The Behavioral and Cognitive Executive Disorders of Stroke: The GREFEX Study.

BACKGROUND: Many studies have highlighted the high prevalence of executive disorders in stroke. However, major uncertainties remain due to use of variable and non-validated methods. The objectives of this study were: 1) to characterize the executive disorder profile in stroke using a standardized battery, validated diagnosis criteria of executive disorders and validated framework for the interpretation of neuropsychological data and 2) examine the sensitivity of the harmonization standards protocol proposed by the National Institute of Neurological Disorders and Stroke and Canadian Stroke Network (NINDS-CSN) for the diagnosis of Vascular Cognitive Impairment. METHODS: 237 patients (infarct: 57; cerebral hemorrhage: 54; ruptured aneurysm of the anterior communicating artery (ACoA): 80; cerebral venous thrombosis (CVT): 46) were examined by using the GREFEX battery. The patients' test results were interpreted with a validated framework derived from normative data from 780 controls. RESULTS: Dysexecutive syndrome was observed in 88 (55.7%; 95%CI: 48-63.4) out of the 156 patients with full cognitive and behavioral data: 40 (45.5%) had combined behavioral and cognitive syndromes, 29 (33%) had a behavioral disorder alone and 19 (21.6%) had a cognitive syndrome alone. The dysexecutive profile was characterized by prominent impairments of initiation and generation in the cognitive domain and by hypoactivity with disinterest and anticipation loss in the behavioral domain. Cognitive impairment was more frequent (p = 0.014) in hemorrhage and behavioral disorders were more frequent (p = 0.004) in infarct and hemorrhage. The harmonization standards protocol underestimated (p = 0.007) executive disorders in CVT or ACoA. CONCLUSIONS: This profile of executive disorders implies that the assessment should include both cognitive tests and a validated inventory for behavioral dysexecutive syndrome. Initial assessment may be performed with a short cognitive battery, such as the harmonization standards protocol. However, administration of a full cognitive battery is required in selected patients

An Autopsy Case of Amyotrophic Lateral Sclerosis with Waldenström Macroglobulinemia and Anti-MAG Gammopathy

We report the case of a 71-year-old woman with typical signs of bulbar amyotrophic lateral sclerosis (ALS) associated with immunoglobulin M (IgM) monoclonal gammopathy and anti-MAG (myelin-associated glycoprotein) antibodies. This unusual association between ALS and anti-MAG antibodies has previously been reported in a single case. Our present case, at neuropathological examination, demonstrated no causative link between anti-MAG antibodies and ALS

Ownership illusions in patients with body delusions: : Different neural profiles of visual capture and disownership

© 2016 The Authors. Published by Elsevier Ltd. This is an open access article under the CCBY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/) funded by European Research Council. The version of record, Martinaud, O., et al., 'Ownership illusions in patients with body delusions: Different neural profiles of visual capture and disownership,' Cortex, Vol 87, Special Issue, pp. 174-185, first published online 19 October 2016, is available online at doi: http://dx.doi.org/10.1016/j.cortex.2016.09/025The various neurocognitive processes contributing to the sense of body ownership have been investigated extensively in healthy participants, but studies in neurological patients can shed unique light into such phenomena. Here, we aimed to investigate whether visual capture by a fake hand (without any synchronous or asynchronous tactile stimulation) affects body ownership in a group of hemiplegic patients with or without disturbed sensation of limb ownership (DSO) following damage to the right hemisphere. We recruited 31 consecutive patients, including seven patients with DSO. The majority of our patients (64.5% overall and up to 86% of the patients with DSO) experienced strong feelings of ownership over a rubber hand within 15 sec following mere visual exposure, which correlated with the degree of proprioceptive deficits across groups and in the DSO group. Using voxel-based lesion-symptom mapping analysis, we were able to identify lesions associated with this pathological visual capture effect in a selective fronto-parietal network, including significant voxels (p < .05) in the frontal operculum and the inferior frontal gyrus. By contrast, lesions associated with DSO involved more posterior lesions, including the right temporoparietal junction and a large area of the supramarginal gyrus, and to a lesser degree the middle frontal gyrus. Thus, this study suggests that our sense of ownership includes dissociable mechanisms of multisensory integration.Peer reviewedFinal Published versio

Déficits cognitifs et comportementaux après rupture d'anévrisme de l'artère communicante antérieure (corrélations anatomo-cliniques)

ROUEN-BU Médecine-Pharmacie (765402102) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Reconnaissance visuelle et modules fonctionnels (étude neuropsychologique, anatomique et fonctionnelle)

Ce travail est consacré à l étude du rôle du cortex occipitotemporal dans la reconnaissance visuelle des mots, ainsi que d autres catégories d objets : visages, lieux, outils. A cette fin, nous avons associé l étude de patients cérébrolésés et l imagerie cérébrale anatomique et fonctionnelle. Dans la 1ère étude en IRM anatomique et fonctionnelle, nous avons (a) établi que les lésions affectant une région précise du cortex occipitotemporal gauche (Visual Word Form Area, VWFA) sont critiques pour l apparition d une alexie pure, (b) corrélé d autres types de troubles de la lecture avec des lésions définies du cortex ou de la substance blanche postérieure, (c) mis en évidence des voies de suppléances autorisant une compensation fonctionnelle. Dans la 2ème étude, nous avons (a) développé des tests comportementaux originaux, qui nous ont permis de montrer, dans une série consécutive de lésions du territoire des artères cérébrales postérieures, que les troubles agnosiques visuels sont bien plus fréquents qu il n est habituellement reconnu, (b) montré que si les corrélations anatomocliniques sont robustes dans le domaine de la lecture, elles le sont moins pour les autres catégories d objets visuels, notamment du fait de la bilatéralité des régions impliquées (FFA, PPA, LOC) et de leur variabilité individuelle. La 3ème étude rapporte le cas exceptionnel d'une jeune patiente présentant une agnosie visuelle développementale majeure, contrastant avec la préservation des fonctions visuo-spatiales associées à la voie visuelle dorsale. Nous avons analysé ses déficits perceptifs, et tenté de les corréler avec la configuration des activations fonctionnelles et les anomalies focales de l électrogenèse cérébrale. Conclusion : L étude des patients cérébrolésés, enrichie par l imagerie fonctionnelle, demeure indispensable à la démonstration des liens de causalité entre structures cérébrales et fonctions cognitives. Nous avons appliqué cette approche au domaine de la reconnaissance visuelle, apportant notamment une contribution majeure à la dissection anatomo-fonctionnelle des mécanismes cérébraux de la lecture. Nous avons également développé des outils directement utiles dans la prise en charge diagnostique des troubles neurovisuels acquis ou de développementPARIS-BIUSJ-Biologie recherche (751052107) / SudocSudocFranceF

Retrograde amnesia with transposition in the past: A neuropsychological and PET study of a case.

International audienceRetrograde amnesia (RA) with a "transposition in the past" phenomenon has been rarely reported. Patients presenting disproportionate RA for all events over a defined period of time offer an opportunity to investigate the unclear relationship between autobiographical memory and the self, through the well-known self-memory system (SMS)

Anatomy of executive deficit following ruptured anterior communicating artery aneurysm.

International audienceBACKGROUND AND PURPOSE: To evaluate behavioral and cognitive deficits following anterior communicating artery aneurysm rupture and determine critical lesion locations. METHODS: We investigated 74 patients with standardized cognitive tests and behavioral inventory. Two examiners rated MRI signal abnormalities in 51 predetermined regions of interest. Classification tree analysis was used to select regions associated with each cognitive deficit. RESULTS: Eleven patients presented behavioral executive deficits and 10 had cognitive executive deficit. Their presence depended on left hemisphere lesions only: (i) ventral striatum lesion was associated with behavioral executive deficit (P = 0.04), reduction of activities (P = 0.01), and hyperactivity (P = 0.02); (ii) superior frontal gyrus lesion, with cognitive executive deficit (P = 0.01), action initiation deficit (P = 0.02), and rule deduction deficit (P = 0.02); (iii) anterior half of centrum semiovale lesion, with Stroop inhibition deficit (P = 0.02); (iv) medial superior and middle frontal gyri lesions, with task coordination deficit (P = 0.01); and (v) middle frontal gyrus lesion, with words generation deficit (P = 0.02). CONCLUSION: This study supports that (i) cognitive executive deficits depend mostly on lateral prefrontal lesions, (ii) with locations varying according to executive process, and (iii) behavioral executive deficits are mainly due to left ventral striatum lesion in post-aneurysmal damage

The pathophysiology of letter-by-letter reading

Pure alexia is a frequent and incapacitating consequence of left occipitotemporal lesions. It is thought to result from the disruption or the disconnection of the visual word form area (VWFA), a region reproducibly located within the left occipito-temporal sulcus, and encoding the abstract identity of strings of visual letters. Alexic patients often retain effective single letter recognition abilities, and develop an effortful letter-by-letter reading strategy which is the basis of most rehabilitation techniques. We study a patient who developed letter-by-letter reading following the surgical removal of left occipito-temporal regions. Using anatomical and functional MRI in the patient and in normal controls, we show that alexia resulted from the deafferentation of left fusiform cortex, and we analyze the network of brain regions subtending letter-by-letter reading. We propose that during letter-by-letter reading (1) letters are identified in the intact right-hemispheric visual system, with a central role for the region symetrical to the VWFA; (2) letters are serially transferred to the left hemisphere through the intact segment of the corpus callosum; (3) word identity is eventually recovered in the left hemisphere through verbal working memory processes involving inferior frontal and supramarginal cortex