Relation between intracarotid amobarbital memory asymmetry scores and hippocampal sclerosis in patients undergoing anterior temporal lobe resections

The intracarotid amobarbital procedure (IAP) is used to evaluate memory function preoperatively in candidates for anterior temporal lobe resections (ATL). We examined IAP memory asymmetry scores in 30 patients undergoing ATL (17 R, 13 L), as a function of the presence (HS+) or absence (HS-) of hippocampal sclerosis. Ictal onset zones were determined by extraoperative recording with subdural strip electrodes in all but 3 patients in whom magnetic resonance imaging (MRI) scan showed HS. MRI scans were otherwise normal. All patients were left hemisphere dominant for language except 1, in whom language was represented bilaterally. IAP memory testing involved presentation of eight subjects during anesthesia of each hemisphere, followed by recognition testing after patients recovered from amobarbital effects. A score of 1 was given for each correctly recognized object, and 0.5 was deducted for each false-positive identification. There were 16 foils. A total asymmetry score was calculated, which was positive if there was agreement between the direction of the symmetry and side of operation and negative if reversed. The mean asymmetry score for HS- (n = 8) was 0.9; that for HS+ (n = 22) was 4.1 (p < 0.01). IAP memory performance provided lateralizing information (asymmetry score > or = + or -2) in 73% of cases; among these, the lateralization was correct in 91%. Our data indicate that IAP memory asymmetry predicts both laterality of ictal onset and the presence of HS.     

Long-term effects of selective neonatal temporal lobe lesions on learning and memory in monkeys.

Rhesus monkeys with neonatal damage to either the medial temporal lobe or the inferior temporal cortical area TE, and their normal controls, were reassessed in visual habit formation (24-hour intertrial interval task) and visual recognition (delayed nonmatching to sample [DNMS]) at 4–5 years of age and then tested on tactile and spatial DNMS. Results on the two visual tasks were the same as those obtained when the monkeys were under 1 year of age. Specifically, early medial temporal lesions, like late lesions, left habit formation intact but severely impaired recognition memory. Furthermore, the memory deficit extended to the tactile and spatial modalities. By contrast, early damage to TE, unlike late damage to it, yielded only mild deficits on both visual tasks and had no effect on tactile or spatial DNMS. Compensatory mechanisms that promote substantial and permanent recovery thus appear to be available after neonatal TE lesions but not after neonatal medial temporal lesions. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Subjective memory evaluations in patients with focal frontal, diencephalic, and temporal lobe lesion

This paper examines subjective memory evaluations and their correlates in patients with focal frontal, diencephalic, or temporal lobe lesions. Although all patient groups showed significantly lower subjective memory evaluations than healthy subjects, the temporal lobe group rated themselves significantly lower than the frontal lobe or diencephalic groups despite comparable severity of amnesia, implying more severely impaired 'insight' in the latter two groups. There was a 'temporal gradient' such that patients rated their memory for 'old' (premorbid) items better than their memory for 'new' (recent) or prospective items. As in previous studies, subjective memory evaluations were not correlated with measures of 'objective' anterograde memory performance, but the present study suggests that subjective evaluations are not randomly determined. It seemed to be the site of lesion (frontal and/or diencephalic), rather than underlying aetiology, which produced a particularly severe loss of 'insight'. Whether the earliest remote or autobiographical memories were preserved or not appeared to be an important correlate of current subjective memory evaluations, and patients who had been memory-disordered for longer were more likely to evaluate their memory as poor than those with a more recent onset.     

Temporal and spatial context memory in patients with focal frontal, temporal lobe, and diencephalic lesions

Patients with focal frontal, temporal lobe, or diencephalic lesions were investigated on measures of temporal (recency) and spatial (position) context memory, after manipulating exposure times to match recognition memory for targets (pictorial stimuli) as closely as possible. Patients with diencephalic lesions from an alcoholic Korsakoff syndrome showed significant impairment on the temporal context (recency) task, as did patients with frontal lesions penetrating the dorsolateral frontal cortex, according to MRI (and PET) evidence. Patients with temporal lobe lesions showed only a moderate (non-significant) impairment on this task, and patients with medial frontal lesions, or large frontal lesions not penetrating the dorsolateral cortical margins, performed as well as healthy controls at this task. On the spatial context memory task, patients with lesions in the temporal lobes showed significant impairment, and patients with right temporal lesions performed significantly worse than patients with left temporal lesions. Patients with diencephalic lesions showed only a modest (non-significant) impairment on this task, and the frontal lobe group performed normally. When a group of patients with temporal lobe lesions resulting from herpes encephalitis were examined separately, an identical pattern of results was obtained, the herpes group being significantly impaired on spatial memory and showing a trend towards impairment for temporal context memory. There were strong correlations between anterograde memory quotients and context memory performance (despite the use of an exposure time titration procedure) and a weak association in the frontal group with one frontal/executive task [corrected] (card-sorting perservations). It is predicted that correlations between temporal context memory and frontal/executive tasks will be greater in samples of patients all of whom have frontal lesions invading the dorsolateral cortical margin.     

Relationships between normal aging, frontal lobe function, and memory for temporal and spatial information.

Young and old participants were evaluated on tests of frontal lobe function, recognition memory, and memory for temporal and spatial information. Older participants showed significant impairments on memory for temporal order, and this impairment was found to correlate with deficits on frontal lobe tests measuring spontaneous flexibility but not reactive flexibility. However, spatial memory showed no evidence of an age effect. An interpretation of this latter finding based on the differential availability of contextual cues is ruled out because similar results were obtained when spatial memory was assessed in a different context to that used during learning. The researchers concluded that memory for temporal order and spatial memory are affected differentially by age. Theoretical interpretations of this difference are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A test of spatial memory and its clinical utility in the pre-surgical investigation of temporal lobe epilepsy patients

Deficits in memory for figurative detail, spatial composition and the spatial location of objects in a scene have been reported postoperatively in right temporal lobectomy patients. The aim of this study was to examine whether these deficits can be used as a sign of lateralised dysfunction in pre-surgical temporal lobe epilepsy (TLE) patients. Sixty-nine patients with lateralised TLE (27 right, 42 left) were assessed on a battery of neuropsychological tests, including tests of general intellectual functioning and psychomotor speed and standardised memory tests involving the learning and recall of verbal and non-verbal material. A new task, the "Aspects of Spatial Memory Test" (AoSMT), based on the experimental tasks developed by Pigott and Milner [39] was also administered. The RTLE and LTLE groups did not differ in their overall level of intellectual function or on measures of cognitive and motor speed. On the AoSMT the LTLE group recognised significantly more figurative detail changes than the RTLE group. In addition, the RTLE group took significantly longer than the LTLE group to identify changes in orientation, figurative detail and filled/unfilled spaces. Poor scores on the AoSMT were significantly correlated with quantitative MRI measures of right hippocampal pathology. The clinical and theoretical implications of these findings are discussed.     

Material-specific memory in temporal lobe epilepsy: Effects of seizure laterality and language dominance.

This study investigated the effects of seizure laterality and language dominance on material-specific memory in temporal lobe epilepsy (TLE). Left TLE (LTLE) patients with left-hemisphere language dominance (LHLD) showed significantly higher nonverbal than verbal memory capacity, whereas right TLE patients with LHLD showed significantly better verbal than nonverbal memory capacity. LTLE patients with non-left-hemisphere language dominance (NLHLD) showed significantly better verbal memory capacity compared with LTLE patients with LHLD. Thus, selective verbal or nonverbal memory deficits that are dependent on side of seizure onset were apparent in patients with LHLD but not in patients with NLHLD. Relative sparing of verbal memory capacity in LTLE patients with NLHLD may reflect interhemispheric reorganization of verbal memory function. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Differential neuronal encoding of novelty, familiarity and recency in regions of the anterior temporal lobe

Activity of 2072 neurones was recorded in the anterior temporal lobe--in area TE, perirhinal cortex, entorhinal cortex and hippocampus--during performance of a visual recognition task by monkeys. In area TE, perirhinal cortex and entorhinal cortex, 454 neurones (38% of the 1162 visually responsive neurones) responded differentially on the basis of the relative familiarity or recency of presentation of the stimuli; in the hippocampus only one (3%) of its 40 visually responsive neurones) did so. The differentially responsive neurones were classified into those signalling information concerning the recency (19%), familiarity (37%) or novelty (38%) of stimuli. For 98% of these neurones a decreased response signalled that stimuli had occurred previously: no large response increments were observed. The mean differential latency of each of these types of neurone was shorter (approximately 75 ms) in area TE than in the other areas. Examples of each of these types of neurone with memory spans of approximately 24 h were found in each region. The mean memory span of recency neurones was significantly longer in perirhinal cortex than area TE. For familiarity neurones a significant mean response decrement took 4-8 min to develop, indicating a slow underlying plastic change, in contrast to the rapid change seen for recency and novelty neurones. The implications of these results are discussed in relation to the neuronal basis of recognition memory.     

MMPI in differentiation of temporal lobe and nontemporal lobe epilepsy: Investigation of three levels of test performance.

Using carefully matched samples, a variety of MMPI techniques were explored in an attempt to document the clinically accepted personality differences between temporal lobe (n?=?37) and nontemporal lobe (n?=?28) epileptics. Analysis of the traditional clinical scales, as well as additional procedures employed in an attempt to improve test sensitivity (content scales, code type, category frequencies, and item analyses), did not support the position that temporal lobe epileptics are more likely to manifest personality disturbance than are other epileptics. (10 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The effect of posterior lobe extract, adrenalin, and pilocarpine on the response of the thyroid gland to the thyreoactivator hormone of the anterior lobe of the hypophysis

The studies reported here were directed toward ascertaining in a variety of organisms whether or not any of the three lobes of the pituitary gland affected thyroid activity. We documented a thyroid stimulating action of the anterior lobe of the pituitary gland extract that was not shared in by either the intermediate or posterior lobes. Pilocarpine first depressed the stimulating action of the pituitary extract but, after the fifth injection, it accentuated the response of the thyroid gland to the pituitary extract.     

Neurological findings in the normal elderly: prevalence and relationships with memory performance

Portal hypertension is a result of chronic liver disease in the majority of cases. Rare, potentially curable causes of portal hypertension include vascular conditions such as hepatic or portal venous thrombosis and arterio-portal fistulas. We present the rare case of a spontaneous splenic arterio-venous fistula in a 40 year old multiparous woman. The young woman presented with massive diarrhea, ascites, abdominal pain, and an abdominal machinery type bruit and represents the second ever reported case with diarrhea as presenting symptom of splenic arterio-venous fistula. The diagnosis was confirmed by color Doppler ultrasound. Transfemoral aortography was performed to assess the possibility of catheter embolization. Surgical intervention was initially complicated by collateral arterial tributaries of the fistula and finally resulted in a dramatic recovery with persistent resolution of all symptoms. This case report demonstrates a curable form of portal hypertension that must be considered in acute onset portal hypertension in multiparous women and in the absence of liver disease. A machinery type bruit in the upper left abdominal quadrant represents an important and simple diagnostic symptom found by auscultation. Color Doppler ultrasound represents a non invasive, universally applicable and fast method of establishing the diagnosis. The literature and management of splenic arterio-venous fistulas are reviewed.     

Right hippocampal contribution to visual memory: a presurgical and postsurgical study in patients with temporal lobe epilepsy

Crowding of Culex sitiens Wiedemann larvae was investigated to determine whether pupation was delayed by the presence of chemical factors in the water or by mechanical interference. As the larval density increased from 0.05 to 1.0 larvae per milliliter of water, the duration of larval development increased from 7.5 to 23.0 d and larvae mortality increased from 1.7 to 99.6%. At high larval densities (2 larvae per milliliter), the larvae did not pupate, but remained alive as 4th instars for at least 50 d, even after their abundance subsequently declined due to mortality. When not crowded, 80% of the larvae fed at the surface; the remainder fed mainly on the bottom (even at a depth of 35 cm). Removal of chemical retardants by changing the water daily increased pupation to 65% (compared with 4% in controls, in which the water was not changed), but this was less than the effect of reducing mechanical interference by increasing the surface area, which increased pupation to 98%. Therefore, the main density-dependent factor was mechanical interference during feeding, but prolonged development to 19 d showed that chemical retardants also were important. The chemical retardant was not stable, so that 2nd generation larvae reared in the same water were unaffected, but its effect was irreversible, because most crowded larvae moved to clean water and a lower density did not pupate.     

Components of Type A, hostility, and anger-in: Further relationships to angiographic findings.

In a previous study of 131 patients undergoing angiography, the 2nd author et al (in press) reported that of all components of the Type A (coronary prone) behavior pattern (TABP), only potential for hostility and anger-in were significantly associated with extent of coronary artery disease (CAD). Ss had been assessed with R. H. Rosenman's (1978) structured interview, by which the S's voice mannerisms served as the principal criteria for making the Type A designation. The present study was undertaken to replicate these findings using a different patient population. Tape-recorded structured interviews from 125 male angiography patients (aged 21–69 yrs) were scored blindly using the component scoring system employed in the previous study. Results confirm the previous findings. Global TABP was completely unrelated to extent of CAD, while potential for hostility and anger-in were significant independent predictors of disease severity. These findings argue for a reconceptualization of the manner in which the TABP is defined and assessed. (28 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

PET regional cerebral blood flow during working and declarative memory: Relationship with task performance.

Functional and anatomical relationships between working and declarative memory were investigated by contrasting regional cerebral blood flow (rCBF) change during standard working (Wisconsin Card Sorting Test, WCST) and declarative memory (Paired Associate Recognition Test, PART) tasks using identical stimulus-response modalities. The tasks and a resting baseline were administered to 30 participants (16 men, 14 women) during successive 10-min positron emission tomography –2–5O-water measures of rCBF. For both tasks, rCBF increased over baseline in inferior frontal and occipitotemporal regions, with more consistent dorsolateral prefrontal activation for WCST than PART. Additional orbitofrontal increases and dorsomedial decreases were seen for the PART. Activation patterns diverged when performance was considered. For the WCST, high performers activated dorsolateral and inferior frontal regions, whereas top PART performers activated only the occipitotemporal region. These results suggest operation of a frontotemporal network subserving both types of memory function that becomes more focal as performance increases. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

PET regional cerebral blood flow change during working and declarative memory: relationship with task performance

Functional and anatomical relationships between working and declarative memory were investigated by contrasting regional cerebral blood flow (rCBF) change during standard working (Wisconsin Card Sorting Test, WCST) and declarative memory (Paired Associate Recognition Test, PART) tasks using identical stimulus-response modalities. The tasks and a resting baseline were administered to 30 participants (16 men, 14 women) during successive 10-min positron emission tomography 15O-water measures of rCBF. For both tasks, rCBF increased over baseline in inferior frontal and occipitotemporal regions, with more consistent dorsolateral prefrontal activation for WCST than PART. Additional orbitofrontal increases and dorsomedial decreases were seen for the PART. Activation patterns diverged when performance was considered. For the WCST, high performers activated dorsolateral and inferior frontal regions, whereas top PART performers activated only the occipitotemporal region. These results suggest operation of a frontotemporal network subserving both types of memory function that becomes more focal as performance increases.     

Internal carotid artery dissection causes hypoglossal nerve palsy: CT, MRI, and angiographic findings

Systemic thrombolytic therapy for pulmonary embolism (PAE) is an established and common procedure. Due to increased risk, however, it is not much used in pulmonary embolism combined with thrombotic mass in the right ventricle. We applied it in a 59-year-old male patient with small intracardiac thrombus in the right ventricle (diameter = 1 cm) and peripheral pulmonary embolism whose diagnosis was obtained with transthoracal echocardiography (TTE) and helix lung CT. Twelve hours after thrombolytic treatment, helix lung CT scan showed a reduction in the size of the pulmonary embolism and no thrombotic masses in the right ventricle. In this patient with a small cardiac thrombus and rather peripheral pulmonary emboli, a systemic thrombolytic therapy proved to be effective and safe.     

Episodic, generalized, and semantic memory tests: Switching and strength effects.

We continue the process of investigating the probabilistic paired associate paradigm in an effort to understand the memory access control processes involved and to determine whether the memory structure produced is in transition between episodic and semantic memory. In this paradigm two targets are probabilistically paired with a cue across a large number of short lists. Participants can recall the target paired with the cue in the most recent list (list specific test), produce the first of the two targets that have been paired with that cue to come to mind (generalised test), and produce a free association response (semantic test). Switching between a generalised test and a list specific test did not produce a switching cost indicating a general similarity in the control processes involved. In addition, there was evidence for a dissociation between two different strength manipulations (amount of study time and number of cue-target pairings) such that number of pairings influenced the list specific, generalised and the semantic test but amount of study time only influenced the list specific and generalised test. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Overestimation and unreliability in "feeling-of-doing" judgements about temporal ordering performance: impaired self-awareness following frontal lobe damage

"Feeling-of-doing" accuracy in a temporal ordering task in 33 patients with frontal lobe lesions and a matched control group was investigated. The temporal ordering task used word lists that had high, medium, or no semantic interrelatedness. Patients with frontal lobe lesions showed an impairment in temporal ordering across all three word lists. Both groups performed better on the lists with higher semantic interrelatedness. Patients with frontal lobe lesions overestimated their ability to order words accurately. On the less semantically interrelated lists, metamemory judgment in patients with frontal lesions did not correlate with their performance. These results indicate that both temporal order judgment and metacognitive decisions about temporal order judgment are subserved by the prefrontal cortex and further clarifies the role of the frontal lobes in behavioral monitoring.     

The relationships among working memory, math anxiety, and performance.

Individuals with high math anxiety demonstrated smaller working memory spans, especially when assessed with a computation-based span task. This reduced working memory capacity led to a pronounced increase in reaction time and errors when mental addition was performed concurrently with a memory load task. The effects of the reduction also generalized to a working memory-intensive transformation task. Overall, the results demonstrated that an individual difference variable, math anxiety, affects on-line performance in math-related tasks and that this effect is a transitory disruption of working memory. The authors consider a possible mechanism underlying this effect—disruption of central executive processes—and suggest that individual difference variables like math anxiety deserve greater empirical attention, especially on assessments of working memory capacity and functioning. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Spontaneous bacterial peritonitis: clinical study, microbiological findings and clinical course

One hundred and forty-four episodes of spontaneous bacterial peritonitis (SBP) treated in our service between July 1988 and September 1995 were studied retrospectively to assess the clinical presentation, microbiological findings, possible pathogens, treatment and course. Ascites, abdominal pain and fever were the most common symptoms. Only 3.5% of cases were asymptomatic. The outcome was fatal in 12 (8.33%). Among the factors analyzed, only a prothrombin time of less than 35% correlated significantly with a higher mortality rate (60% and 8.33%, respectively; p < 0.01). Ascitic fluid culture was positive in 43.05% of cases; significant differences existed between these patients and those with negative ascitic fluid culture with respect to clinical findings or course. Gram-negative microorganisms were those most frequently isolated (48.38%). Treatment was initiated within 12 hours in 77.7% of the patients, between 12 and 72 hours in 11.8% and later in 10.41%. Intravenous cefotaxime was administered in 86.1% of cases and other drugs or drug combinations in only 13.9%; the mortality rate was much lower with cefotaxime (2.4% vs 45%; p < 0.01).