SANDRA MARILYN MILLER, PH.D.
Neurogens Clinical and Research Consultation
PHONE - 678.506.1846
THE LION’S MANE SIGN: SURGICAL RESULTS USING THE BILATERAL FRONTO-ORBITO-NASAL APPROACH IN LARGE AND GIANT ANTERIOR SKULL BASE MENINGIOMAS
Extreme vasogenic edema exemplified by finger-like hyperintensities extending into bifrontal white mater and external capsule predicts an increased duration of stay in the ICU after bilateral fronto-orbito-nasal approach for resection of large and giant anterior skull base meningiomas. This measure proved to be a better predictor of complications than edema index.
IMPORTANCE OF VENTRICLE-TO-BRAIN RATIO (VBR) AND VOLUME OF CSF DRAINAGE IN THE TREATMENT OF VERY LOW PRESSURE HYDROCEPHALUS
Sometimes, low-pressure hydrocephalus, a known complication of prolonged hydrocephalus, is treatable with continued low-pressure drainage at subatmostpheric pressures. This article proposes a method for determining when this treatment may be therapeutic versus ineffective.
IMPORTANCE OF FRONTAL HORN RATIO AND OPTIMAL CSF DRAINAGE IN THE TREATMENT OF VERY LOW-PRESSURE HYDROCEPHALUS
Unlike low-pressure hydrocephalus, very low pressure hydrocephalus (VLPH) is a rarely reported clinical entity previously described to be associated with poor outcomes and to be possibly refractory to treatment with continued cerebrospinal fluid (CSF) drainage at subatmospheric pressures. We present four cases of VLPH following resection of suprasellar lesions and hypothesize that untreatable patients can be identified early, thereby avoiding futile prolonged external ventricular drainage in ICU.
THE EXCITABLE BRAIN: WHAT EVERY CLINICIAN SHOULD KNOW ABOUT EPILEPSY
This course reviews the various types of seizure disorders and syndromes. Procedures for diagnosing seizures are presented, including neuropsychological evaluation as well as Wada testing, cortical stimulation mapping, and functional neuroimaging. Special emphasis is placed on neurocognitive and neurobehavioral sequelae of complex partial seizures. Also of focus is the role of neuropsychological assessment in epilepsy diagnosis and in pre-/post-surgical evaluation. Further, differential diagnoses including psychogenic non-epileptic seizures are discussed.
CAN FRONTAL LOBE FUNCTIONING BE MODIFIED BY COGNITIVE REHABILITATION AFTER STABLE MALIGNANT NEOPLASM?
Traditional cognitive rehabilitation has focused on retraining of attention and memory in patients with CHI or stroke. Few treatment programs include retraining of frontal lobe functions, and those which do focus on a narrow segment of executive functioning. Very few brain tumor patients receive cognitive intervention although most experience some deficits, if not a progressive decline, in neurocognitive abilities following surgery and post-operative interventions. For frontal lobe tumor patients, changes in frontal lobe functioning have profound effects on interpersonal relationships and higher cognitive tasks. This study examines the efficacy of cognitive retraining of frontal lobe functioning in primary frontal lobe tumor patients. Seven patients with stable disease were studied following tumor resection, chemotherapy, and radiation, both before and after brief cognitive rehabilitation. Treatment sessions focused on executive functioning, disinhibition, affective disorders, memory, and word fluency. Patients were compared with seven frontal lobe tumor patients who did not undergo treatment. The results of this study showed overall improvement from baseline in executive functioning (0.05), with a trend in affective functioning and verbal memory following cognitive retraining. However, when compared to the non-treatment group, which decreased in level of functioning, results were significant (0.05) for all three areas. No significant changes were seen in level of disinhibition.
ICTAL FEAR AND AFFECTIVE DISORDERS IN COMPLEX PARTIAL SEIZURE PATIENTS
Ictal fear has been associated with higher risk for psychopathology, implicating the anteromedial temporal lobe or associated limbic structures in the presentation of psychiatric difficulties. Fewer studies have systematically focused on the role of ictal fear in affective disorders, even though studies have shown complex partial seizure patients to be at higher risk for depression than the general population. The present study is a two-center investigation examining the relationship between ictal fear and affective disorders, namely depression and anxiety. Forty complex partial seizure patients were administered the Beck Inventory and the State Trait Anxiety Inventory. History of ictal fear was obtained as well. Findings suggest that ictal fear is significantly correlated with both depression (p<.03) and state-anxiety (p<.05) but not trait-anxiety. Laterality was not associated with depression, anxiety, or ictal fear.
INTRACRANIAL HYPERTENSION IN RELATION TO MEMORY FUNCTIONING DURING THE FIRST YEAR AFTER SEVERE HEAD INJURY
The relationship between intracranial hypertension and residual memory deficit after closed head injury was evaluated using the 6-month and 1-year neurobehavioral outcome data obtained by the Traumatic Coma Data Bank. Intracranial pressure was analyzed using the percentage of time that it exceeded 20 mm Hg and the maximum value recorded during the first 72 hours after injury. Memory measures included recall of word lists, prose recall, and visual memory for designs that were obtained 6 months (n = 149) and 1 year (n = 132) after injury. Intracranial hypertension occurred in more than half of the Traumatic Coma Data Bank cohort who met the criteria for the neurobehavioral follow-up study. Linear regression analysis disclosed an effect of elevated intracranial pressure on some, but not all, measures of memory at 6 months, whereas the results were negative for the 1-year follow-up examination. We conclude that the elevation of intracranial pressure exerts little if any effect on later memory functioning, and that any effect it does have diminishes over 1 year in survivors of severe head injury.
NEUROBEHAVIORAL OUTCOME 1 YEAR AFTER SEVERE HEAD INJURY: EXPERIENCE OF THE TRAUMATIC COMA DATA BANK
The outcome 1 year after they had sustained a severe head injury was investigated in patients who were admitted to the neurosurgery service at one of four centers participating in the Traumatic Coma Data Bank (TCDB). Of 300 eligible survivors, the quality of recovery 1 year after injury was assessed by at least the Glasgow Outcome Scale (GOS) in 263 patients (87%), whereas complete neuropsychological assessment was performed in 127 (42%) of the eligible survivors. The capacity of the patients to undergo neuropsychological testing 1 year after injury was a criterion of recovery as reflected by a significant relationship to neurological indices of acute injury and the GOS score at the time of hospital discharge. The neurobehavioral data at 1 year after injury were generally comparable across the four samples of patients and characterized by impairment of memory and slowed information processing. In contrast, language and visuospatial ability recovered to within the normal range. The lowest postresuscitation Glasgow Coma Scale (GCS) score and pupillary reactivity were predictive of the 1-year GOS score and neuropsychological performance. The lowest GCS score was especially predictive of neuropsychological performance 1 year postinjury in patients who had at least one nonreactive pupil following resuscitation. Notwithstanding limitations related to the scope of the TCDB and attrition in follow-up material, the results indicate a characteristic pattern of neurobehavioral recovery from severe head injury and encourage the use of neurobehavioral outcome measurements in clinical trials to evaluate interventions for head-injured patients.
More papers to be posted online soon!