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We report a patient with a cavernous malformation involving the right lentiform nucleus. Pre-surgical planning included fMRI localization of language, motor, and sensory processing, and DTI of white matter tracts. fMRI results revealed no activation near the planned resection zone. However, post-surgery the patient developed a subdural fluid collection, which applied pressure to the primary motor cortex (M1). Follow-up scans revealed that motor activation had shifted due to pressure, and then shifted to a new location after the fluid collection subsided. This case report suggests that long-term neural reorganization can occur in response to short term compression in the cortex.

Virtual reality therapy (VRT) uses multimodal stimulation that includes visual, auditory, olfactory, and gustatory stimuli. The aim of this study was to assess the effectiveness of VRT in treating subjects with alcohol dependence (AD) by evaluating changes in brain metabolism.The VRT protocol consisted of three steps: relaxation, presentation of a high-risk situation, and presentation of an aversive situation. Twelve alcohol-dependent subjects underwent 10 sessions of VRT. The alcohol-dependent subjects were assessed with 18F-fluorodeoxyglucose positron emission tomography images before and after VRT, whereas the control group underwent imaging according to the same protocol only at baseline.Compared with the healthy control group, AD subjects showed higher metabolism in the right lentiform nucleus and right temporal lobe (BA20) at baseline (P(FDR.05) = .026). In addition, the metabolism in the left anterior cingulate was lower in subjects with AD (P(uncorr) = .001). After VRT, alcohol-dependent subjects showed decreased brain metabolism in the right lentiform nucleus (P(FDR.05) = .026) and right temporal lobe (BA38, P(FDR.05) = .032) relative to that at baseline.Our results suggest a neurobiological imbalance, notably, a high sensitivity to stimuli, in the limbic system in subjects with AD. Furthermore, we determined that metabolism decreased in the basal ganglia after VRT, which may explain the limbic-regulated responses of reward and regulation. Therefore, we tentatively recommend VRT to treat AD through its regulating effect on limbic circuits.

We report a 12-year-old lightning victim with right subcortical parenchymal and right lentiform nucleus haemorrhages documented by computed tomography (CT) and magnetic resonance imaging (MRI). A linear entry burn with an area of singed hair on the scalp was obvious. Neurological examination did not show any lateralized deficit. Cranial nerves were intact. A laceration on the right external auditory canal, elevated cardiac enzymes and electrocardiographic changes were also recorded. The boy was discharged on the sixth day. Prolonged loss of consciousness in lightning victims may suggest intracranial injury. Although brain CT can demonstrate intracranial haemorrhages, MRI is mandatory to show subcortical parenchymal haemorrhage in lightning victims.