Search

The finding that patients with neglect make larger errors when bisecting longer lines could be due to failure to disengage attention from a segment of the line on the ipsilesional side, or to a reduced ability to direct attention and/or action contralaterally. The findings are reported from a patient with left-sided neglect who set the midpoint further away from the right end of lines as their length increased, a finding consistent with the latter interpretation. His errors were significantly related to length and lateral extent of lines presented in left hemispace, but only to length of lines presented in right hemispace.

Previous clinical observations on patients with hemispatial neglect from unilateral hemispheric lesions suggest the brain's attentional mechanisms are organized along the horizontal dimensions of extrapersonal space. We now report a patient with Balint's syndrome caused by bilateral parieto-occipital infarctions, who demonstrated altitudinal neglect. On visual and tactile bisection of vertical rods, the patient consistently placed her mark well above the true midpoint, and this performance remained unchanged when the stimuli were simultaneously explored visually and tactually. She also showed altitudinal inattention in the visual modality by extinguishing the stimulus presented in the lower quadrants during double simultaneous stimulation across the horizontal meridian. These findings suggest that bilateral damage to the parietal lobes can lead to multimodal attentional and exploratory deficits along the vertical dimensions of extrapersonal space.

A patient with a well-circumscribed neoplasm, which destroyed the posterior fornix bilaterally, developed a profound disturbance of recent memory. Unlike previously reported patients who had undergone anterior fornix sections and whose memories were not severely disturbed, this patient's posteriorly located lesion may have cut off hippocampal input into the mamillary bodies and the dorsomesial nucleus, thereby producing a severe amnestic state.

Eight patients with acquired agraphia were studied using the same writing tests and were compared with normal and brain-damaged controls. Four patients fulfilled the criteria for lexical agraphia and on CT scan had lesions of the posterior angular gyrus that spared the supramarginal gyrus. The other 4 fulfilled the criteria for phonological agraphia. They had lesions on CT scan that were similar to those found in previously described patients with phonological agraphia. Their lesions involved the supramarginal gyrus or insula deep to it and spared the angular gyrus. These studies support the hypothesis that there are two dissociable spelling systems and that these spelling systems are disrupted by focal lesions in separate but distinct brain regions. Further studies investigated the relationships between phonological agraphia and phonological dyslexia (alexia), and lexical agraphia and surface dyslexia (lexical alexia). The data support the hypothesis that individual systems subserve the four processes of phonological spelling, phonological reading, lexical spelling and lexical reading.

Two major hypotheses have been advanced to account for stimulus-response compatibility effects in the situation in which the location of the target is irrelevant for choosing the correct response. According to the attentional hypothesis, compatibility effects reflect a response bias, favoring the effector on the same side as the stimulus. According to the coding hypothesis, compatibility effects result from a correspondence between the spatial codes of the stimulus and effector. In the present study, two components of attention--selective attention and intention--were independently manipulated by providing selective preparatory information before onset of a target stimulus. Attentional information indicated where the target stimulus would occur; intentional information indicated which hand would have to be used to respond. Compatibility effects were observed only in the condition in which intentional information, but no attentional information, was provided. These findings support the attentional hypothesis and indicate that a specific aspect of attention, namely a selective readiness to respond to the stimulus, is a necessary condition for compatibility effects to occur.

In the past two to three decades, clinicians and neuroscientists have been studying the functions of the right hemisphere. Neither hemisphere seems to be dominant in the absolute sense. Each appears to be specialized and is dominant for different functions. However, most functions require the cooperation of both hemispheres. When one is damaged, the other can often compensate for the damaged one. Lesions of the left hemisphere are associated with language (speech, reading, and writing) and praxic disorders, and lesions of the right hemisphere can result in visuospatial, attentional, and emotional disorders. The authors review some of the major behavior disorders associated with right hemisphere dysfunction and concentrate on three major types of disorders--visuospatial, attentional, and emotional. Although not all the behavioral defects associated with right hemisphere damage can be subgrouped under these three types, they are the ones most often associated with right hemisphere lesions.

A 39-year-old man developed retrograde and anterograde amnesia following haemorrhage from an arteriovenous malformation situated near the splenium of the corpus callosum. MRI studies demonstrated damage to the splenium, and to a region containing the retrosplenial cortex and the cingulate bundle. The fornix was anterior and inferior to the site of maximal damage, but may have been involved; the stria terminalis was probably spared. Structures known to be important in memory but spared by the lesion included the hippocampus, thalamus, and basal forebrain. The retrosplenial cortex receives input from the subiculum and projects to the anterior thalamus, thus providing an alternative route between hippocampus and thalamus. Perhaps more importantly, medial temporal structures involved in memory receive anterior thalamic input directly via the cingulate bundle and indirectly through a relay in the retrosplenial cortex. We suggest that this thalamocortical portion of Papez' circuit may be important in memory, and that lesions of the cingulum and retrosplenial cortex may cause amnesia by disrupting this pathway.

In a prior study it was shown that apraxic patients with posterior infarctions that included the parietal lobe could not discriminate between gestures. In this study these observations were replicated using a nonverbal paradigm in which the subjects did not have to discriminate between gestures, but instead had to comprehend their meaning. Pantomimed acts on videotape were shown to six apraxic-aphasic patients, seven nonapraxic-aphasic patients, and six normal subjects. Four drawings were also shown, one of which matched the pantomime (for example, if the pantomime was of hammering, one drawing was of a nail and three were foils). Subjects responded by pushing a button corresponding to the desired picture. The apraxics made more errors than the aphasics or controls.

One aspect of Broca's aphasia, induced by anterior perisylvian lesions, is an inability to read closed-class words (eg, articles, prepositions) with a preserved ability to read open-class words (eg, nouns, verbs). We examined a man with profound Wernicke's aphasia induced by an infarct of the posterior portion of the superior temporal gyrus (Wernicke's area). He could not read substantive words or pronounceable nonwords but could read closed-class words. These observations suggest that the reading of closed- and open-class words is mediated by separable systems. Whereas the anterior perisylvian region appears to be important in reading functional words, the posterior perisylvian region is important in reading substantive words.

We tested the hypothesis that the right hemisphere is dominant for motor activation of "intention." If the right hemisphere is dominant for intention and if intention is a prerequisite for movement, motor impairment should be worse after an infarct in the right hemisphere than in the left. We asked nine subjects with right and nine with left hemisphere infarcts to elevate each shoulder independently. Subjects with right hemisphere lesions had more trouble moving the contralateral shoulder. The data are consistent with the hypothesis that the right hemisphere is dominant for motor activation or intention.

Lesions of ascending dopaminergic pathways induce neglect in animals. Apomorphine, a dopamine receptor agonist, decreases the magnitude of neglect in rats with cortical lesions. We treated two patients with 15 mg of bromocriptine daily for 3 to 4 weeks, one with chronic (longer than 6 months) and one with relatively more acute disabling neglect. Tests for neglect that significantly improved on therapy and worsened after its withdrawal included line, letter, and geometric figure cancellation tasks. Neither patient noted any untoward effects. Based on this open trial of dopamine agonist therapy in humans with neglect, larger controlled studies may be warranted.

Liepmann postulated that the left hemisphere of right-handed persons contains the "movement formulas" that control purposeful skilled movements of the limbs on both sides of the body. Accordingly, in right-handers apraxia should follow damage to the left hemisphere, whereas right hemisphere damage should not lead to apraxia. Although this is generally true, we recently examined a right-handed man who after a right hemispheric stroke became aphasic and apraxic with his nonparalyzed right hand. Our observations suggest that the right hemisphere of this right-handed man made a critical contribution to the planning and execution of skilled movements. This case provides evidence that right-handers should not be considered a homogeneous group in terms of cerebral motor dominance and that contrary to Liepmann's postulate, hemispheric dominance for the control of skilled movements does not entirely determine handedness.

P3 potentials evoked by spoken words were recorded from seven patients with disorders of recent memory and seven age-matched controls. Inclusion criteria included a clearly identifiable P3 to pure tone stimuli. Absence or marked decrement of P3 to word stimuli was seen in the patients even though they could perform the word task. The results are consistent with an encoding disorder and failure in elaboration of information processing.

Recurrent episodes of speech arrest were observed in a man as the primary manifestation of a partial seizure disorder. To determine whether speech arrest was associated with a language disorder, the Syntactic Comprehension test was administered during and after speech arrest. This test does not depend upon speech production, but evaluates ability to comprehend sentences in which meaning depends on syntactic relationships. Using this test, we were able to show that speech arrest was associated with a language disturbance.

Pure apraxic agraphia is a condition in which motor writing is impaired but limb praxis and nonmotor writing (typing, anagram letters) are preserved. This condition is believed to result from disruption of a parietal lobe graphemic area which generates grapheme representations used to program motor-writing patterns. We report a single case of pure apraxic agraphia in which defective letter imagery was evident. Results of writing and imagery evaluations suggest that the graphemic area may be responsible for generating letter images. In this respect, clinical evaluation of letter imagery abilities in cases of apraxic agraphia may be useful in identifying subtypes of the disorder resulting in a better understanding of the neuropsychological process involved in writing.

This study tests the hypothesis that children with attention deficit disorder (ADD) resemble adults with inattention and neglect secondary to right hemisphere dysfunction. A letter cancellation task was administered to seven boys with ADD and five controls. As a group, the subjects with ADD made significantly more overall errors of omission and left-sided errors than controls, suggesting that they resemble adults with right hemisphere dysfunction.

It has been proposed that the comprehension of written language requires transcoding from the visual (grapheme) to the auditory (phoneme). It has also been proposed that visual word images can be comprehended without grapheme-phoneme transcoding. We describe three aphasic patients with left hemisphere impairment who had poor speech comprehension but could comprehend written language. One of these patients had a subsequent right hemisphere lesion and lost his ability to read. We propose that the right hemisphere in some individuals may be capable of extracting semantic information from iconic images (ideogram) without phonological processing.

Neglect is a disorder in which the response to stimulation is diminished or absent on the side of the body contralateral to the lesion in the absence of an elemental sensory or motor defect. Most cases of neglect in humans are induced by cortical damage, but there have been no investigations of the pharmacologic basis of neglect induced by cortical damage. We examined the role of the dopamine system in polymodal neglect caused by a unilateral lesion of the medial precentral prefrontal cortex of the rat. A dose-response examination of the effect of apomorphine on neglect revealed that apomorphine, at 0.5 mg/kg, the highest dose examined, significantly improved the orientation scores of subjects in all modalities tested and significantly decreased the total number of allesthetic responses. The therapeutic effect of apomorphine was mediated by dopamine receptors as the therapeutic effect of apomorphine was blocked by prior administration of spiroperidol. These results demonstrate the important role of disruption of dopamine mechanisms in neglect induced by a lesion of medial precentral cortex.

Six patients with left side unilateral neglect from lesions of the right cerebral hemisphere were tested with verbal and visuospatial crossing-out tasks. The symptoms of neglect were less severe with the visuospatial than with verbal tasks. We hypothesize that changes in the symptoms of neglect were produced because the tasks altered hemispheric arousal.

To determine whether normal left-handers were more adept than were normal right-handers at mirror writing, we tested right-handers and left-handers for their ability to mirror write. Independent of hand used, left-handers wrote mirror words (but not normal words) faster than did right-handers, which suggest that left-handers may be better able to reverse directions (left leads to right to right leads to left). Although when using their preferred hand, left-handers made fewer errors than did right-handers (using their preferred hand), the left hand both in right- and in left-handers was superior to the right hand. That the left hand was superior to the right is compatible with the hypothesis either that the right hemisphere contains mirror engrams or that movements away from the body are more accurate than movements toward the body or both.

Animal experiments suggest that neurochemical and anatomic asymmetries exist within the basal ganglia, particularly the globus pallidus, and that these asymmetries correlate with both preferred direction of rotation and limb preference in lever pressing. Human neurotransmitter studies have also revealed a significant asymmetry within the globus pallidus, the left containing greater amounts of dopamine and choline acetyltransferase than the right. Recent anatomic studies of human subcortical regions, limited to the striatum, have failed to show a size asymmetry. We examined 18 normal brains in subjects ranging in age from 26 weeks gestation to 86 years for volumetric asymmetry of the globus pallidus. We found a significant asymmetry, the left side measuring larger in 16 of 18 brains. Considering the role of the basal ganglia in motor control, this data may reflect a structural basis of either axial or limb motor dominance in humans.

Two spelling systems have been described. The phonological system transcodes speech sounds to letters and is thought to be useful for spelling regular words and pronounceable nonwords. Although the second system, the lexical-semantic system, is thought to use visual word images and meaning to spell irregular words, it is not known if this system is dependent on semantic knowledge. We used a homophone spelling test to examine the lexical-semantic system in five patients. The patients were asked to spell individual homophones (doe or dough) using the context of a sentence. Semantically incorrect and correct homophones were spelled equally well, whether they were regular or irregular. These results demonstrate that an irregular word may be spelled without knowledge of the word's meaning. Therefore, the lexical system can be dissociated from semantic influence.

Two patients with chronic unilateral medial frontal lobe lesions, including the supplementary motor area, were given tasks of response preparation and response inhibition. Whereas the patient with a left-sided lesion, like normal controls, did benefit from preparatory information regarding a subsequent response, the patient with a right-sided lesion did not. On a task requiring the inhibition of an inappropriate response, the patient with a left-sided lesion again performed normally. Conversely, the patient with a right-sided lesion had significant problems inhibiting the extremity contralateral to the lesion. We postulate that the medial frontal lobe may participate in response preparation and response inhibition by modulating the levels of excitability of the motor systems. Our findings also suggest that the right hemisphere may have a dominant role in mediating these processes.

Destruction or disconnection of specific neuronal structures or failure to activate those structures may impair brain function. Because the right hemisphere seems dominant for mediating arousal, which is an important determinant of the capacity for cerebral activation, we predicted that subjects with right hemisphere damage would have a greater reduction in the capacity for cerebral activation than subjects with left hemisphere damage. A paradigm requiring that two simple tasks be performed singly and simultaneously was used to assess the capacity for activation. Subjects with right hemisphere damage had significantly greater impairment in the capacity for cerebral activation than subjects with left hemisphere damage. This impairment may partly explain the associations between right hemisphere damage and decreased ability to perform certain analytic and linguistic tasks.

To learn whether animals with parietotemporal lesions have sensory inattention or defective intention, we trained monkeys to respond with the contralateral limb to a threshold tactile stimulus. After parietotemporal lesions that induced neglect, the monkeys continued to respond normally to threshold stimuli on the side opposite the lesion (the neglected side), but made errors when stimulated on the normal side (ipsilateral to the lesion), often failing to use the contralateral extremity. On this learned task, there was no abnormality of sensory input or sensory attention. The problem was attributed to an impaired preparation to respond (intention).

A prospective study has been done on the relationship between closed head trauma and aphasia. The most frequent type of aphasia seen after closed head injury is an anomic aphasia. This aphasia is often associated with other defects of higher cortical function. The second most common type of aphasia is a Wernicke's aphasia. Other types of aphasia were not seen in this study. The areas of the head which when injured produce aphasia are the right orbitofrontal region and the left temporoparietal region. The prognosis for recovery appeared highly variable.