precuneus

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  • 文章类型: Case Reports
    尽管越来越多的证据表明相反,经典的神经外科假设许多大脑区域是非雄辩的,因此,他们的切除是可能的和安全的。前扣带和后扣带就是这种情况,在各种认知功能过程中参与的两个互动中心,包括反思性自我意识;视觉空间和感觉运动处理;以及处理社交线索。这种不可分割的二重奏确保了这些过程的皮质-皮质下连通性。一名表现出右前骨低度神经胶质瘤侵犯后扣带的成年人接受了直接电刺激(DES)的清醒开颅手术。在定位上纵束II后,实现了超最大切除。手术期间,我们发现了线平分和心理测试的阳性刺激部位,这些部位能够确定手术通道和边界以进行病灶切除.对术中记录进行后处理时,我们进一步确定了在试验制定和指导测试中对DES反应积极的区域.此外,在整个手术过程中观察到患者的自我评估能力明显恶化。清醒的认知神经外科方法通过达到皮质-皮质下功能极限而允许超最大切除。社会认知和自我意识等复杂功能的映射是通过最大化切除病变和周围区域的能力来保持患者术后认知健康的关键。
    Despite mounting evidence pointing to the contrary, classical neurosurgery presumes many cerebral regions are non-eloquent, and therefore, their excision is possible and safe. This is the case of the precuneus and posterior cingulate, two interacting hubs engaged during various cognitive functions, including reflective self-awareness; visuospatial and sensorimotor processing; and processing social cues. This inseparable duo ensures the cortico-subcortical connectivity that underlies these processes. An adult presenting a right precuneal low-grade glioma invading the posterior cingulum underwent awake craniotomy with direct electrical stimulation (DES). A supramaximal resection was achieved after locating the superior longitudinal fasciculus II. During surgery, we found sites of positive stimulation for line bisection and mentalizing tests that enabled the identification of surgical corridors and boundaries for lesion resection. When post-processing the intraoperative recordings, we further identified areas that positively responded to DES during the trail-making and mentalizing tests. In addition, a clear worsening of the patient\'s self-assessment ability was observed throughout the surgery. An awake cognitive neurosurgery approach allowed supramaximal resection by reaching the cortico-subcortical functional limits. The mapping of complex functions such as social cognition and self-awareness is key to preserving patients\' postoperative cognitive health by maximizing the ability to resect the lesion and surrounding areas.
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  • 文章类型: Systematic Review
    背景:成年后的偶发性口吃是一种罕见的疾病,这在文献中很少描述。
    方法:我们描述了一个62岁男性的病例,他在急诊室出现了三起新发作的短暂孤立性口吃,没有其他言语障碍或相关的局灶性神经功能缺损。他的脑部磁共振成像值得注意的是,出现了涉及左前叶皮质的小型急性缺血性中风。
    我们进行了系统的文献综述,以评估卒中与获得性神经性口吃之间的关联。迄今为止发表的证据表明,获得性口吃的潜在病理生理学并不局限于孤立或病灶区域。继发于中风的口吃的发展可能是介导言语执行的皮质-皮质-皮质整合途径中任何水平中断的结果。
    结论:在这里,我们旨在强调仔细评估新发复发性发作性口吃以排除潜在的卒中或其他神经源性病因的重要性。我们提供对后天口吃的全面审查,其鉴别诊断,及其评价。
    BACKGROUND: Acquired episodic stuttering in adulthood represents a rare condition, which has been infrequently described in the literature.
    METHODS: We describe the case of a 62-year-old male who presented to the emergency room with three episodes of new-onset brief isolated stuttering with no other speech impairment or associated focal neurologic deficits. His brain magnetic resonance imaging was notable for the presence of a small acute ischemic stroke involving the left precuneus cortex.
    UNASSIGNED: We performed a systematic literature review to evaluate the association between stroke and acquired neurogenic stuttering. The evidence published to this date suggests that the underlying pathophysiology of acquired stutter does not localize to an isolated or focal region. The development of stuttering secondary to strokes may be the result of a disruption at any level in a cortico-striato-cortical integrative pathway mediating speech execution.
    CONCLUSIONS: Here we aimed to emphasize the importance of carefully evaluating new-onset recurrent episodic stuttering to rule out an underlying stroke or another neurogenic etiology. We provide a comprehensive review of acquired stuttering, its differential diagnosis, and its evaluation.
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  • 文章类型: Case Reports
    一名68岁的右撇子妇女因急性发作而无法站立而入院。虽然左偏瘫是轻微的,入院时的神经系统检查显示,当她站着或踩着眼睛和双脚闭时,左侧有明显的身体外侧撕脱(BL)。不存在共济失调和感觉障碍。脑部MRI和3D-CT血管造影显示,由于右脑前动脉的解剖,右后扣带回和前肌梗死。BL在第10天有所改善,第26天出院,无后遗症。由脑部病变引起的BL很少见,我们应该认识到后扣带和/或前突的梗死可导致BL。
    A 68-year-old right-handed woman with acute-onset inability to stand was admitted to our department. Although left hemiparesis was minor, the neurological examination on admission showed marked body lateropulsion (BL) to the left when she stood or stepped with eyes open and feet closed. Neither ataxia nor sensory disturbance was present. Brain MRI and 3D-CT angiography revealed infarction of the right posterior cingulate and the precuneus due to dissection of the right anterior cerebral artery. BL improved on day 10 and she was discharged without sequelae on day 26. BL caused by cerebral lesions is rare, and we should recognize that infarction of the posterior cingulate and/or the precuneus can cause BL.
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