Unilateral spatial neglect: a review over symptoms, frequency diagnosis and prognosis

Neðst á síðunni er hægt að nálgast greinina í heild sinni með því að smella á hlekkinn View/OpenUnilateral spatial neglect is a disorder commonly encountered after hemisphere stroke, most often in the right hemisphere. Neglect patients fail to attend and respond to stimuli presented on the side of space opposite to the brain lesion. Neglect implies a complex dysfunction in the co-action between perception, motor behavior and the environment where the patients attentive capacities and the environmental space are of special importance. Patients difficulties can be seen in that they do not eat from the left side of the plate or omit words to the left when asked to read. Commonly patients do not have a complete insight into their neglect problems. Neglect in stroke patients has been associated with poor outcome on functional activities. Signs of neglect are not always obvious but can be explored and assessed quickly by bedside neuropsychological testing. Neglect is often more unclear to an observer than, e.g. if a patient suffers from paresis or aphasia. Education for patients, their relatives and others are therefore important.Gaumstol er tiltölulega algeng truflun sem hlýst af heilaskaða, einkum heilablóðfalli í hægra heilahveli. Það kemur fram í því að sjúklingur gefur umhverfi og hlutum til gagnstæðrar áttar við heilaskaðan ónógan gaum og bregst ekki við því sem gerist til þeirrar áttar. Gaumstol felur í sér flókna röskun á samspili skynjunar, hreyfingar og umhverfis sjúklings þar sem athygli hans og rýmið sem umlykur hann skiptir miklu máli. Vandi sjúklings getur verið að hann borðar einungis af hægri hlið disks við máltíðir og les einungis orð í setningum sem eru til hægri við miðju. Oft hafa sjúklingar ekki fullt innsæi í eigin vanda og hjá sjúklingum með heilablóðfall dregur gaumstol úr batalíkum. Gaumstol er ekki alltaf augljóst en til eru fljótleg próf sem má beita til frekari glöggvunar og staðfestingar á einkennum sjúklinga. Gaumstol og afleiðingar þess eru oft óljósari en til að mynda lamanir og málstol og því er gildi greiningar og fræðslu fyrir sjúklinga, aðstandendur og aðra mikilvæg

Unilateral neglect: a review of causes, anatomical localization, theories and interventions

Neðst á síðunni er hægt að nálgast greinina í heild sinni með því að smella á hlekkinn View/OpenUnilateral neglect is usually caused by right hemisphere damage from stroke, leading to difficulties in attending to stimuli in the left perceptual hemifield. As an example, a patient suffering from neglect may read only the right part of a word or the right part of sentences, or eat only from the right side his plate. Neglect is more common, and most often more severe, following infarcts in the right hemisphere than the left. Brain damage leading to neglect usually involves infarcts in the inferior parietal lobe, temporo-parietal junction and/or the superior temporal lobe. Most theories of the nature of neglect assume that neglect involves dysfunctional attentional mechanisms. Increased understanding of neglect has led to the development of several effective therapeutic interventions, where prism adaptation has received the most attention in recent years. This article reviews brain damage in neglect, theories of neglect, therapeutic methods for neglect and their possible future developments.Gaumstol er skynröskun í kjölfar heilaskemmda, oftast vegna heilablóðfalls og lýsir sér að jafnaði þannig að sjúklingur tekur ekki eftir eða bregst ekki við því sem á sér stað til vinstri. Þetta getur komið fram í því að sjúklingur les aðeins hægri helming orðs eða setninga, lítur til hægri þegar einhver gengur framhjá vinstra megin við hann, eða borðar einungis af hægri helmingi disks síns. Gaumstol má oftast rekja til skemmda í neðri hluta hvirfilblaðs, á mótum hnakka- og gagnaugablaðs, eða í efstu gagnaugablaðsfellingu. Ýmsar kenningar hafa verið settar fram til skýringar á gaumstoli og í þeim flestum er gert ráð fyrir að um einhvers konar truflun á athygliskerfum sé að ræða. Aukinn skilningur á eðli gaumstols hefur virkað sem hvati að þróun meðferðarleiða þar sem strendingsaðlögun hefur vakið hvað mesta athygli á síðustu árum. Hér verður fjallað um heilaskemmdir, kenningar og meðferðarúrræði gaumstols

Conversion disorder - review

Neðst á síðunni er hægt að nálgast greinina í heild sinni með því að smella á hlekkinn View/OpenIn modern medicine the term "functional symptoms" is usually used to refer to symptoms where an organic cause cannot be found. Studies have shown that up to half of all patients consulting their family physician and approximately one third of all those attending neurology outpatient clinics present with such symptoms. These patients commonly go between doctors, repeatedly undergo unnecessary tests, even surgery, and various drugs are tried with limited success. These problems tend to be prolonged and greatly reduce the quality of life for the patients involved. Both the DSM IV and ICD 10 classifications include a group for the so-called medically unexplained disorders. Among these disorders is conversion disorder where patients present with neurological symptoms, affecting motor or sensory function, but with no neurological explanation. Here we provide an overview of the current ideas on the aetiology, diagnosis, treatment and prognosis of conversion disorder.Í nútímalæknisfræði er oft talað um starfrænar truflanir þegar vísað er til einkenna sem ekki finnst vefræn skýring á. Rannsóknir hafa sýnt að allt að helmingur sjúklinga sem leitar sér læknisaðstoðar hjá sérfræðingum í heimilislækningum og um þriðjungur allra sjúklinga sem sækja til taugalækna utan spítala hafa slík einkenni. Þessir sjúklingar ganga oft á milli lækna og undirgangast óþarfa rannsóknir og meðferðir með litlum árangri. Vandinn getur orðið langvinnur og haft í för með sér færniskerðingu og minnkuð lífsgæði. Til er flokkun í bæði DSM IV og ICD 10 greiningarkerfunum sem inniheldur raskanir er fela í sér líkamleg einkenni þar sem ekki er hægt að sýna fram á vefræna orsök. Til þessa hóps raskana telst hugbrigðaröskun þar sem einstaklingar hafa einkenni frá taugakerfinu á borð við lamanir og skyntruflanir án þess að vefræn orsök finnist. Hér verður veitt yfirlit yfir nútímahugmyndir um orsök, greiningu, meðferð og horfur hugbrigðaröskunar

Allocentric neglect strongly associated with egocentric neglect.

To access publisher's full text version of this article. Please click on the hyperlink in Additional Links field.Following brain injury, many patients experience egocentric spatial neglect, where they fail to respond to stimuli on the contralesional side of their body. On the other hand, allocentric, object-based neglect refers to the symptom of ignoring the contralesional side of objects, regardless of the objects' egocentric position. There is an established tradition for considering these two phenomena as both behaviorally and anatomically dissociable. However, several studies and some theoretical work have suggested that these rather reflect two aspects of a unitary underlying disorder. Furthermore, in a recent large study Yue et al. [Archives of Physical Medicine and Rehabilitation 93 (2012) 156] reported that acute allocentric neglect is only observed in cases where substantial egocentric neglect is also present. In a new sample of right hemisphere stroke patients, we attempted to control for potential confounds by using a novel continuous measure for allocentric neglect (in addition to a recently developed continuous measure for egocentric neglect). Our findings suggest a strong association between egocentric and allocentric neglect. Consistent with the work of Yue et al. (2012), we found allocentric behavioral deficits only in conjunction with egocentric deficits as well as a large corresponding overlap for the anatomical regions associated with egocentric and with allocentric neglect. We discuss how different anatomical and behavioral findings can be explained in a unified physiologically plausible framework, whereby allocentric and egocentric effects interact.National Institutes of Health NS054266 DC009571 Deutsche Forschungsgemeinschaft KA 1258/10-1 HA 5839/3-1 PAK 270/

Atrial fibrillation is associated with reduced brain volume and cognitive function independent of cerebral infarcts.

To access publisher's full text version of this article, please click on the hyperlink in Additional Links field or click on the hyperlink at the top of the page marked Files. This article is open access.Atrial fibrillation (AF) has been associated with cognitive decline independent of stroke, suggesting additional effects of AF on the brain. We aimed to assess the association between AF and brain function and structure in a general elderly population.This is a cross-sectional analysis of 4251 nondemented participants (mean age, 76 ± 5 years) in the population-based Age, Gene/Environment Susceptibility-Reykjavik Study. Medical record data were collected for the presence, subtype, and time from first diagnosis of AF; 330 participants had AF. Brain volume measurements, adjusted for intracranial volume, and presence of cerebral infarcts were determined with magnetic resonance imaging. Memory, speed of processing, and executive function composites were calculated from a cognitive test battery. In a multivariable linear regression model, adjustments were made for demographic factors, cardiovascular risk factors, and cerebral infarcts.Participants with AF had lower total brain volume compared with those without AF (P<0.001). The association was stronger with persistent/permanent than paroxysmal AF and with increased time from the first diagnosis of the disease. Of the brain tissue volumes, AF was associated with lower volume of gray and white matter hyperintensities (P<0.001 and P = 0.008, respectively), but not of white matter hyperintensities (P = 0.49). Participants with AF scored lower on tests of memory.AF is associated with smaller brain volume, and the association is stronger with increasing burden of the arrhythmia. These findings suggest that AF has a cumulative negative effect on the brain independent of cerebral infarcts.Landspitali National University Hospital of Iceland Science Fund Helga Jonsdottir and Sigvaldi Kristjansson Memorial Fund National Institutes of Health/N01-AG-1-2100 National Institute on Aging Intramural Research Program Icelandic Heart Association Althingi (the Icelandic Parliament

Brain age predicts long-term recovery in post-stroke aphasia

Funding Information: This study was supported by the following grant sponsors: National Institute on Deafness and Other Communication Disorders (P50 DC014664; DC008355); National Institute of Neurological Disorders and Stroke (NS054266). Publisher Copyright: © 2022 The Author(s).The association between age and language recovery in stroke remains unclear. Here, we used neuroimaging data to estimate brain age, a measure of structural integrity, and examined the extent to which brain age at stroke onset is associated with (i) cross-sectional language performance, and (ii) longitudinal recovery of language function, beyond chronological age alone. A total of 49 participants (age: 65.2 ± 12.2 years, 25 female) underwent routine clinical neuroimaging (T1) and a bedside evaluation of language performance (Bedside Evaluation Screening Test-2) at onset of left hemisphere stroke. Brain age was estimated from enantiomorphically reconstructed brain scans using a machine learning algorithm trained on a large sample of healthy adults. A subsample of 30 participants returned for follow-up language assessments at least 2 years after stroke onset. To account for variability in age at stroke, we calculated proportional brain age difference, i.e. the proportional difference between brain age and chronological age. Multiple regression models were constructed to test the effects of proportional brain age difference on language outcomes. Lesion volume and chronological age were included as covariates in all models. Accelerated brain age compared with age was associated with worse overall aphasia severity (F(1, 48) = 5.65, P = 0.022), naming (F(1, 48) = 5.13, P = 0.028), and speech repetition (F(1, 48) = 8.49, P = 0.006) at stroke onset. Follow-up assessments were carried out ≥2 years after onset; decelerated brain age relative to age was significantly associated with reduced overall aphasia severity (F(1, 26) = 5.45, P = 0.028) and marginally failed to reach statistical significance for auditory comprehension (F(1, 26) = 2.87, P = 0.103). Proportional brain age difference was not found to be associated with changes in naming (F(1, 26) = 0.23, P = 0.880) and speech repetition (F(1, 26) = 0.00, P = 0.978). Chronological age was only associated with naming performance at stroke onset (F(1, 48) = 4.18, P = 0.047). These results indicate that brain age as estimated based on routine clinical brain scans may be a strong biomarker for language function and recovery after stroke.Peer reviewe

Fourteen sequence variants that associate with multiple sclerosis discovered by meta-analysis informed by genetic correlations

To access publisher's full text version of this article, please click on the hyperlink in Additional Links field or click on the hyperlink at the top of the page marked FilesA meta-analysis of publicly available summary statistics on multiple sclerosis combined with three Nordic multiple sclerosis cohorts (21,079 cases, 371,198 controls) revealed seven sequence variants associating with multiple sclerosis, not reported previously. Using polygenic risk scores based on public summary statistics of variants outside the major histocompatibility complex region we quantified genetic overlap between common autoimmune diseases in Icelanders and identified disease clusters characterized by autoantibody presence/absence. As multiple sclerosis-polygenic risk scores captures the risk of primary biliary cirrhosis and vice versa (P = 1.6 x 10(-7), 4.3 x 10(-9)) we used primary biliary cirrhosis as a proxy-phenotype for multiple sclerosis, the idea being that variants conferring risk of primary biliary cirrhosis have a prior probability of conferring risk of multiple sclerosis. We tested 255 variants forming the primary biliary cirrhosis-polygenic risk score and found seven multiple sclerosis-associating variants not correlated with any previously established multiple sclerosis variants. Most of the variants discovered are close to or within immune-related genes. One is a low-frequency missense variant in TYK2, another is a missense variant in MTHFR that reduces the function of the encoded enzyme affecting methionine metabolism, reported to be dysregulated in multiple sclerosis brain.Swedish Research Council Knut and Alice Wallenberg Foundation AFA Foundation Swedish Brain Foundatio

Advantages in diagnostic and treatment of MS [editorial]

Neðst á síðunni er hægt að nálgast greinina í heild sinni með því að smella á hlekkinn View/OpenÁ undanförnum árum hafa orðið miklar framfarir í greiningu og meðferð MS sjúkdómsins. Fram til ársins 2001 var MS-greining klínísk og við það miðað að sjúklingur hefði fengið tvö köst ólík að einkennum og aðskilin í tíma. Þetta breyttist árið 2001 með McDonalds-viðmiðum. Í þeim er miðað við að greiningu megi setja eftir eitt kast ef seinni segulómunarskoðun sýnir fram á nýjar breytingar (1). Viðmiðin voru endurskoðuð 2005 en gilda í aðalatriðum áfram (2). Einkenni og köst sjúklinga skipta áfram mestu þegar sjúkdómsvirkni MS er metin en eins og ofangreind viðmið bera með sér má einnig meta hana með segulómskoðun heila og mænu; oftast er stuðst við segulskærar breytingar á T2 myndum en einnig skuggaefnisupphleðslu á T1 myndum. Rannsóknir með segulómskoðun hafa sýnt að vefjarýrnun í MS tekur ekki bara til hvíta efnisins (eins og áður var talið) heldur einnig grás svæðis og þar með heilabarkar (3)

Advantages in diagnostic and treatment of MS [editorial]

Neðst á síðunni er hægt að nálgast greinina í heild sinni með því að smella á hlekkinn View/OpenÁ undanförnum árum hafa orðið miklar framfarir í greiningu og meðferð MS sjúkdómsins. Fram til ársins 2001 var MS-greining klínísk og við það miðað að sjúklingur hefði fengið tvö köst ólík að einkennum og aðskilin í tíma. Þetta breyttist árið 2001 með McDonalds-viðmiðum. Í þeim er miðað við að greiningu megi setja eftir eitt kast ef seinni segulómunarskoðun sýnir fram á nýjar breytingar (1). Viðmiðin voru endurskoðuð 2005 en gilda í aðalatriðum áfram (2). Einkenni og köst sjúklinga skipta áfram mestu þegar sjúkdómsvirkni MS er metin en eins og ofangreind viðmið bera með sér má einnig meta hana með segulómskoðun heila og mænu; oftast er stuðst við segulskærar breytingar á T2 myndum en einnig skuggaefnisupphleðslu á T1 myndum. Rannsóknir með segulómskoðun hafa sýnt að vefjarýrnun í MS tekur ekki bara til hvíta efnisins (eins og áður var talið) heldur einnig grás svæðis og þar með heilabarkar (3)

Visual and tactile neglect

Neglect patients typically fail to report, respond, or orient to information presented in locations further away from the side of the brain lesion. Neglect is most often reported after acute stroke, and is more severe and more frequent after right hemisphere damage. This thesis concerns different aspects of the "neglect syndrome" in stroke patients. It was divided into three parts. Study I examined a large sample of patients which performed a line cancellation test where the direction of arm movement and the direction of visual scanning were decoupled. The results support previous findings of a differentiation between perceptual and motor aspects of neglect, and provide further evidence that these components correlate with parietal and frontal brain lesions, respectively. In studies II-V, patients performed bisection tasks under different experimental conditions. It was found that performance improved in darkness as compared with performance in normal room illumination. The effect of darkness is probably mediated by the absence of background stimuli which direct attention rightward, or capture attention on the right side. Bisection performance also improved when it was preceded by tactile exploration of the object to be bisected. This improvement was shown across conditions in which patients bisected rods with or without the aid of vision, while patients performed poorly when exploration was excluded in the visual condition. In rod bisection performance, exploration is thus of greater importance than if vision is excluded. Patients bisected three-dimensional objects more accurately than two-dimensional objects, and two-dimensional objects more accurately than lines. It is likely that the two- and three dimensional conditions enable patients to apply a more global mode in their perceptual processing, thereby increasing the subjective display size and making bisection more accurate. No effect of different figure-ground contrast conditions was found. Finally, performance was compared when patients bisected lines with their right hand, and with a red laser point from a lamp mounted centrally on the forehead. No difference was found between these conditions. This argues against the right hand operating as a spatial cue to the right. This also argues against activation of the right hemisphere, induced by the lamp use, improving performance. It is pointed out that this may be due to the widespread right-sided lesions of patients, as intact brain areas are required for hemisphere activation to take place. Study VI found an association between chronic neglect and impaired sustained attention, while patients' awareness of their disability did not associate with chronic neglect. Key words: Visual neglect, tactile neglect, premotor neglect, perceptual neglect, bisection tasks, darkness, tactile exploration, right hand use, right hemisphere activation, three-dimensionality, figure-ground contrast, chronic neglect, sustained attention, awareness of disability. Haukur Hjaltason, Department of Neurology, Karolinska Hospital, 171 76 Stockholm, Sweden. ISBN 91-628-2443-