<b><span style="font-family:Verdana;">Background: </span></b><span style="font-family:Verdana;">Bilateral frontal lobes cerebral contusion and laceration is one unique...<b><span style="font-family:Verdana;">Background: </span></b><span style="font-family:Verdana;">Bilateral frontal lobes cerebral contusion and laceration is one unique brain injury in neurosurgery department. It is characteristic of recessive attacking and develops quickly. The unilateral cerebral falx incision is a new minimally invasive surgery </span><span style="font-family:Verdana;">that </span><span style="font-family:""><span style="font-family:Verdana;">can solve bilateral frontal lobes cerebral contusion and laceration in one surgery. However, it has some limitations in removal of contralateral frontal hematoma and hemostasis due to the limited field of view under the microscope. The unilateral bone window cerebral falx incision of bilateral frontal lobes cerebral contusion and laceration under a neuroendoscopy can acquire a good illumination and field of view. This is beneficial to complete removal of contralateral hematoma, effective hemostasis and retaining brain tissue functions to the maximum extent. </span><b><span style="font-family:Verdana;">Case Presentation:</span></b><span style="font-family:Verdana;"> The patient, a 55-year-old man, was hospitalized for “consciousness disorder by 12 h because of car accident”. </span><b><span style="font-family:Verdana;">Physical Examination: </span></b><span style="font-family:Verdana;">Coma, GCS score of E1V2M5, bilateral pupil diameter of 2 mm, presence of light response, contusion of scalp at the left top, peripheral dysphoria and bilateral Bartter syndrome negative. The patient has a history of non-traumatic cerebral stroke 3 years ago.</span><b><span style="font-family:Verdana;"> Head CT: </span></b><span style="font-family:Verdana;">Longitudinal fracture of frontal parietal occipital bone, bilateral frontal lobes contusion and laceration, subarachnoid hemorrhage. </span><b><span style="font-family:Verdana;">Diagnosis:</span></b><span style="font-family:Verdana;"> Bilateral frontal lobes contusion and laceration, longitudinal fracture of frontal parietal occipital bone, subarachnoid hemorrhage and hematoma of scalp. In emergency treatment, unilateral bone window cerebral falx incision of bilateral frontal lobes cerebral contusion and laceration under a neuroendoscopy was performed. The surgery has achieved satisfying effect. </span><b><span style="font-family:Verdana;">Discussion: </span></b><span style="font-family:Verdana;">This case realized the goal of removing contralateral frontal hematoma through unilateral craniotomy under a neuroendoscopy. Due to the clear field of view, it retained extracerebral layer structures of contralateral olfactory nerve protection frontotemporal completely. Moreover, this surgical technique is conducive to intraoperative recognition of pericallosal</span><span style="background:yellow;"> </span><span style="font-family:Verdana;">arteries and lateral fractured blood vessels. It also involves protection, which conforms to the minimally invasive philosophy. The proposed surgical technology can eliminate contralateral frontal hematoma under a good field of view. However, it is suggested not to manage with the further operation on patients who have brain swelling and difficulties in exposure of cerebral falx. These patients need to determine causes of brain swelling and choose bilateral craniectomy if necessary. </span><b><span style="font-family:Verdana;">Conclusions: </span></b><span style="font-family:Verdana;">Unilateral bone window cerebral falx incision of bilateral frontal lobes cerebral contusion and laceration under a neuroendoscopy is a new application of minimally invasive philosophy in craniocerebral injury operation. It still needs further clinical verifications and experience accumulation.展开更多
Electroacupuncture was performed at the Wangu （GB 12） acupoint, whose position is similar to the cerebellar fastigial nucleus in rats with post-stroke depression. Results showed that the expression of nuclear factor...Electroacupuncture was performed at the Wangu （GB 12） acupoint, whose position is similar to the cerebellar fastigial nucleus in rats with post-stroke depression. Results showed that the expression of nuclear factor-κB and the levels of tumor necrosis factor-α and interleukin-1β decreased. Simultaneously, the extent of edema in the hippocampus and frontal lobe decreased, and the morphology of the nerve cells recovered to near normal. In addition, fluoxetine treatment displayed a similar effect on post-stroke depression as electroacupuncture at GB 12 acupoint. The results indicate that electroacupuncture at GB 12 acupoint can reduce the levels of cytokines in the hippocampus and frontal lobe of rats with post-stroke depression, and thus provide a neuroprotective effect on post-stroke depression.展开更多
The prefrontal cortex is involved in a multitude of cognitive, emotional, motivational, and social processes, so exploring its specific functions is crucial for understanding human experience and behavior. Functional ...The prefrontal cortex is involved in a multitude of cognitive, emotional, motivational, and social processes, so exploring its specific functions is crucial for understanding human experience and behavior. Functional imaging approaches have largely contributed to the enhancement of our understanding, but might have limitations in establishing causal relationships between physiology and the related psychological and behavioral processes. Non-invasive electrical stimulation with direct or alternating currents can help to enhance our understanding with regard to specific processes, and might provide future protocols able to improve them in case of malfunctions. We review the current state of the field, and provide an outlook for future developments.展开更多
Electroacupuncture （EA） has been clinically used to treat depression and has resulted in favorable effects in China. However, results from animal studies and pathology do not reflect the influence of electroacupunct...Electroacupuncture （EA） has been clinically used to treat depression and has resulted in favorable effects in China. However, results from animal studies and pathology do not reflect the influence of electroacupuncture treatment on in vivo physiological functions. To thoroughly and dynamically observe pathological changes during depression, the present study established EA ＋ fluoxetine and fluoxetine groups to observe depression in patients. 1H-magnetic resonance spectroscopy was utilized to determine the correlation between hippocampal frontal lobe metabolite changes and mental disorder scale. Results revealed significantly increased N-acetylaspartate （NAA）/creatine （Cr） in the bilateral hippocampus and right frontal lobe of depression patients treated with EA compared with fluoxetine. Changes in NAA/Cr in bilateral hippocampus and right frontal lobe in both groups, before and after treatment, negatively correlated with severity and curative effects. Choline/Cr changes in the bilateral frontal lobes of both groups were significant before and after treatment, but negatively correlated with curative effects. Choline/Cr changes in the bilateral hippocampus were significant in the EA ＋ fluoxetine group before and after treatment, but negatively correlated with severity and the curative effects of depression. These results demonstrate abnormal biochemical metabolism in bilateral frontal lobes and hippocampus of depression patients, and show that EA significantly altered biochemical indices in the frontal lobes and hippocampus compared with fluoxetine.展开更多
BACKGROUND： Inducible nitric oxide synthase （iNOS） cannot be detected in the neurons and glial cells of normal rats, but iNOS can be found in some neurons and glial cells of rats following ischemic, traumatic, neur...BACKGROUND： Inducible nitric oxide synthase （iNOS） cannot be detected in the neurons and glial cells of normal rats, but iNOS can be found in some neurons and glial cells of rats following ischemic, traumatic, neurotoxic or inflammatory damage. OBJECTIVE： To investigate iNOS expression and iNOS-positive cell types at various time points following damage to the rat frontal lobe using a sharp instrument. DESIGN： A nerve molecular biology, randomized, controlled study. TIME AND SETTING： This experiment was performed at the Department of Human Anatomy, Institute of Neurobiology, Medical School of Nantong University, between April 2006 and December 2007. MATERIALS： Rabbit anti-iNOS antibody （Santa Cruz, USA）, biotin labeled goat anti-rabbit antibody （Sigma, USA）, reverse transcription kit （Biouniquer, Hong Kong, China） and horseradish peroxidase labeled goat anti-rabbit antibody （Pierce, USA） were used for this study. METHODS： A total of 112 healthy rats aged 3 months were randomly assigned into a sham operation group （n = 28） and a damage group （n = 84）. Rat models of frontal lobe damage were induced in the damage group using a sharp instrument to make an incision in the frontal lobe cortex. In the sham operation group, the rat bone window was opened but brain tissues were left intact. MAIN OUTCOME MEASURES： Parameters were measured at 3, 6, 12, 24, 72, 120 and 168 hours following damage in both groups. Pathological changes were observed using Nissl staining and hematoxylin-eosin staining. Expression of iNOS mRNA, iNOS protein and iNOS-positive cells were examined by RT-PCR, Western blot analysis and immunohistochemistry, respectively. RESULTS： A large number of inflammatory cells infiltrated the damaged region 12 and 24 hours following damage, iNOS mRNA and iNOS protein expression increased in and around the damaged region 3 hours following damage, reached a peak at 24 hours, and then gradually decreased. The changes in iNOS-positive cell number reflected the changes in iNOS mRNA and iNOS protein expression after damage, iNOS was mainly found in neural cells at 3 and 6 hours, in macrophages at 12 and 24 hours, and in glial cells at 72 and 120 hours after damage. iNOS-positive cells were few in and surrounding the damaged region at 168 hours. There were a few iNOS-positive neural cells in the rat frontal lobe cortex in the sham operation group. CONCLUSION： Neurons, macrophages and glial cells can express iNOS following rat frontal lobe damage caused by a sharp instrument. The levels of iNOS expression, and the cell types expressing iNOS, change with time.展开更多
The aim of the present study is to investigate the brain functional network changes of patients with frontal lobe epilepsy(FLE)by resting-state functional magnetic resonance imaging(rsfMRI)and graph theoretical analys...The aim of the present study is to investigate the brain functional network changes of patients with frontal lobe epilepsy(FLE)by resting-state functional magnetic resonance imaging(rsfMRI)and graph theoretical analysis.rsfMRI is performed in 46 adult patients with FLE and 46 age matched healthy controls(HCs).A functional network is built from these subjects,and the topological properties of such network are analyzed quantitatively using graph theoretical methods.According to the results,both FLE patients and HCs exhibit prominent small world features.Compared with HCs,FLE shows a decrease in local efficiency(Eloc),clustering coefficient,nodal efficiency as well as nodal degree.Furthermore,FLE(seven)has fewer hubs than HCs(ten).The functional abnormalities in the network organization suggest functional disturbances in patients with FLE.This study helps to gain new insights into the functional disorder in patients with FLE.The networks built here can also be a set of potential biomarkers for the diagnosis,monitoring and the treatment of FLE.展开更多
AIMTo apply the Frontal Assessment Battery to cirrhotic patients with or without overt hepatic encephalopathy (OHE) and controls. METHODSThe frontal assessment battery (FAB) was applied to 87 patients with liver cirrh...AIMTo apply the Frontal Assessment Battery to cirrhotic patients with or without overt hepatic encephalopathy (OHE) and controls. METHODSThe frontal assessment battery (FAB) was applied to 87 patients with liver cirrhosis (16 with and 71 without OHE) and 40 control subjects without cirrhosis treated at the alcohol and liver outpatient clinics and the gastroenterology ward of the Cassiano Antônio de Moraes University Hospital (Hospital Universitário Cassiano Antônio de Moraes - HUCAM), Espírito Santo, Brazil. RESULTSThe average FAB score was lower for the cirrhotic than for the non-cirrhotic patients (10.6 ± 3.67 vs 12.25 ± 2.72, P = 0.015). The FAB score was lower for the cirrhotic patients with OHE than for the patients without OHE (8.25 ± 4.55 vs 11.14 ± 3.25, P = 0.027). The total FAB score was lower for the cirrhotic patients without OHE than for the non-cirrhotic patients, although this difference was not significant (11.14 ± 3.25 vs 12.25 ± 2.72, P = 0.067). Nevertheless, the difference in the scores on the subtest that assessed the ability to inhibit a response previously conditioned to a stimulus was significant (1.72 ± 0.93 vs 2.2 ± 0.85, P = 0.011). CONCLUSIONThe present study indicates that the FAB is a promising tool for outpatient minimal HE screening and the assessment of HE severity.展开更多
Objective: This study aimed to carry out a topographical analysis of frontal lobe executive function components in post-stroke patients. Methods: A descriptive, cross-sectional study. The assessment using the WCST (Wi...Objective: This study aimed to carry out a topographical analysis of frontal lobe executive function components in post-stroke patients. Methods: A descriptive, cross-sectional study. The assessment using the WCST (Wisconsin Card Sorting Test) included sixteen patients with a clinical diagnosis of CVA and frontal lobe impairment. Results from the two groups were compared (patients with right frontal lobe impairment and patients with left frontal lobe impairment). Statistical analysis was performed using the program “Statistical Package for Social Sciences” (SPSS) Version 20.0. For comparison between groups was used Mann-Whitney test and considered the alpha level of 0.05 on the statistically significant results. Results: There was no statistically significant difference between the groups, thus showing that executive functions are symmetrically distributed across the frontal lobes. Conclusion: Executive functions are symmetrically organized across the two frontal lobes, since the comparison between the groups did not demonstrate a statistically significant difference for any of the variables of WSCT.展开更多
Auditory stimuli are proposed as beneficial neurorehabilitation methods in patients with disorders of consciousness. However, precise and accurate quantitative indices to estimate their potential effect remain scarce....Auditory stimuli are proposed as beneficial neurorehabilitation methods in patients with disorders of consciousness. However, precise and accurate quantitative indices to estimate their potential effect remain scarce. Fourteen patients were recruited from the Neuro-Rehabilitation Unit of Hangzhou Hospital of Zhejiang Armed Police Corps of China. Altogether, there were seven cases of unresponsive wakefulness syndrome（five males and two females, aged 45.7 ± 16.8 years） and seven cases of minimally conscious state（six males and one female, aged 42.3 ± 20.8 years）. Simultaneously, fourteen healthy controls（10 males and 4 females, aged 51.7 ± 9.7 years） also participated in this case-control experiment. Brain response to music, subjects＇ own name, and noise was monitored by quantitative electroencephalography（QEEG） in the resting state and with acoustic stimulation. Predictive QEEG values in various brain regions were investigated. Our results show that cerebral activation was high in subjects stimulated by their own name, especially in the temporal lobe in patients with disorders of consciousness, and the frontal lobe in the control group. Further, during resting and stimulation, QEEG index（δ ＋ θ/α ＋ β ratio） negatively correlated with the Coma Recovery Scale-Revised score in traumatic disorders of consciousness patients. Hence, we speculate that a subject＇s own name might be an effective awakening therapy for patients with disorders of consciousness. Moreover, QEEG index in specific stimulation states may be used as a prognostic indicator for disorders of consciousness patients（sensitivity, 75%; specificity, 50%）.展开更多
The pathophysiology of migraine is complex.Neuroimaging studies reveal functional and structural changes in the brains of migraine patients.We sought to explore regional volume differences in intracranial structures i...The pathophysiology of migraine is complex.Neuroimaging studies reveal functional and structural changes in the brains of migraine patients.We sought to explore regional volume differences in intracranial structures in patients with episodic and chronic migraine.Sixteen episodic migraine patients,16 chronic migraine patients,and 24 normal controls were recruited and underwent 3.0 T MRI scanning.The volumes of 142 brain regions were calculated by an automatic volumetric algorithm and compared with clinical variables.Results demonstrated that the volumes of specific regions in the frontal and occipital lobes,and the right putamen,were increased and the volume of the fourth ventricle was decreased in the episodic migraine patients compared with controls.The volumes of the left basal forebrain,optic chiasm,and,the fourth ventricle were decreased in the chronic migraine patients,while the occipital cortex and the right putamen were larger.Compared to episodic migraine patiants,chronic migraine patients displayed larger left thalamus and smaller frontal regions.Correlation analysis showed that headache frequency was negatively correlated with the volume of the right frontal pole,right lateral orbital gyrus,and medial frontal lobes and positively correlated with the volume of the left thalamus.The sleep disturbance score was negatively correlated with the volume of the left basal forebrain.This suggests that migraine patients have structural changes in regions associated with pain processing and modulation,affective and cognitive processing,and visual perception.The remodeling of selective intracranial structures may be involved in migraine attacks.This study was approved by the Ethics Committee of Chinese PLA General Hospital(approval No.S2018-027-02)on May 31,2018.展开更多
Psychosis is a common non-motor symptom of Parkinson’s disease whose pathogenesis remains poorly understood. Parkinson’s disease in conjunction with psychosis has been shown to induce injury to extracorticospinal tr...Psychosis is a common non-motor symptom of Parkinson’s disease whose pathogenesis remains poorly understood. Parkinson’s disease in conjunction with psychosis has been shown to induce injury to extracorticospinal tracts as wel as within some cortical areas. In this study, Parkinson’s disease patients with psychosis who did not receive antipsychotic treatment and those without psychosis underwent diffusion tensor imaging. Results revealed that in Parkinson’s disease patients with psychosis, damage to the left frontal lobe, bilateral occipital lobe, left cingulated gyrus, and left hippocampal white-matter fibers were greater than damage to the substantia nigra or the globus pal idus. Damage to white-matter fibers in the right frontal lobe and right cingulate gyrus were also more severe than in the globus pal idus, but not the substantia nigra. Damage to frontal lobe and cingulate gyrus white-matter fibers was more apparent than that to occipital or hippocampal fiber damage. Compared with Parkinson’s disease patients without psychosis, those with psychosis had significantly lower fractional anisotropy ratios of left frontal lobe, bilateral occipital lobe, left cingu-lated gyrus, and left hippocampus to ipsilateral substantia nigra or globus pal idus, indicating more severe damage to white-matter fibers. These results suggest that psychosis associated with Par-kinson’s disease is probably associated with an imbalance in the ratio of white-matter fibers be-tween brain regions associated with psychiatric symptoms （frontal lobe, occipital lobe, cingulate gyrus, and hippocampus） and those associated with the motor symptoms of Parkinson’s disease （the substantia nigra and globus pal idus）. The relatively greater damage to white-matter fibers in psychiatric symptom-related brain regions than in extracorticospinal tracts might explain why psy-chosis often occurs in Parkinson’s disease patients.展开更多
Voxel-based morphometry-diffeomorphic anatomical registration using exponentiated lie algebra analysis was used to investigate the structural characteristics of white matter in young males with antisocial personality ...Voxel-based morphometry-diffeomorphic anatomical registration using exponentiated lie algebra analysis was used to investigate the structural characteristics of white matter in young males with antisocial personality disorder （APD） and healthy controls without APD. The results revealed that APD subjects, relative to healthy subjects, exhibited increased white matter volume in the bilateral prefrontal lobe, right insula, precentral gyrus, bilateral superior temporal gyrus, right postcentral gyrus, right inferior parietal Iobule, right precuneus, right middle occipital lobe, right parahippocampal gyrus and bilateral cingulate, and decreased volume in the middle temporal cortex and right cerebellum. The white matter volume in the medial frontal gyrus was significantly correlated with antisocial type scores on the Personality Diagnostic Questionnaire in APD subjects. These experimental findings indicate that white matter abnormalities in several brain areas may contribute to antisocial behaviors in APD subjects.展开更多
<strong>Background:</strong> Ictal psychosis without remarkable cognitive impairment is uncommon occurrence, presents diagnostic challenges to clinicians, often misdiagnosed as functional psychosis. <st...<strong>Background:</strong> Ictal psychosis without remarkable cognitive impairment is uncommon occurrence, presents diagnostic challenges to clinicians, often misdiagnosed as functional psychosis. <strong>Case Presentation:</strong> We present 3 cases of young adult men admitted to psychiatric ward as functional psychosis. They presented with irritability, physical aggression and mild cognitive impairment with intense emotional symptoms, and persecutory ideas and delusions. Two were wrongly diagnose as mania while the third was mimicking schizophrenia in its presentation. They received antipsychotic treatment and misdiagnosed as functional psychosis. They did not respond well to such treatment, until, series electroencephalograms were taken which revealed evidence of ictal psychosis. All, thence, responded well to addition of antiepileptic treatment. This, not only, proves to be effective, but also determined future management and prognosis. <strong>Conclusion: </strong>These cases shine light onto the role of the frontal cortex in the genesis of quasi-manic episodes and highlight the importance of EEG investigations in first episode of acute psychosis.展开更多
Background:Frontal lobe epilepsy(FLE),the second most common refractory focal epilepsy,of which focal cortical dysplasia(FCD)is a common etiology.Electrophysiological analysis offers crucial insights into FCD subtype ...Background:Frontal lobe epilepsy(FLE),the second most common refractory focal epilepsy,of which focal cortical dysplasia(FCD)is a common etiology.Electrophysiological analysis offers crucial insights into FCD subtype differentiation.Thus,we aim to evaluate scalp electroencephalography(EEG)and stereoelectroencephalography(SEEG)features,clinical characteristics,and postsurgical outcomes in a uniform series of patients with pathologically confirmed FCD type I or II who underwent FLE surgery.Methods:Thirty-four consecutive patients were retrospectively analyzed.The interictal and ictal EEG and SEEG features,clinical characteristics,and surgical outcomes were evaluated.Results:Six interictal EEG patterns were identified.Focal continuous fast epileptiform discharges were only encountered in FCD II,with a high specificity of 100%.Continuous periodic spikes were predominantly observed in FCD II,with a high specificity of 94.4%;while repetitive discharges were largely observed in FCD I,with a specificity of 94.4%.Patients with a shorter epilepsy duration were more likely to show continuous irregular slowing(P=0.034).Five EEG ictal onset patterns(IOPs)were identified.Spikes and slow waves were observed only in the FCD I group,whereas alpha activity was observed only in the FCD II group.Four interictal SEEG patterns were identified.Continuous periodic spikes were most frequently observed in the FCD II group(P=0.044).Seven SEEG IOPs values were identified.Slow-wave or baseline shift followed by low-voltage fast activity(LVFA)and delta brush were observed only in FCD I.In contrast,preictal spiking followed by LVFA was mostly observed in the FCD II.Fast activity was observed only in the FCD I group.The average follow-up time was 1.8 years,and favorable surgical outcomes were observed more often in patients with FCD II(66.7%)than in those with FCD I(44.4%)but without significance(P?0.315).Conclusion:FCD subtypes share distinct EEG and SEEG signatures,and some special patterns may be indicative of specific subtypes.展开更多
Objective： To study the effect and indications ofintracranial pressure （ICP） monitoring for frontal lobe contusion patients. Methods： During January 2005-December 2008, 34 cases of frontal lobe contusion received ...Objective： To study the effect and indications ofintracranial pressure （ICP） monitoring for frontal lobe contusion patients. Methods： During January 2005-December 2008, 34 cases of frontal lobe contusion received ICP monitoring in our department （monitoring group）. Different treatment protocols were adopted according to the results of ICP. Mean-while 46 cases of same type of head-injured patients who did not undergo ICP monitoring served as control group. Results： We found that ICP elevated dramatically within 24 hours after head injury if the contusions were located in frontal longitudinal dehiscence, bilateral undersurface of frontal lobe or dispersed in bilateral lobe. After half a year follow-up and on the basis of Glasgow Coma Scale assessment, the monitoring group showed better outcome than the control group with good recovery in 24 cases （70.6%）, moderate disability in 7 cases （20.6%）, severe disability in 2 （5.88%） and death in 1 （2.94%）. The outcome of control group displayed good condition in 25 cases （54.3%）, moderate disabilities in 8 （17.4%）, severe disability in 7 （15.2%）, and death in 6 （13.0%）. Conclusions： Frontal lobe contusions are vulnerable and complex head injuries, especially when the contusions are located in frontal longitudinal dehiscence, bilateral undersurface of frontal lobe or diffused in bilateral lobes. These patients should undergo ICP monitoring regardless of their consciousness status. IflCP elevates over 25 mm Hg, the craniotomy is mandatory and will markedly reduce the mortality and disability of these patients.展开更多
Objective:Endoscopic repair of large anterior skull base(ASB)defects has excellent results when using multilayered repairs with a nasoseptal flap.However,in extensive intranasal tumors,a nasoseptal flap may not always...Objective:Endoscopic repair of large anterior skull base(ASB)defects has excellent results when using multilayered repairs with a nasoseptal flap.However,in extensive intranasal tumors,a nasoseptal flap may not always be available.One alternative option is a flexible single-layer ASB repair.Initial studies indicate low cerebrospinal fluid leak rates with a single-layer repair.However,the level of frontal lobe support,particularly the propensity for a significant inferior displacement of the frontal lobe,is not known.The goal of this study is to determine the frontal lobe position after single-layer acellular dermal allograft repair in large ASB defects.Study Design:Retrospective cohort study.Setting:Tertiary care medical center.Subjects and Methods:This cohort study compares the frontal lobe position in adults who underwent endoscopic endonasal ASB tumor resection and single-layer cadaveric dermal matrix repair(ASB cohort)with control subjects without intracranial abnormalities(control cohort).The ASB cohort includes subjects with an ASB defect of≥5 cm anterior/posterior and≥1.5 cm wide and who had imaging at least 2 months after surgery.The frontal lobe position is measured on sagittal CT/MRI using a reference line from the base of the sella to the nasion.A value of zero indicates that the inferior-most aspect of the frontal lobe is at the level of the nasion-sellar line.A positive value indicates that the frontal lobe is inferior to the nasion-sellar line.The ASB cohort frontal lobe position is compared with the control cohort using the Mann-WhitneyU test.A priori we set an absolute difference of 5 mm as a clinically significant difference.Results:The ASB cohort includes 47 subjects who are 57%male with an average age of 60 years(range:31-89 years).The most common ASB pathology is esthesioneuroblastoma(n=21)and 81%of the ASB cohort had postoperative radiation.The control cohort includes 20 subjects who are 60%male,with a mean age of 45 years(range:19-74 years).The majority of controls underwent imaging for head trauma(n=13).The ASB mean frontal lobe position is-0.2 mm superior to the nasion-sellar line(range:-9.2 to 10.4 mm),while the control’’s mean frontal lobe position is 1.1 mm inferior to the nasion-sellar line.This difference is not statistically significant(P=0.13)and does not reach our a priori definition of clinical significance.The frontal lobe position of ASB subjects who had radiation is closer to the nasion-sellar line as compared with those who did not undergo radiation.Conclusions:Single-layer acellular dermal graft repair maintains frontal lobe support and position in large ASB defects.展开更多
Background Children with nonverbal learning disabilities (NLD) usually manifest defective attention function This study sought to investigate the neuropsychological characteristics of selective attention, such as atte...Background Children with nonverbal learning disabilities (NLD) usually manifest defective attention function This study sought to investigate the neuropsychological characteristics of selective attention, such as attention control, working memory, and attention persistence of the frontal lobe in children with NLD Methods Using the auditory detection test (ADT), Wisconsin card sorting test (WCST), and C WISC, 27 children with NLD and 33 normal children in the control group were tested, and the results of C WISC subtests were analyzed with factor analysis Results Compared with the control group, the correct response rate in the auditory detection test in the NLD group was much lower ( P <0 01), and the number of incorrect responses was much higher ( P <0 01); NLD children also scored lower in WCST categories achieved (CA) and perseverative errors (PE) ( P <0 05) Factor analysis showed that perceptual organization (PO) related to visual space and freedom from distractibility (FD) relating to attention persistence in the NLD group were obviously lower than in the control group ( P <0 01) Conclusions Children with NLD have attention control disorder and working memory disorder mainly in the frontal lobe We believe that the disorder is particularly prominent in the right frontal lobe展开更多
To study the effect of special brain area regional cerebral blood flow(rCBF)abnormal perfusion on learning and memory function and its molecular mechanism,64 adult male healthy Sprague-Dawley(SD)rats were randomly div...To study the effect of special brain area regional cerebral blood flow(rCBF)abnormal perfusion on learning and memory function and its molecular mechanism,64 adult male healthy Sprague-Dawley(SD)rats were randomly divided into two groups,the false operation group(control group)and the operation group(model group).After surgical operation,the operation group undertook bilateral common carotid artery permanent ligation,while the other group did not.Learning and memory function were measured by Y-maze at 4 h,8 h,24 h and 3 d after surgical operation,respectively.The rCBF of the right frontal lobe and hippocampus was also detected by the PerifluxPF model laser Doppler flowmetry,and the expressions of c-fos or c-jun or Bcl-2 and Bax were also measured by immune histochemistry S-P method accordingly.Results showed that the rCBF of the right frontal lobe and hippocampus in the operation group was significantly lower than that in the false operation group(P,0.05).The learning indexes,error number(EN),day of reach standard and total reaction time(TRT)in the operation group,were significantly higher than that in the false operation group(P,0.05).However,the initiative evasion rate in the operation group was significantly lower than that in the false operation group.The study also found that the rCBF was relatively more,the indexes(EN,the day of reach standard and TRT)relatively fewer,but the initiative evasion rate and the memory keeping rate were relatively more.The positive expression and the average absorbency of Fos and Jun in the operation group were significantly higher than that in the false operation group(P<0.05).Furthermore,Bax and Bcl-2 positive cells were all increased over time in the operation group,and the expression ratio of Bax/Bcl-2 in the operation group was significantly higher than that in the false operation group(P<0.01).In conclusion,rCBF decrease can impair the learning and memory function in rats,which may be related to the increase of the expression ratio of c-fos or c-jun or Bcl-2 or Bax in the frontal cortex and hippocampus.展开更多
Background Focal cortical dysplasia(FCD)is a common cause of drug-resistant epilepsy.Electroencephalography(EEG)biomarkers that predict good postoperative outcomes are essential for identifying patients with focal epi...Background Focal cortical dysplasia(FCD)is a common cause of drug-resistant epilepsy.Electroencephalography(EEG)biomarkers that predict good postoperative outcomes are essential for identifying patients with focal epilepsies.Case presentation We report the case of a 21-year-old female with seizure onset at the age of 9,characterized by left-hand dystonic posturing and impaired awareness,which evolved to bilateral tonic-clonic seizures,evaluated in a neurological referral center in Lima,Peru.During 6-h video-EEG,interictal EEG revealing focal brief potentially ictal rhythmic discharges(BIRDs)over the right frontal central region,lasting less than 10 s.The ictal features were characterized by low-voltage fast activity over the same area.Brain magnetic resonance imaging(MRI)demonstrated a focal lesion of focal cortical dysplasia type II in the right frontal lobe.The patient underwent a lesionectomy guided by electrocorticography,which showed continuous polyspikes.BIRDs showing a brief burst of spikes lasting longer than 0.5 s,were also identified on intraoperative electrocorticography(ECoG)and helped define the extent of resection.The patient obtained an Engel Outcome Class IA at 6 years of follow-up.Conclusions The atypical BIRDs on ECoG can be used as a prognostic biomarker for prolonged seizure-freedom outcome in patients with epilepsy.Additional reports are needed in developing countries with and without brain MRI lesions to advance outpatient presurgical evaluations despite limited resources.展开更多
文摘<b><span style="font-family:Verdana;">Background: </span></b><span style="font-family:Verdana;">Bilateral frontal lobes cerebral contusion and laceration is one unique brain injury in neurosurgery department. It is characteristic of recessive attacking and develops quickly. The unilateral cerebral falx incision is a new minimally invasive surgery </span><span style="font-family:Verdana;">that </span><span style="font-family:""><span style="font-family:Verdana;">can solve bilateral frontal lobes cerebral contusion and laceration in one surgery. However, it has some limitations in removal of contralateral frontal hematoma and hemostasis due to the limited field of view under the microscope. The unilateral bone window cerebral falx incision of bilateral frontal lobes cerebral contusion and laceration under a neuroendoscopy can acquire a good illumination and field of view. This is beneficial to complete removal of contralateral hematoma, effective hemostasis and retaining brain tissue functions to the maximum extent. </span><b><span style="font-family:Verdana;">Case Presentation:</span></b><span style="font-family:Verdana;"> The patient, a 55-year-old man, was hospitalized for “consciousness disorder by 12 h because of car accident”. </span><b><span style="font-family:Verdana;">Physical Examination: </span></b><span style="font-family:Verdana;">Coma, GCS score of E1V2M5, bilateral pupil diameter of 2 mm, presence of light response, contusion of scalp at the left top, peripheral dysphoria and bilateral Bartter syndrome negative. The patient has a history of non-traumatic cerebral stroke 3 years ago.</span><b><span style="font-family:Verdana;"> Head CT: </span></b><span style="font-family:Verdana;">Longitudinal fracture of frontal parietal occipital bone, bilateral frontal lobes contusion and laceration, subarachnoid hemorrhage. </span><b><span style="font-family:Verdana;">Diagnosis:</span></b><span style="font-family:Verdana;"> Bilateral frontal lobes contusion and laceration, longitudinal fracture of frontal parietal occipital bone, subarachnoid hemorrhage and hematoma of scalp. In emergency treatment, unilateral bone window cerebral falx incision of bilateral frontal lobes cerebral contusion and laceration under a neuroendoscopy was performed. The surgery has achieved satisfying effect. </span><b><span style="font-family:Verdana;">Discussion: </span></b><span style="font-family:Verdana;">This case realized the goal of removing contralateral frontal hematoma through unilateral craniotomy under a neuroendoscopy. Due to the clear field of view, it retained extracerebral layer structures of contralateral olfactory nerve protection frontotemporal completely. Moreover, this surgical technique is conducive to intraoperative recognition of pericallosal</span><span style="background:yellow;"> </span><span style="font-family:Verdana;">arteries and lateral fractured blood vessels. It also involves protection, which conforms to the minimally invasive philosophy. The proposed surgical technology can eliminate contralateral frontal hematoma under a good field of view. However, it is suggested not to manage with the further operation on patients who have brain swelling and difficulties in exposure of cerebral falx. These patients need to determine causes of brain swelling and choose bilateral craniectomy if necessary. </span><b><span style="font-family:Verdana;">Conclusions: </span></b><span style="font-family:Verdana;">Unilateral bone window cerebral falx incision of bilateral frontal lobes cerebral contusion and laceration under a neuroendoscopy is a new application of minimally invasive philosophy in craniocerebral injury operation. It still needs further clinical verifications and experience accumulation.
基金the National Natural Science Foundation of China, No. 81041058the Natural Science Foundation of Liaoning Province, No. 20092191
文摘Electroacupuncture was performed at the Wangu （GB 12） acupoint, whose position is similar to the cerebellar fastigial nucleus in rats with post-stroke depression. Results showed that the expression of nuclear factor-κB and the levels of tumor necrosis factor-α and interleukin-1β decreased. Simultaneously, the extent of edema in the hippocampus and frontal lobe decreased, and the morphology of the nerve cells recovered to near normal. In addition, fluoxetine treatment displayed a similar effect on post-stroke depression as electroacupuncture at GB 12 acupoint. The results indicate that electroacupuncture at GB 12 acupoint can reduce the levels of cytokines in the hippocampus and frontal lobe of rats with post-stroke depression, and thus provide a neuroprotective effect on post-stroke depression.
文摘The prefrontal cortex is involved in a multitude of cognitive, emotional, motivational, and social processes, so exploring its specific functions is crucial for understanding human experience and behavior. Functional imaging approaches have largely contributed to the enhancement of our understanding, but might have limitations in establishing causal relationships between physiology and the related psychological and behavioral processes. Non-invasive electrical stimulation with direct or alternating currents can help to enhance our understanding with regard to specific processes, and might provide future protocols able to improve them in case of malfunctions. We review the current state of the field, and provide an outlook for future developments.
基金the National Natural Science Foundation of China,No.30701122the Key Program of Beijing Natural Science Foundation,No.7051003
文摘Electroacupuncture （EA） has been clinically used to treat depression and has resulted in favorable effects in China. However, results from animal studies and pathology do not reflect the influence of electroacupuncture treatment on in vivo physiological functions. To thoroughly and dynamically observe pathological changes during depression, the present study established EA ＋ fluoxetine and fluoxetine groups to observe depression in patients. 1H-magnetic resonance spectroscopy was utilized to determine the correlation between hippocampal frontal lobe metabolite changes and mental disorder scale. Results revealed significantly increased N-acetylaspartate （NAA）/creatine （Cr） in the bilateral hippocampus and right frontal lobe of depression patients treated with EA compared with fluoxetine. Changes in NAA/Cr in bilateral hippocampus and right frontal lobe in both groups, before and after treatment, negatively correlated with severity and curative effects. Choline/Cr changes in the bilateral frontal lobes of both groups were significant before and after treatment, but negatively correlated with curative effects. Choline/Cr changes in the bilateral hippocampus were significant in the EA ＋ fluoxetine group before and after treatment, but negatively correlated with severity and the curative effects of depression. These results demonstrate abnormal biochemical metabolism in bilateral frontal lobes and hippocampus of depression patients, and show that EA significantly altered biochemical indices in the frontal lobes and hippocampus compared with fluoxetine.
基金Supported by:Natural Science Research Plan for Jiangsu Colleges,No. 05KJD180165
文摘BACKGROUND： Inducible nitric oxide synthase （iNOS） cannot be detected in the neurons and glial cells of normal rats, but iNOS can be found in some neurons and glial cells of rats following ischemic, traumatic, neurotoxic or inflammatory damage. OBJECTIVE： To investigate iNOS expression and iNOS-positive cell types at various time points following damage to the rat frontal lobe using a sharp instrument. DESIGN： A nerve molecular biology, randomized, controlled study. TIME AND SETTING： This experiment was performed at the Department of Human Anatomy, Institute of Neurobiology, Medical School of Nantong University, between April 2006 and December 2007. MATERIALS： Rabbit anti-iNOS antibody （Santa Cruz, USA）, biotin labeled goat anti-rabbit antibody （Sigma, USA）, reverse transcription kit （Biouniquer, Hong Kong, China） and horseradish peroxidase labeled goat anti-rabbit antibody （Pierce, USA） were used for this study. METHODS： A total of 112 healthy rats aged 3 months were randomly assigned into a sham operation group （n = 28） and a damage group （n = 84）. Rat models of frontal lobe damage were induced in the damage group using a sharp instrument to make an incision in the frontal lobe cortex. In the sham operation group, the rat bone window was opened but brain tissues were left intact. MAIN OUTCOME MEASURES： Parameters were measured at 3, 6, 12, 24, 72, 120 and 168 hours following damage in both groups. Pathological changes were observed using Nissl staining and hematoxylin-eosin staining. Expression of iNOS mRNA, iNOS protein and iNOS-positive cells were examined by RT-PCR, Western blot analysis and immunohistochemistry, respectively. RESULTS： A large number of inflammatory cells infiltrated the damaged region 12 and 24 hours following damage, iNOS mRNA and iNOS protein expression increased in and around the damaged region 3 hours following damage, reached a peak at 24 hours, and then gradually decreased. The changes in iNOS-positive cell number reflected the changes in iNOS mRNA and iNOS protein expression after damage, iNOS was mainly found in neural cells at 3 and 6 hours, in macrophages at 12 and 24 hours, and in glial cells at 72 and 120 hours after damage. iNOS-positive cells were few in and surrounding the damaged region at 168 hours. There were a few iNOS-positive neural cells in the rat frontal lobe cortex in the sham operation group. CONCLUSION： Neurons, macrophages and glial cells can express iNOS following rat frontal lobe damage caused by a sharp instrument. The levels of iNOS expression, and the cell types expressing iNOS, change with time.
基金supported by the Natural Science Foundation of China(Nos.81422022,81271553,81201155,81171328,61131003,81401402,and 81201161)the Grant for a Young Scholar of Jinling Hospital(No.2015055)12.5 Key Grants(Nos.BWS11J063 and 10z026)
文摘The aim of the present study is to investigate the brain functional network changes of patients with frontal lobe epilepsy(FLE)by resting-state functional magnetic resonance imaging(rsfMRI)and graph theoretical analysis.rsfMRI is performed in 46 adult patients with FLE and 46 age matched healthy controls(HCs).A functional network is built from these subjects,and the topological properties of such network are analyzed quantitatively using graph theoretical methods.According to the results,both FLE patients and HCs exhibit prominent small world features.Compared with HCs,FLE shows a decrease in local efficiency(Eloc),clustering coefficient,nodal efficiency as well as nodal degree.Furthermore,FLE(seven)has fewer hubs than HCs(ten).The functional abnormalities in the network organization suggest functional disturbances in patients with FLE.This study helps to gain new insights into the functional disorder in patients with FLE.The networks built here can also be a set of potential biomarkers for the diagnosis,monitoring and the treatment of FLE.
文摘AIMTo apply the Frontal Assessment Battery to cirrhotic patients with or without overt hepatic encephalopathy (OHE) and controls. METHODSThe frontal assessment battery (FAB) was applied to 87 patients with liver cirrhosis (16 with and 71 without OHE) and 40 control subjects without cirrhosis treated at the alcohol and liver outpatient clinics and the gastroenterology ward of the Cassiano Antônio de Moraes University Hospital (Hospital Universitário Cassiano Antônio de Moraes - HUCAM), Espírito Santo, Brazil. RESULTSThe average FAB score was lower for the cirrhotic than for the non-cirrhotic patients (10.6 ± 3.67 vs 12.25 ± 2.72, P = 0.015). The FAB score was lower for the cirrhotic patients with OHE than for the patients without OHE (8.25 ± 4.55 vs 11.14 ± 3.25, P = 0.027). The total FAB score was lower for the cirrhotic patients without OHE than for the non-cirrhotic patients, although this difference was not significant (11.14 ± 3.25 vs 12.25 ± 2.72, P = 0.067). Nevertheless, the difference in the scores on the subtest that assessed the ability to inhibit a response previously conditioned to a stimulus was significant (1.72 ± 0.93 vs 2.2 ± 0.85, P = 0.011). CONCLUSIONThe present study indicates that the FAB is a promising tool for outpatient minimal HE screening and the assessment of HE severity.
文摘Objective: This study aimed to carry out a topographical analysis of frontal lobe executive function components in post-stroke patients. Methods: A descriptive, cross-sectional study. The assessment using the WCST (Wisconsin Card Sorting Test) included sixteen patients with a clinical diagnosis of CVA and frontal lobe impairment. Results from the two groups were compared (patients with right frontal lobe impairment and patients with left frontal lobe impairment). Statistical analysis was performed using the program “Statistical Package for Social Sciences” (SPSS) Version 20.0. For comparison between groups was used Mann-Whitney test and considered the alpha level of 0.05 on the statistically significant results. Results: There was no statistically significant difference between the groups, thus showing that executive functions are symmetrically distributed across the frontal lobes. Conclusion: Executive functions are symmetrically organized across the two frontal lobes, since the comparison between the groups did not demonstrate a statistically significant difference for any of the variables of WSCT.
基金supported by grants from the General Project Plan of Zhejiang Medical Technology of China,No.2014RCA007the Medical Science and Technology Project Co-founded by Zhejiang Province and the Ministry of Health of China,No.2016152769
文摘Auditory stimuli are proposed as beneficial neurorehabilitation methods in patients with disorders of consciousness. However, precise and accurate quantitative indices to estimate their potential effect remain scarce. Fourteen patients were recruited from the Neuro-Rehabilitation Unit of Hangzhou Hospital of Zhejiang Armed Police Corps of China. Altogether, there were seven cases of unresponsive wakefulness syndrome（five males and two females, aged 45.7 ± 16.8 years） and seven cases of minimally conscious state（six males and one female, aged 42.3 ± 20.8 years）. Simultaneously, fourteen healthy controls（10 males and 4 females, aged 51.7 ± 9.7 years） also participated in this case-control experiment. Brain response to music, subjects＇ own name, and noise was monitored by quantitative electroencephalography（QEEG） in the resting state and with acoustic stimulation. Predictive QEEG values in various brain regions were investigated. Our results show that cerebral activation was high in subjects stimulated by their own name, especially in the temporal lobe in patients with disorders of consciousness, and the frontal lobe in the control group. Further, during resting and stimulation, QEEG index（δ ＋ θ/α ＋ β ratio） negatively correlated with the Coma Recovery Scale-Revised score in traumatic disorders of consciousness patients. Hence, we speculate that a subject＇s own name might be an effective awakening therapy for patients with disorders of consciousness. Moreover, QEEG index in specific stimulation states may be used as a prognostic indicator for disorders of consciousness patients（sensitivity, 75%; specificity, 50%）.
基金supported by the Natural Science Foundation of Hainan Province of China,No.818MS153(to ZYC)the National Natural Science Foundation of China,No.81771200(to ZD)+2 种基金the National Key Research and Development Projects of Beijing Science and Technology Plan of China,No.Z161100002616013(to SYY)the Special Financial Grant from the China Postdoctoral Science Foundation,No.2014T70960(to ZYC)the Nursery Technology Innovation Fund of Chinese PLA General Hospital,No.12KMM39(to XYC)
文摘The pathophysiology of migraine is complex.Neuroimaging studies reveal functional and structural changes in the brains of migraine patients.We sought to explore regional volume differences in intracranial structures in patients with episodic and chronic migraine.Sixteen episodic migraine patients,16 chronic migraine patients,and 24 normal controls were recruited and underwent 3.0 T MRI scanning.The volumes of 142 brain regions were calculated by an automatic volumetric algorithm and compared with clinical variables.Results demonstrated that the volumes of specific regions in the frontal and occipital lobes,and the right putamen,were increased and the volume of the fourth ventricle was decreased in the episodic migraine patients compared with controls.The volumes of the left basal forebrain,optic chiasm,and,the fourth ventricle were decreased in the chronic migraine patients,while the occipital cortex and the right putamen were larger.Compared to episodic migraine patiants,chronic migraine patients displayed larger left thalamus and smaller frontal regions.Correlation analysis showed that headache frequency was negatively correlated with the volume of the right frontal pole,right lateral orbital gyrus,and medial frontal lobes and positively correlated with the volume of the left thalamus.The sleep disturbance score was negatively correlated with the volume of the left basal forebrain.This suggests that migraine patients have structural changes in regions associated with pain processing and modulation,affective and cognitive processing,and visual perception.The remodeling of selective intracranial structures may be involved in migraine attacks.This study was approved by the Ethics Committee of Chinese PLA General Hospital(approval No.S2018-027-02)on May 31,2018.
基金supported by the Applied Basic Research Foundation of Yunnan Province in China,No.2009CD193
文摘Psychosis is a common non-motor symptom of Parkinson’s disease whose pathogenesis remains poorly understood. Parkinson’s disease in conjunction with psychosis has been shown to induce injury to extracorticospinal tracts as wel as within some cortical areas. In this study, Parkinson’s disease patients with psychosis who did not receive antipsychotic treatment and those without psychosis underwent diffusion tensor imaging. Results revealed that in Parkinson’s disease patients with psychosis, damage to the left frontal lobe, bilateral occipital lobe, left cingulated gyrus, and left hippocampal white-matter fibers were greater than damage to the substantia nigra or the globus pal idus. Damage to white-matter fibers in the right frontal lobe and right cingulate gyrus were also more severe than in the globus pal idus, but not the substantia nigra. Damage to frontal lobe and cingulate gyrus white-matter fibers was more apparent than that to occipital or hippocampal fiber damage. Compared with Parkinson’s disease patients without psychosis, those with psychosis had significantly lower fractional anisotropy ratios of left frontal lobe, bilateral occipital lobe, left cingu-lated gyrus, and left hippocampus to ipsilateral substantia nigra or globus pal idus, indicating more severe damage to white-matter fibers. These results suggest that psychosis associated with Par-kinson’s disease is probably associated with an imbalance in the ratio of white-matter fibers be-tween brain regions associated with psychiatric symptoms （frontal lobe, occipital lobe, cingulate gyrus, and hippocampus） and those associated with the motor symptoms of Parkinson’s disease （the substantia nigra and globus pal idus）. The relatively greater damage to white-matter fibers in psychiatric symptom-related brain regions than in extracorticospinal tracts might explain why psy-chosis often occurs in Parkinson’s disease patients.
基金the National Natural Science Foundation of China, No. 30570609
文摘Voxel-based morphometry-diffeomorphic anatomical registration using exponentiated lie algebra analysis was used to investigate the structural characteristics of white matter in young males with antisocial personality disorder （APD） and healthy controls without APD. The results revealed that APD subjects, relative to healthy subjects, exhibited increased white matter volume in the bilateral prefrontal lobe, right insula, precentral gyrus, bilateral superior temporal gyrus, right postcentral gyrus, right inferior parietal Iobule, right precuneus, right middle occipital lobe, right parahippocampal gyrus and bilateral cingulate, and decreased volume in the middle temporal cortex and right cerebellum. The white matter volume in the medial frontal gyrus was significantly correlated with antisocial type scores on the Personality Diagnostic Questionnaire in APD subjects. These experimental findings indicate that white matter abnormalities in several brain areas may contribute to antisocial behaviors in APD subjects.
文摘<strong>Background:</strong> Ictal psychosis without remarkable cognitive impairment is uncommon occurrence, presents diagnostic challenges to clinicians, often misdiagnosed as functional psychosis. <strong>Case Presentation:</strong> We present 3 cases of young adult men admitted to psychiatric ward as functional psychosis. They presented with irritability, physical aggression and mild cognitive impairment with intense emotional symptoms, and persecutory ideas and delusions. Two were wrongly diagnose as mania while the third was mimicking schizophrenia in its presentation. They received antipsychotic treatment and misdiagnosed as functional psychosis. They did not respond well to such treatment, until, series electroencephalograms were taken which revealed evidence of ictal psychosis. All, thence, responded well to addition of antiepileptic treatment. This, not only, proves to be effective, but also determined future management and prognosis. <strong>Conclusion: </strong>These cases shine light onto the role of the frontal cortex in the genesis of quasi-manic episodes and highlight the importance of EEG investigations in first episode of acute psychosis.
基金supported by grants from the Capital Medical University Natural Foundation(No.PYZ20119)Epilepsy Research Fund of the China Association against Epilepsy(No.CU-B-2021-24)Beijing Natural Science Foundation(No.L182015).
文摘Background:Frontal lobe epilepsy(FLE),the second most common refractory focal epilepsy,of which focal cortical dysplasia(FCD)is a common etiology.Electrophysiological analysis offers crucial insights into FCD subtype differentiation.Thus,we aim to evaluate scalp electroencephalography(EEG)and stereoelectroencephalography(SEEG)features,clinical characteristics,and postsurgical outcomes in a uniform series of patients with pathologically confirmed FCD type I or II who underwent FLE surgery.Methods:Thirty-four consecutive patients were retrospectively analyzed.The interictal and ictal EEG and SEEG features,clinical characteristics,and surgical outcomes were evaluated.Results:Six interictal EEG patterns were identified.Focal continuous fast epileptiform discharges were only encountered in FCD II,with a high specificity of 100%.Continuous periodic spikes were predominantly observed in FCD II,with a high specificity of 94.4%;while repetitive discharges were largely observed in FCD I,with a specificity of 94.4%.Patients with a shorter epilepsy duration were more likely to show continuous irregular slowing(P=0.034).Five EEG ictal onset patterns(IOPs)were identified.Spikes and slow waves were observed only in the FCD I group,whereas alpha activity was observed only in the FCD II group.Four interictal SEEG patterns were identified.Continuous periodic spikes were most frequently observed in the FCD II group(P=0.044).Seven SEEG IOPs values were identified.Slow-wave or baseline shift followed by low-voltage fast activity(LVFA)and delta brush were observed only in FCD I.In contrast,preictal spiking followed by LVFA was mostly observed in the FCD II.Fast activity was observed only in the FCD I group.The average follow-up time was 1.8 years,and favorable surgical outcomes were observed more often in patients with FCD II(66.7%)than in those with FCD I(44.4%)but without significance(P?0.315).Conclusion:FCD subtypes share distinct EEG and SEEG signatures,and some special patterns may be indicative of specific subtypes.
文摘Objective： To study the effect and indications ofintracranial pressure （ICP） monitoring for frontal lobe contusion patients. Methods： During January 2005-December 2008, 34 cases of frontal lobe contusion received ICP monitoring in our department （monitoring group）. Different treatment protocols were adopted according to the results of ICP. Mean-while 46 cases of same type of head-injured patients who did not undergo ICP monitoring served as control group. Results： We found that ICP elevated dramatically within 24 hours after head injury if the contusions were located in frontal longitudinal dehiscence, bilateral undersurface of frontal lobe or dispersed in bilateral lobe. After half a year follow-up and on the basis of Glasgow Coma Scale assessment, the monitoring group showed better outcome than the control group with good recovery in 24 cases （70.6%）, moderate disability in 7 cases （20.6%）, severe disability in 2 （5.88%） and death in 1 （2.94%）. The outcome of control group displayed good condition in 25 cases （54.3%）, moderate disabilities in 8 （17.4%）, severe disability in 7 （15.2%）, and death in 6 （13.0%）. Conclusions： Frontal lobe contusions are vulnerable and complex head injuries, especially when the contusions are located in frontal longitudinal dehiscence, bilateral undersurface of frontal lobe or diffused in bilateral lobes. These patients should undergo ICP monitoring regardless of their consciousness status. IflCP elevates over 25 mm Hg, the craniotomy is mandatory and will markedly reduce the mortality and disability of these patients.
文摘Objective:Endoscopic repair of large anterior skull base(ASB)defects has excellent results when using multilayered repairs with a nasoseptal flap.However,in extensive intranasal tumors,a nasoseptal flap may not always be available.One alternative option is a flexible single-layer ASB repair.Initial studies indicate low cerebrospinal fluid leak rates with a single-layer repair.However,the level of frontal lobe support,particularly the propensity for a significant inferior displacement of the frontal lobe,is not known.The goal of this study is to determine the frontal lobe position after single-layer acellular dermal allograft repair in large ASB defects.Study Design:Retrospective cohort study.Setting:Tertiary care medical center.Subjects and Methods:This cohort study compares the frontal lobe position in adults who underwent endoscopic endonasal ASB tumor resection and single-layer cadaveric dermal matrix repair(ASB cohort)with control subjects without intracranial abnormalities(control cohort).The ASB cohort includes subjects with an ASB defect of≥5 cm anterior/posterior and≥1.5 cm wide and who had imaging at least 2 months after surgery.The frontal lobe position is measured on sagittal CT/MRI using a reference line from the base of the sella to the nasion.A value of zero indicates that the inferior-most aspect of the frontal lobe is at the level of the nasion-sellar line.A positive value indicates that the frontal lobe is inferior to the nasion-sellar line.The ASB cohort frontal lobe position is compared with the control cohort using the Mann-WhitneyU test.A priori we set an absolute difference of 5 mm as a clinically significant difference.Results:The ASB cohort includes 47 subjects who are 57%male with an average age of 60 years(range:31-89 years).The most common ASB pathology is esthesioneuroblastoma(n=21)and 81%of the ASB cohort had postoperative radiation.The control cohort includes 20 subjects who are 60%male,with a mean age of 45 years(range:19-74 years).The majority of controls underwent imaging for head trauma(n=13).The ASB mean frontal lobe position is-0.2 mm superior to the nasion-sellar line(range:-9.2 to 10.4 mm),while the control’’s mean frontal lobe position is 1.1 mm inferior to the nasion-sellar line.This difference is not statistically significant(P=0.13)and does not reach our a priori definition of clinical significance.The frontal lobe position of ASB subjects who had radiation is closer to the nasion-sellar line as compared with those who did not undergo radiation.Conclusions:Single-layer acellular dermal graft repair maintains frontal lobe support and position in large ASB defects.
文摘Background Children with nonverbal learning disabilities (NLD) usually manifest defective attention function This study sought to investigate the neuropsychological characteristics of selective attention, such as attention control, working memory, and attention persistence of the frontal lobe in children with NLD Methods Using the auditory detection test (ADT), Wisconsin card sorting test (WCST), and C WISC, 27 children with NLD and 33 normal children in the control group were tested, and the results of C WISC subtests were analyzed with factor analysis Results Compared with the control group, the correct response rate in the auditory detection test in the NLD group was much lower ( P <0 01), and the number of incorrect responses was much higher ( P <0 01); NLD children also scored lower in WCST categories achieved (CA) and perseverative errors (PE) ( P <0 05) Factor analysis showed that perceptual organization (PO) related to visual space and freedom from distractibility (FD) relating to attention persistence in the NLD group were obviously lower than in the control group ( P <0 01) Conclusions Children with NLD have attention control disorder and working memory disorder mainly in the frontal lobe We believe that the disorder is particularly prominent in the right frontal lobe
基金supported by the Foundation of Science and Technology Bureau (No.2004JH006)Scientific Research of Shandong Province,China (No.JOTYE12)。
文摘To study the effect of special brain area regional cerebral blood flow(rCBF)abnormal perfusion on learning and memory function and its molecular mechanism,64 adult male healthy Sprague-Dawley(SD)rats were randomly divided into two groups,the false operation group(control group)and the operation group(model group).After surgical operation,the operation group undertook bilateral common carotid artery permanent ligation,while the other group did not.Learning and memory function were measured by Y-maze at 4 h,8 h,24 h and 3 d after surgical operation,respectively.The rCBF of the right frontal lobe and hippocampus was also detected by the PerifluxPF model laser Doppler flowmetry,and the expressions of c-fos or c-jun or Bcl-2 and Bax were also measured by immune histochemistry S-P method accordingly.Results showed that the rCBF of the right frontal lobe and hippocampus in the operation group was significantly lower than that in the false operation group(P,0.05).The learning indexes,error number(EN),day of reach standard and total reaction time(TRT)in the operation group,were significantly higher than that in the false operation group(P,0.05).However,the initiative evasion rate in the operation group was significantly lower than that in the false operation group.The study also found that the rCBF was relatively more,the indexes(EN,the day of reach standard and TRT)relatively fewer,but the initiative evasion rate and the memory keeping rate were relatively more.The positive expression and the average absorbency of Fos and Jun in the operation group were significantly higher than that in the false operation group(P<0.05).Furthermore,Bax and Bcl-2 positive cells were all increased over time in the operation group,and the expression ratio of Bax/Bcl-2 in the operation group was significantly higher than that in the false operation group(P<0.01).In conclusion,rCBF decrease can impair the learning and memory function in rats,which may be related to the increase of the expression ratio of c-fos or c-jun or Bcl-2 or Bax in the frontal cortex and hippocampus.
文摘Background Focal cortical dysplasia(FCD)is a common cause of drug-resistant epilepsy.Electroencephalography(EEG)biomarkers that predict good postoperative outcomes are essential for identifying patients with focal epilepsies.Case presentation We report the case of a 21-year-old female with seizure onset at the age of 9,characterized by left-hand dystonic posturing and impaired awareness,which evolved to bilateral tonic-clonic seizures,evaluated in a neurological referral center in Lima,Peru.During 6-h video-EEG,interictal EEG revealing focal brief potentially ictal rhythmic discharges(BIRDs)over the right frontal central region,lasting less than 10 s.The ictal features were characterized by low-voltage fast activity over the same area.Brain magnetic resonance imaging(MRI)demonstrated a focal lesion of focal cortical dysplasia type II in the right frontal lobe.The patient underwent a lesionectomy guided by electrocorticography,which showed continuous polyspikes.BIRDs showing a brief burst of spikes lasting longer than 0.5 s,were also identified on intraoperative electrocorticography(ECoG)and helped define the extent of resection.The patient obtained an Engel Outcome Class IA at 6 years of follow-up.Conclusions The atypical BIRDs on ECoG can be used as a prognostic biomarker for prolonged seizure-freedom outcome in patients with epilepsy.Additional reports are needed in developing countries with and without brain MRI lesions to advance outpatient presurgical evaluations despite limited resources.
