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Haselow DT, Brown E, Tracy JK, Magnien R, Grattan LM, Morris JG, Oldach DW. Gastrointestinal and respiratory tract symptoms following brief environmental exposure to aerosols during a pfiesteria-related fish kill. J Toxicol Environ Health A 2001; 63:553-564. [PMID: 11549115 DOI: 10.1080/152873901316857734] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
An outbreak of illness with flulike symptoms among state workers responding to a Pfiesteria bloom that resulted in fish death and distress on the Chicamacomico River on Maryland's Eastern Shore was investigated. Using case-control methodology, seven workers present at the Chicamacomico were compared to seven occupationally matched controls not present. Participants completed questionnaires assessing their exposures to water and their symptom histories and were assessed with a standard neuropsychological test battery. Three months later, the same questionnaires and neuropsychological tests were repeated. Three of the seven exposed workers cited minimal direct contact with water and four cited none. During the event, four developed burning eyes or nares and six developed a headache or sore throat. Six developed crampy abdominal pain, nausea, or diarrhea within 4 h of their exposure. In contrast, the only aforementioned symptom reported by controls was headache in two individuals. Acute and follow-up neuropsychological tests showed no consistent pattern of deficiency among the exposed. In conclusion, a flulike clinical illness was observed following exposure to a Pfiesteria-related fish kill, possibly as a result of inhalation of toxic aerosols.
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Affiliation(s)
- D T Haselow
- Department of Epidemiology and Preventive Medicine, University of Maryland School of Medicine, Baltimore, USA
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Grattan LM, Oldach D, Perl TM, Lowitt MH, Matuszak DL, Dickson C, Parrott C, Shoemaker RC, Kauffman CL, Wasserman MP, Hebel JR, Charache P, Morris JG. Learning and memory difficulties after environmental exposure to waterways containing toxin-producing Pfiesteria or Pfiesteria-like dinoflagellates. Lancet 1998; 352:532-9. [PMID: 9716058 DOI: 10.1016/s0140-6736(98)02132-1] [Citation(s) in RCA: 118] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND At the beginning of autumn, 1996, fish with "punched-out" skin lesions and erratic behaviour associated with exposure to toxins produced by Pfiesteria piscicida or Pfiesteria-like dinoflagellate species were seen in the Pocomoke River and adjacent waterways on the eastern shore of the Chesapeake Bay in Maryland, USA. In August, 1997, fish kills associated with Pfiesteria occurred in these same areas. People who had had contact with affected waterways reported symptoms, including memory difficulties, which raises questions about the human-health impact of environmental exposure to Pfiesteria toxins. METHODS We assessed 24 people who had been exposed. We collected data on exposure history and symptoms, did a complete medical and laboratory assessment (13 people), and carried out a neuropsychological screening battery. Performance on neuropsychological measures was compared with a matched control group. RESULTS People with high exposure were significantly more likely than occupationally matched controls to complain of neuropsychological symptoms (including new or increased forgetfulness); headache; and skin lesions or a burning sensation of skin on contact with water. No consistent physical or laboratory abnormalities were found. However, exposed people had significantly reduced scores on the Rey Auditory Verbal Learning and Stroop Color-Word tests (indicative of difficulties with learning and higher cognitive function), and the Grooved Pegboard task. There was a dose-response effect with the lowest scores among people with the highest exposure. By 3-6 months after cessation of exposure, all those assessed had test scores that had returned to within normal ranges. INTERPRETATION People with environmental exposure to waterways in which Pfiesteria toxins are present are at risk of developing a reversible clinical syndrome characterised by difficulties with learning and higher cognitive functions. Risk of illness is directly related to degree of exposure, with the most prominent symptoms and signs occurring among people with chronic daily exposure to affected waterways.
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Affiliation(s)
- L M Grattan
- Department of Neurology, University of Maryland School of Medicine, Baltimore 21201, USA
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Greenberg DR, Tracy JK, Grattan LM. A critical review of the Pfiesteria hysteria hypothesis. Md Med J 1998; 47:133-6. [PMID: 9601200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Mass hysteria or mass psychogenic illness is the spread of the belief of an illness (symptoms and the origins of the symptoms) through a population. The characteristics of mass psychogenic illness were reviewed and compared to the recent outbreak of human illness in the Pocomoke region in Maryland in the summer of 1997. The findings suggest that the nature of the symptoms complex--the onset and recovery course; the absence of secondary gain or job-related stress for most of the symptomatic persons; the predominance of males in the symptomatic group; and the baseline emotional stability of all persons examined--are inconsistent with the reported features of psychogenic illness in response to unknown environmental or chemical toxins. Although there may be individuals who exhibited hypochondriacal, hysterical, or other functionally based reactions, the recent outbreak of Pfiesteria-related illness probably does not represent an episode of mass psychogenic illness.
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Affiliation(s)
- D R Greenberg
- Department of Neurology, University of Maryland Medical School, USA
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Grattan LM. Current status and future directions for the investigation and management of the human health effects of exposure to Pfiesteria piscicida or Pfiesteria-like dinoflagellates. Md Med J 1998; 47:148-51. [PMID: 9601203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- L M Grattan
- Department of Neurology, University of Maryland Medical School, USA
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Grattan LM, Oldach D, Tracy JK, Greenberg DR. Neurobehavioral complaints of symptomatic persons exposed to Pfiesteria piscicida or morphologically related organisms. Md Med J 1998; 47:127-9. [PMID: 9601198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Over the next year, additional persons in Maryland may be at risk for exposure of toxic Pfiesteria or morphologically related organisms. These persons may present with a variety of memory and other behavioral complaints. This paper examines the kinds of complaints that persons with a documented Pfiesteria-related syndrome have compared to a nonexposed control group. The exposed group was more likely to report difficulties with concentration, forgetfulness, prospective memory, and information overload as well as feelings of confusion, bewilderment, and uncertainty as direct effects of toxin exposure. The exposed group was also more likely to report feeling uneasy, on edge, nervous, and shaky, which is probably a reaction to their newly acquired cognitive deficits and uncertainty about their recovery. In contrast, retrograde memory loss, disturbances of language or social behavior, depression, anger, hostility, or diminished activity levels are not symptoms that exposed persons are likely to report.
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Affiliation(s)
- L M Grattan
- University of Maryland School of Medicine, USA
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Tracy JK, Oldach D, Greenberg DR, Grattan LM. Psychologic adjustment of watermen with exposure of Pfiesteria piscicida. Md Med J 1998; 47:130-2. [PMID: 9601199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Preliminary study of the psychologic adjustment of watermen with exposure to Pfiesteria piscicida was conducted on watermen with the most severe exposures and their occupationally matched controls. Participants in the exposed group were seven symptomatic recreational and commercial fishermen who had direct exposure to the Pocomoke River or other estuarial waters on Maryland's Eastern Shore before, during, and/or after periods of documented fish kills and Pfiesteria activity. The control group included eight commercial fishermen who worked on the ocean side of the Eastern Shore and had no reported exposure to estuaries with documented Pfiesteria activity. Both exposed symptomatic and nonexposed watermen completed the Profile of Mood States to assess depression, anxiety, and other relevant mood states as part of their participation in the larger investigation of the human health effects of Pfiesteria piscicida. Preliminary results suggest that both exposed symptomatic and nonexposed watermen are psychologically healthy and exhibit what psychologists refer to as the classic Iceberg Mood Profile. The Iceberg Profile is characterized by endorsement of symptoms suggestive of high energy, enthusiasm and positive mood (e.g., lively, active, energetic, cheerful, vigorous, etc.) and relative minimization of symptoms suggestive of negative or depressed mood (e.g., tense, anxious, restless, grouchy, forgetful). Therefore, the Pfiesteria-related symptom complex documented in the exposed watermen cannot be explained by functional or psychiatric factors and is probably due to exposure.
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Affiliation(s)
- J K Tracy
- University of Maryland School of Medicine, USA
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Golub JE, Haselow DT, Hageman JC, Lopez AS, Oldach DW, Grattan LM, Perl TM. Pfiesteria in Maryland: preliminary epidemiologic findings. Md Med J 1998; 47:137-43. [PMID: 9601201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
In the fall of 1996, fish kills in Maryland rivers were attributed to the dinoflagellate, Pfiesteria piscicida. After a group of researchers established a potential link between exposure to Pfiesteria and an illness causing memory problems, state health authorities closed a portion of the Pocomoke River. To determine the extent of illness, the range of symptoms, potential risk factors for disease, and to provide information to concerned citizens, a toll-free hotline was created. All symptomatic persons who called the toll-free number were administered a standardized questionnaire. Persons who had been exposed to Pfiesteria or Pfiesteria-laden waters were more likely to have respiratory, neurologic, dermatologic, and gastrointestinal problems than those persons without exposure. Among the persons calling the hotline, many had extensive neuropsychologic testing. Of the neuropsychologic test battery, low scores on the Rey Auditory Verbal Learning Test (RAVLT), a standardized measure of learning and memory, best characterized illness related to Pfiesteria exposure. Patients with low RAVLT scores were more likely to have neurologic symptoms and skin lesions than control subjects. Low RAVLT scores were associated with fishing (OR, 9.00, 95% CI, 106, 409.87), catching fish with lesions (OR, 6.17, 95% CI 1.27, 32.10), and handling fish with lesions (OR, 5.34, 95% CI, 1.05, 29.92), but not with consumption of seafood. While preliminary, these results do suggest that some risk factors for Pfiesteria-related illness may be easy to modify and used to prevent unnecessary human exposure.
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Affiliation(s)
- J E Golub
- Department of Epidemiology, Johns Hopkins School of Hygiene and Public Health, Baltimore, USA
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Eslinger PJ, Easton A, Grattan LM, Van Hoesen GW. Distinctive forms of partial retrograde amnesia after asymmetric temporal lobe lesions: possible role of the occipitotemporal gyri in memory. Cereb Cortex 1996; 6:530-9. [PMID: 8670679 DOI: 10.1093/cercor/6.3.530] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
We tested the hypothesis that partial forms of retrograde amnesia were associated with highly asymmetric lesions to the inferior and anterior-medial temporal lobe. Postencephalitic subjects EK and DR were both impaired on standardized retrograde memory tests, but showed strikingly different profiles in cognitive tasks of name stem completion, name:face matching, temporal ordering, forced choice recognition, and occupational judgments of famous names and faces from the past 3 decades. EK sustained left inferior and anterior-medial temporal lobe lesion with a small right temporal polar lesion, and showed near-complete loss of retrieval, knowledge, and familiarity associated with famous names but minimal deficiencies with famous faces. DR sustained right inferior and anterior-medial temporal lobe lesion and showed a milder retrograde loss limited to utilizing famous face prompts in name stem completion, name:face matching, occupational judgments, and forced choice recognition. These impairments were also different from the memory retrieval deficit, but intact recognition shown by a case of ruptured anterior communicating artery aneurysm with presumed basal forebrain damage. We hypothesize that EK's extensive loss of famous name knowledge was related to left inferior temporal lobe damage, particularly in the lateral and medial occipitotemporal gyri. This region in the left temporal lobe may serve as a critical processing area for retrograde memory that permits activation of established semantic, temporal, and visual (i.e., facial) associations biographically dependent on the category of proper names. On the basis of connectional anatomy patterns in the nonhuman primate, this region receives extensive hippocampal output and is interconnected with the temporal polar region and cortical association areas, which have been implicated in retrieval and storage aspects of retrograde memory. In the right hemisphere, the occipitotemporal gyri may serve an important role in famous face processing as part of a bilateral neural network.
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Affiliation(s)
- P J Eslinger
- Division of Neurology, Laboratory of Neuropsychology and Cognitive Neuroscience, College of Medicine, PA State University, Milton S Hershey Medical Center, Hershey, PA 17033, USA
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Krumholz A, Sung GY, Fisher RS, Barry E, Bergey GK, Grattan LM. Complex partial status epilepticus accompanied by serious morbidity and mortality. Neurology 1995; 45:1499-504. [PMID: 7644048 DOI: 10.1212/wnl.45.8.1499] [Citation(s) in RCA: 174] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Nonconvulsive status epilepticus (NCSE) accounts for approximately 20% of all status epilepticus (SE). Although convulsive SE is recognized as a medical emergency, prompt diagnosis and treatment of patients with NCSE is often not emphasized because its consequences are thought to be benign. We report 10 patients with persistent neurologic deficits or death after well-documented NCSE in the form of complex partial status epilepticus (CPSE). All patients had prolonged CPSE lasting 36 hours or longer, as documented by clinical and EEG findings. Causes for CPSE were preexisting epilepsy with partial and secondarily generalized seizures (3 patients), vascular disease (2 patients), encephalitis (2 patients), and metabolic disease (1 patient); causes were unknown for two patients. Poor outcomes identified included persistent (lasting at least 3 months) or permanent cognitive or memory loss (5 patients), cognitive or memory loss plus motor and sensory dysfunction (3 patients), and death (3 patients). NCSE in the form of CPSE is not a benign entity. Serious morbidity and mortality may occur due to the adverse effects of prolonged seizures and as a result of acute brain disorders that precipitate the seizures.
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Affiliation(s)
- A Krumholz
- Department of Neurology, University of Maryland School of Medicine, Baltimore, USA
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Abstract
The serial position function is a powerful and highly reliable feature of human learning, with well-described primacy and recency effects. We tested the hypothesis that frontal lobe lesions in patients would disrupt the serial position function since such patients are known to have disturbed temporal ordering, learning in the presence of interference, encoding and organizational approaches to learning. Performance was compared in patients with focal, acquired lesions of frontal and non-frontal cortices, using a standardized paradigm of verbal list learning. Results indicated a similar pattern of performance on first trial learning for the two groups. However, across learning trials, frontal lesion subjects failed to maintain significant primacy and recency effects. Non-frontal lesion subjects consistently showed the expected U-shaped serial position curve across all trials. Subjective organization in learning was particularly deficient in the dorsolateral frontal lesion subjects. We propose that serial position effects are qualitatively different after frontal lobe lesion, being transitory and prone to alteration by the cumulative effects of disturbed temporal-spatial processing across learning trials.
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Affiliation(s)
- P J Eslinger
- Department of Medicine (Division of Neurology), Pennsylvania State University College of Medicine, Milton S. Hershey Medical Center, Hershey 17033
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Abstract
Frontal lobe and basal ganglia lesions have been associated with similar cognitive impairments, although their specialized roles in behavior are likely to be different. We examined whether these structures mediate distinctive or overlapping aspects of a complex behavioral process that has been associated with both neural sites, i.e. cognitive flexibility. Patients with focal ischemic lesions to the frontal lobe and basal ganglia were compared on two forms of cognitive flexibility: (1) shifting response set (i.e. reactive flexibility), and (2) producing a diversity of ideas (i.e. spontaneous flexibility). Results indicated that frontal lobe and basal ganglia damage each caused a similar degree of impairment in reactive flexibility, both groups performing at a significantly lower level than posterior cortical lesion and normal comparison groups. However, frontal lobe damage markedly disturbed spontaneous flexibility, while performance after basal ganglia lesion was significantly higher and comparable to posterior cortical lesions. Findings suggest that the frontal lobe and basal ganglia participate differently in the neural substrate of cognitive flexibility. The frontal lobe appears to mediate spontaneous flexibility. The production of diverse ideas may require direct cortical-cortical interactions by the frontal lobe in order to access knowledge systems with novel strategies that transcend the most common semantic linkages. In contrast the corticostriate system appears to mediate reactive flexibility, as the frontal lobe, basal ganglia and their interconnections are required for its operation.
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Affiliation(s)
- P J Eslinger
- Department of Medicine (Division of Neurology), Pennsylvania State University College of Medicine, Milton S. Hershey Medical Center, Hershey 17033
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Abstract
Patient DT was examined 26 years after she acquired focal frontal lobe damage at 7 years of age. This report focused on several aspects of psychological outcome, including the empirical study of social development into early adulthood. Standardized measures of empathy, psychosocial development, and personality were analyzed, along with a moral judgment interview and patterns of adult social behavior. Results indicated that DT has a very limited capacity for empathic understanding, inadequate identity development, difficulties in vocational adjustment, and a concrete level of moral reasoning. Her social behavior and profile of test scores suggest that social development and adaptation have been arrested at early adolescent levels. We conclude that early frontal lobe damage has profound effects on social development, and that the frontal lobes provide a crucial neural substrate for social maturation.
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Affiliation(s)
- L M Grattan
- Department of Neurology, University of Maryland School of Medicine
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Abstract
A 33-year-old woman underwent neurologic and neuropsychological studies 26 years after she sustained damage to the frontal lobe. The findings of the neurologic examination were normal, and magnetic resonance imaging revealed a lesion in left prefrontal cortex and deep white matter. Cerebral blood flow studies showed an abnormal pattern in both left and right frontal regions. The patient exhibited striking neuropsychological defects in higher cognition, most notably in self-regulation of emotion and affect and in social behavior. Analysis of her behavioral development failed to yield a pattern of abrupt onset of defect immediately after the lesion occurred. On the contrary, there was a delayed onset of defects, followed by a period of seeming progression, and finally an arrest of development in adolescence. We suggest that this peculiar pattern is the natural consequence of the varied changes that occurred in brain development and social cognition during the patient's formative years. While certain long-term neuropsychological deficits in our case are similar to those following frontal damage in adults, the delayed onset and progression of deficits are different.
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Affiliation(s)
- P J Eslinger
- Department of Medicine, Pennsylvania State University College of Medicine, Milton S. Hershey Medical Center, Hershey 17033
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Strumpf DA, Millman RP, Carlisle CC, Grattan LM, Ryan SM, Erickson AD, Hill NS. Nocturnal positive-pressure ventilation via nasal mask in patients with severe chronic obstructive pulmonary disease. Am Rev Respir Dis 1991; 144:1234-9. [PMID: 1741532 DOI: 10.1164/ajrccm/144.6.1234] [Citation(s) in RCA: 152] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Intermittent positive pressure ventilation administered nocturnally via a nasal mask has been associated with improvements in pulmonary function and symptoms in patients with restrictive ventilatory disorders. We hypothesized that nocturnal nasal ventilation (NNV) would bring about similar improvements in patients with severe chronic obstructive pulmonary disease (COPD). The study used a randomized, crossover design, with subjects undergoing NNV or "standard care" for sequential 3-month periods. Of 23 patients with obstructive lung disease and a FEV1 less than 1 L who were initially enrolled, 4 were excluded because of obstructive sleep apnea prior to randomization. Among the remaining 19 patients, 7 withdrew because of intolerance of the nose mask, 5 were withdrawn because of intercurrent illnesses, and 7 completed both arms of the protocol. These latter 7 patients used the ventilator for an average of 6.7 h/night, and 3 of the 7 had partial relief of dyspnea during ventilator use. However, in comparison with studies performed upon initiation or after the standard care arm of the study, studies performed after 3 months of NNV revealed no improvements in pulmonary function, respiratory muscle strength, gas exchange, exercise endurance, sleep efficiency, quality or oxygenation, or dyspnea ratings. The only improvements observed were in neuropsychological function, possibly related to a placebo effect or another unknown mechanism. Despite the small sample size, our study indicates that NNV is not well tolerated by and brings about minimal improvements in stable outpatients with severe COPD.
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Affiliation(s)
- D A Strumpf
- Division of Pulmonary and Critical Care Medicine, Rhode Island Hospital, Providence 02903
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Abstract
Disinhibited, exaggerated responses to objects and environmental cues (utilization behavior) occur predominantly with frontal lobe damage. We report a striking example associated with paramedian thalamic infarction suggesting a thalamofrontal component to environmental interactions that require inhibition, self-monitoring, and cognitive flexibility.
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Affiliation(s)
- P J Eslinger
- Department of Psychiatry and Human Behavior, Brown University Program in Medicine, Rhode Island Hospital, Providence
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