Cerebral vascular disease and behavior. I. The syndrome of the mesencephalic artery (basilar artery bifurcation).
TL;DR: There are two different conditions to which the term akinetic mutism or vigilant coma are properly applied, in which the patient lies in bed, immobile yet seemingly alert, ready to be aroused, and to follow with his gaze whatever events happen in the visual fields.
Abstract: THERE are two different conditions to which the term akinetic mutism or vigilant coma are properly applied. In one form of akinetic mutism the patient lies in bed, immobile yet seemingly alert, ready to be aroused, and to follow with his gaze whatever events happen in the visual fields; there is no evidence of oculomotor paralysis. This state of inertia can be interrupted in such patients by brief bouts of excitement, restlessness, and motor agitation. If stimulated enough, they may react with a word or two. This is a state best described as "hyperpathic" akinetic mutism or, if the term "coma" is to be used, this is a state of "vigilant" coma. In the other form, the patient is apathetic and somnolent most of the time. When he opens his eyes, he may keep them open if stimulation is sustained by calling the patient by name, pinching him, etc,
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TL;DR: A network approach to the localization of complex functions offers an alternative to more extreme approaches, some of which stress an exclusive concentration of function within individual centers in the brain and others which advocate a more uniform (equipotential or holistic) distribution.
Abstract: Unilateral neglect reflects a disturbance in the spatial distribution of directed attention. A review of unilateral neglect syndromes in monkeys and humans suggests that four cerebral regions provide an integrated network for the modulation of directed attention within extrapersonal space. Each component region has a unique functional role that reflects its profile of anatomical connectivity, and each gives rise to a different clinical type of unilateral neglect when damaged. A posterior parietal component provides an internal sensory map and perhaps also a mechanism for modifying the extent of synaptic space devoted to specific portions of the external world; a limbic component in the cingulate gyrus regulates the spatial distribution of motivational valence; a frontal component coordinates the motor programs for exploration, scanning, reaching, and fixating; and a reticular component provides the underlying level of arousal and vigilance. This hypothetical network requires at least three complementary and interacting representations of extrapersonal space: a sensory representation in posterior parietal cortex, a schema for distributing exploratory movements in frontal cortex, and a motivational map in the cingulate cortex. Lesions in only one component of this network yield partial unilateral neglect syndromes, while those that encompass all the components result in profound deficits that transcend the mass effect of the larger lesion. This network approach to the localization of complex functions offers an alternative to more extreme approaches, some of which stress an exclusive concentration of function within individual centers in the brain and others which advocate a more uniform (equipotential or holistic) distribution. In human beings, unilateral neglect syndromes are more frequent and severe after lesions in the right hemisphere. Also, right hemisphere mechanisms appear more effective in the execution of attentional tasks. Furthermore, the attentional functions of the right hemisphere span both hemispaces, while the left hemisphere seems to contain the neural apparatus mostly for contralateral attention. This evidence indicates that the right hemisphere of dextrals has a functional specialization for the distribution of directed attention within extrapersonal space.
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TL;DR: It is proposed as a tentative hypothesis that there may be common pathophysiological mechanisms underlying the subcortical dementias—in particular, disturbances of timing and activation.
Abstract: Progressive supranuclear palsy (Steele et al.) has a characteristic pattern of dementia: (1) forgetfulness, (2) slowing of thought processes, (3) emotional or personality changes (apathy or depression with occasional outbursts of irritability), and (4) impaired ability to manipulate acquired knowledge. In many neurological disease states associated with subcortical pathology a similar pattern of dementia exists. The neurobehavioural changes of progressive supranuclear palsy thus typify a clinical pattern which may be referred to as subcortical dementia. The subcortical dementias have a striking clinical resemblance to the dementia which occurs after bifrontal lobe disease. However, the subcortical dementias can be clearly distinguished clinically from cortical dementias, other than frontal dementias. We propose as a tentative hypothesis that there may be common pathophysiological mechanisms underlying the subcortical dementias—in particular, disturbances of timing and activation. There are immediate practical implications of this hypothesis: drugs which have an effect on subcortical timing and activating mechanisms may be useful in the treatment of subcortical dementias.
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Cites background from "Cerebral vascular disease and behav..."
...This syndrome, as has been shown by Segarra (1970), may occasionally result from a small, midline, butterfly-shaped lesion at the thalamomesencephalic junction....
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TL;DR: These vascular syndromes reflect the reciprocal cerebral cortical-thalamic connections that have been interrupted and provide insights into the functional properties of the thalamus.
Abstract: Background— This article reviews the anatomy, connections, and functions of the thalamic nuclei, their vascular supply, and the clinical syndromes that result from thalamic infarction. Summary of R...
674 citations
TL;DR: The delineation into four arterial thalamic territories (inferolateral, tuberothalamic, posterior choroidal, paramedian) corresponded clinically to four different syndromes and the most common etiologies were lacunar infarction, large artery atherosclerosis with presumed artery-to-artery embolism, cardioembolisms, and migrainous stroke.
Abstract: We studied forty patients with CT-proven thalamic infarcts without involvement of the superficial territory of the posterior cerebral artery. The delineation into four arterial thalamic territories (inferolateral, tuberothalamic, posterior choroidal, paramedian) corresponded clinically to four different syndromes. The most common etiologies were lacunar infarction, large artery atherosclerosis with presumed artery-to-artery embolism, cardioembolism, and migrainous stroke. We found no risk factor other than age or oral contraceptive use in six patients. One patient died in the acute phase. During follow-up (45.6 months), the stroke or death rate was 7.4% per year. Delayed pain developed in three patients and abnormal movements in three. Late disability was mainly secondary to persisting neuropsychological dysfunction (thalamic dementia).
551 citations
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Book•
01 Jan 1972
TL;DR: The third edition retains its approach to that art of diagnosis based on the understanding of pathophysiology and pathobiochemistry, but the authors have included new references and illustrations.
Abstract: Advances in the knowledge and understanding of stupor and coma, aided by the considerable impact of CT scanning on neurological diagnosis, are reflected in this substantially revised edition. The authors have included new references and illustrations, but the third edition retains its approach to that art of diagnosis based on the understanding of pathophysiology and pathobiochemistry.
1,088 citations
317 citations
TL;DR: The present study emphasizes the similarities of the case recently reported by Nielsen and Jacobs’ in which there was found at necropsy a destructive lesion involving the anterior cingulate gyri and the underlying corpus callosum.
Abstract: A 40 year old man had been ill for three days prior to his hospital admission. When examined, he was mute, akinetic, indifferent to painful stimuli, and incontinent of urine. His eyes were open; deep tendon reflexes were intact; bilateral Babinski signs were present; muscle tone was normal; he was unable to swallow foods and liquids fed to him; his pupils were of normal size and pupillary reactions to light, both direct and consensual, were normal. Thus by clinical standards, he was unresponsive to external stimuli, yet not in coma. A t necropsy bilateral lesions were found in the anterior cingulate gyri. This patient resembled in many ways the case recently reported by Nielsen and Jacobs’ in which there was found at necropsy a destructive lesion involving the anterior cingulate gyri and the underlying corpus callosum. In a subsequent paper Nielsen’ analyzed the symptomatology referable to bilateral lesions of the anterior cingulate gyri. He also drew attention to the clinical differences between cases in which lesions involved only the corpus callosum and of those in which both the corpus callosum and projection fibers from both cingulate gyri were involved. The present study emphasizes the similarities of these cases.
155 citations
Book•
01 Jan 1966
TL;DR: The authors find that the distribution of the arteries in the newborn is comparable to the adult, the most common change being the relative dependence on the mesencephalic artery by the posterior cerebral artery as a major source of blood for the posterior portion of the cerebral hemisphere.
Abstract: System By Harry A Kaplan and Donald H Ford Price, not given Pp 230 Elsevier Publishing Co, Jan Van Galenstraat 335, Amsterdam, 1966 The purpose of this monograph is to make the material discussed "of use to as many individuals concerned with the problems of the CNS as possible" To this end the authors discuss the embryology of the brain vasculature ; the normal blood supply of the brain, as well as its variations ; the meninges and spinal fluid; and the blood-brain barrier The descriptions are richly supported by numerous illustrations of injections and dissections of the blood vessels in the human brain and by many useful diagrams The description of each blood vessel ends with a helpful diagram of its constituent vessels The nomenclature is that of the Nomina Anatomica After a detailed description of the embryology of the cerebral vessels, the authors find that the distribution of the arteries in the newborn is comparable to the adult, the most common change being the relative dependence on the mesencephalic artery by the posterior cerebral artery as a major source of blood for the posterior portion of the cerebral hemisphere Similarly, in the case of the veins, the pattern in the adult closely resembles that seen at birth The embryological section is purely descriptive, and such correlations as are possible with the adult vascular pattern are pointed out in the description of individual blood vessels Attention is called to the fact that, while the adult posterior cerebral artery is derived from vessels arising from the internal carotid artery, it receives blood from the vertebral-basilar system as well
148 citations