio (p = 0.014) from radiomic analysis. Paresis correlated most with maximum 2D column diameter (p = 0.005), minor axis length (p = 0.006), and kurtosis (p = 0.008) from radiomic analysis. Streamline count yielded no significant correlations. In conclusion, mean or median FA can be used for the assessment of CST integrity in high-grade glioma. Also, several radiomic parameters are suited to describe tract integrity and may be used to quantitatively analyze white matter in the future.

Promoting Growth in Behavioral Neurology: A Path Forward

Behavioral neurology & neuropsychiatry (BNNP) is a field that seeks to understand brain-behavior relationships, including fundamental brain organization principles and the many ways that brain structures and connectivity can be disrupted, leading to abnormalities of behavior, cognition, emotion, perception, and social cognition. In North America, BNNP has existed as an integrated subspecialty through the United Council for Neurologic Subspecialties since 2006. Nonetheless, the number of behavioral neurologists across academic medical centers and community settings is not keeping pace with increasing clinical and research demand. In this commentary, we provide a brief history of BNNP followed by an outline of the current challenges and opportunities for BNNP from the behavioral neurologist's perspective across clinical, research, and educational spheres. We provide a practical guide for promoting BNNP and addressing the shortage of behavioral neurologists to facilitate the continued growth and development of the subspecialty. We also urge a greater commitment to recruit trainees from diverse backgrounds so as to dismantle persistent obstacles that hinder inclusivity in BNNP-efforts that will further enhance the growth and impact of the subspecialty. With rapidly expanding diagnostic and therapeutic approaches across a range of conditions at the intersection of neurology and psychiatry, BNNP is well positioned to attract new trainees and expand its reach across clinical, research, and educational activities.

Mapping of the Language Cortex

Awake craniotomy with intraoperative neurophysiological language mapping (INLM) is an established procedure for patients undergoing surgery to resection tumors in the language cortex area. INLM and continuous neurophysiological monitoring allow assessment of the language function, which is not possible under general anesthesia. INLM of the brain areas provides a helpful tool to the operating surgeon in reducing the risks associated with tumor resection in the motor and language cortex. We present a literature review and the technical method used for INLM by utilizing direct electrical cortical stimulation. We also report the usefulness of INLM for evaluation of the language function during resection of cortical tumors, epilepsy foci, and arteriovenous malformations (AVMs) located near language areas. First, the central sulcus is identified by sensory mapping, followed by the motor cortex's identification by direct electrical cortical stimulation (DECS). Neurological assessment of the patient is done by auditory and visual feedback. The patient is asked to repeat numbers, days, words, sentences, read words, and name pictures during cortical stimulation. DECS may cause a slurring or speech arrest. Electrocorticography (ECoG) is also performed during cortical stimulation to identify any after-discharges. Examination of the patient occurs immediately after surgery, and then 24 hours, one week, six months, and 12 months postoperatively. Bipolar DECS for motor mapping with ECoG can safely and reliably be utilized to identify essential language areas with minimizing permanent language deficits and maximizing the extent of tumor resection.

Emigrated neuroscientists from Berlin to North America

The highest number of German scholars and physicians, forced by the National Socialist regime to emigrate for "race" or political reasons, were from Berlin. Language and medical exams were requested differently in their new host country-the United States-leading to a concentration of immigrants in the New York and Boston areas. Very early Emergency Committees in Aid of German Scholars and Physicians were established. Undergraduate students (like F. A. Freyhan, H. Lehmann, and H.-L. Teuber) from Berlin seemed to integrate easily, in contrast to colleagues of more advanced age. Some of the former chiefs and senior assistants of Berlin's neurological departments could achieve a successful resettlement (C. E. Benda, E. Haase, C. F. List, and F. Quadfasel) and some a minor degree of success (F. H. Lewy and K. Goldstein). A group of neuropsychiatrists from Bonhoeffer's staff at the Berlin Charité Hospital could rely on the forceful intercession of their former chief. The impact of the émigré colleagues on North American neuroscience is traced in some cases. Apart from the influential field of psychoanalysis, a more diffuse infiltration of German and European neuropsychiatry may be assumed. The contribution to the postwar blossoming of neuropsychology by the émigré neuroscientists K. Goldstein, F. Quadfasel, and H.-L. Teuber is demonstrated in this article.