Does the child behavior checklist reveal psychopathological profiles of children with focal unilateral cortical lesions?

Psychopathological profiles were investigated in children with focal unilateral radiologically documented cortical lesions (15 right lesions and 22 left lesions). The 8 clinical subscales of the Child Behavior Checklist Parent Form (CBCL-P) and the Internalizing and Externalizing subscales were the dependent measures. The Internalizing and Externalizing scores did not dissociate as a function of lesion side. There were more Internalizing than Externalizing symptoms. Only the Attention Problems subscale yielded a significant difference as a function of lesion side; children with left lesions unexpectedly presented more problems. No significant differences were observed as a function offrontal versus nonfrontal lesion site, gender, or neurological variables on the Child Behavior Checklist (CBCL) subscales. Although sensitive to the presence of a focal lesion, the CBCL-P scarcely or misleadingly reflects any of the characteristics offocal unilateral cortical lesions in children. As suggested by the literature, most of the CBCL elevations in children with brain lesions could derive from the parent's and child's emotional response to any threatening medical condition.

Prevalence, and intellectual outcome of unilateral focal cortical brain damage as a function of age, sex and aetiology

Neurologists and neuropsychologists are aware that aging men are more at risk than women for brain damage, principally because of the well known male-predominant risk for cardiovascular disease and related cerebrovascular accidents. However, a disproportion in prevalence of brain damage between the sexes in childhood may be less suspected. Furthermore, sex-specific risk for other aetiologies of brain damage may be little known, whether in the pediatric or adult populations. Proposals of a sex difference in cognitive recovery from brain damage have also been controversial. Six hundred and thirty five "consecutive" cases with cortical focal lesions including cases of all ages and both sexes were reviewed. Aetiology of the lesion was determined for each case as was postlesion IQ. Risk was highly male prevalent in all age groups, with a predominance of cardiovascular aetiology explaining much of the adult male prevalence. However, several other aetiological categories were significantly male prevalent in juveniles (mitotic, traumatic, dysplasic) and adults (mitotic, traumatic). There was no sex difference in outcome (i.e., postlesion IQ) of these cortical brain lesions for the cohort as a whole, after statistical removal of the influence of lesion extent, aetiology and presence of epilepsy. Mechanisms potentially responsible for sex differences in prevalence, aetiology of brain damage, and recovery, are reviewed and discussed.

Right body side performance decrement in congenitally dyslexic children and left body side performance decrement in congenitally hyperactive children

OBJECTIVE

Simple and complex visuomotor performance of the right and left sides of the body was investigated in 37 children with left hemisphere lesions, 35 children with right hemisphere lesions, 53 developmentally dyslexic children, 29 developmentally hyperactive children, and 35 "normal" children who had endured a very mild head injury with no sequelae.

BACKGROUND

Lateralized soft signs, EEG topography, metabolic brain imaging, and neuropsychological test profiles suggest a predominance of left hemisphere dysfunction in dyslexia and right hemisphere dysfunction in hyperactivity.

METHOD

Nine measures of lateralized performance were drawn from the Purdue pegboard, Letter cancellation, Rey complex figure, Wechsler Intelligence Scale for Children (WISC) Mazes, and WISC Picture completion tests.

RESULTS

The children with left hemisphere lesions manifested significantly weaker performance on test components involving the right body side, relative to the normal controls, on the Purdue pegboard, Rey complex figure (delayed recall condition), and WISC Picture completion tests, and the dyslexic children on the former two. The children with right hemisphere lesions manifested significantly weaker performance on test components involving the left body side, relative to the normal controls, on the WISC Mazes test, as did the hyperactive children.

CONCLUSIONS

We propose that (1) contralateral performance decrement results from a unilateral cortical lesion in children, and (2) developmental dyslexia may comprise a slight predominance of left hemisphere dysfunction and developmental hyperactivity of right hemisphere dysfunction.

[Hypothalamic hamartoma: detailed presentation of a case]

We describe a seven year old child with a hypothalamic hamartoma. Classical symptoms of hypothalamic hamartoma include gelastic epileptic laughter, precocious puberty, aggressiveness, and progressively worsening epilepsy. After a normal first few years of life, this case presents all these symptoms except the precocious puberty. He has a markedly morbid personality disorder: he assaults strangers and relatives, bites people, spits in their faces unpredictably, is coprolalic and coprophagic, has gelastic laughter, puts pencils, erasers, and other non-comestible objects in his mouth, chews and ingests them, has tics (plays noisily with his saliva, empty chewing, compulsive spitting) and is self-injurious. None of the medications attempted to date have been of any help. Medical prognosis is somber, and this case is difficult to institutionalize, the more "congenial" institutions being insufficiently equipped to protect him and the beneficiaries and staff from his aggressive behavior. MRI showed the typical profile of hypothalamic hamartoma, and the diagnosis was confirmed with partial resection. This case illustrates that a tiny lesion, the size of a small cherry, can have extremely morbid psychological consequences. Detailed neuropsychological evaluation, certain unusual electroencephalographic traits and neurosurgical issues are discussed.

Mania, pseudomania, depression, and pseudodepression resulting from focal unilateral cortical lesions

OBJECTIVE

This consecutive multiple case study was designed to determine whether cortical lesion sites can predict occurrence of mood or psychomotor disorders in adults and children.

BACKGROUND

Most of a large body of research supports the contention that left hemisphere lesions result more often than right ones in depression, and that the inverse occurs in mania. However, it is not clear how psychomotor status fits into this picture, nor whether children respond to the same lesions in a similar manner.

METHOD

Published (n = 88) and unpublished (n = 31) cases of school-aged child and adult patients with focal unilateral cortical lesions and psychomotor agitation or lethargy with or without corresponding mania or depression were reviewed systematically to determine whether lesion location relates systematically to any of those psychiatric conditions. No patients had symptoms prior to detection of their lesion. Manic-depressives and agitated depressives were also excluded.

RESULTS

Patients with mania and/or psychomotor agitation had predominantly right hemisphere lesions. Postlesion hyperactivity (without mania) in children was common but was not more related to lesions in one or the other hemisphere. Adult and child patients with depression and/or psychomotor lethargy had predominantly left hemisphere lesions. The intrahemispherical site of the lesion did not significantly predict the type of mood or psychomotor disorder. Nevertheless, the nonsignificant trend was for right posterorolandic lesions to predict mania or agitation and for left frontal lesions to predict depression or psychomotor lethargy.

CONCLUSIONS

These findings support the neuropsychiatric approach to mood and psychomotor disorder in children and adults.

Pseudoakathisia from a acquired lesion

Akathisia, "inability to remain seated", is a common condition in patients medicated with neuroleptics, and also occurs in other medication regimens. Only a few cases of akathisia resulting from focal lesions have been published. These cases suggest that differing lesion sites are sufficient for producing objective or subjective akathisia. The authors present a patient with akathisia who had no subjective complaints, suggesting that a combined basal ganglia and frontal lobe lesion may lead to objective akathisia (pseudoakathisia).

Zaidel's model of interhemispheric dynamics: empirical tests, a critical appraisal, and a proposed revision

Zaidel has proposed a model of intra- and interhemispheric dynamics which attempts to explain field and hand effects in visual reaction time experiments. The model includes prototypes of two extreme cases: a "callosal relay" pattern, in which interhemispheric transfer is inferred, and a "direct access" pattern, in which each hemisphere is inferred to execute the task independently. Five visual reaction time experiments were carried out to test six predictions which Zaidel has made within the framework of his model. Some of these predictions were supported but others were rejected. These findings, in conjunction with findings of other researchers, were critically analyzed in view of determining the extent to which Zaidel's model can be revised in order to fit the ensemble of relevant findings. It was concluded that the model can indeed be revised but that this requires a redefinition of conditions indicative of presence or absence of interhemispheric relay. A new model is proposed assuming exclusively excitatory callosal relay and focussing on magnitude and valence of field effects obtained at each hand, considered in their interrelation.

Working memory and the Self-Ordered Pointing Task: further evidence of early prefrontal decline in normal aging

Two major lines of investigation are currently clarifying the nature of the impairment of working memory associated with normal aging. Cognitive psychology has formulated the problem in terms such as the balance of impairment of encoding, retrieval, storage and/or attention, whereas neuropsychology has formulated the problem in terms such as the balance of frontal (executive) versus temporal (mnemonic) degeneration. The findings of this study support the contention that the primary impairment of working memory in early normal aging is an active attentional executive processing deficit. Specifically, on the Self-Ordered Pointing Task, there is significantly ineffective exploitation of top-down clustering strategy as a function of aging. On this task, self-organization of encoding and retrieval must occur simultaneously with ongoing responding. The finding cannot be explained as an impairment of encoding, retrieval, storage, or build-up and/or release of proactive interference, since indexes of these did not discriminate young-adult from middle-aged samples.

An empirical test of two opposing theoretical models of prefrontal function

The purpose of this study was to compare the validity of two models which contrast with each other in the manner in which they integrate neuropsychological tests into distinct prefrontal constructs. The first prefrontal model consists of five distinct functional constructs drawn from human clinical neuropsychology. The second model, elaborated by Goldman-Rakic, is based primarily on monkey research and postulates a basic prefrontal function, "on-line representational memory," which guides behavior in the absence of, or despite discriminative environmental stimuli. In the latter model, distinct prefrontal functional constructs are primarily defined in terms of various types of representational memory involved in specific tasks. Eleven "prefrontal" measures were obtained from 259 normal adults, stratified for age, education, and sex. Confirmatory factor analyses revealed that the Goldman-Rakic model "fit" the data better than the model derived from human clinical neuropsychology, while several constructs commonly used in human neuropsychology were refuted. It was concluded that new research on brain-damaged humans with a view to understanding prefrontal function might benefit from using the Goldman-Rakic model as a starting point.

Processing of pragmatic and facial affective information by patients with closed-head injuries

Although several affective impairments have been demonstrated to occur following closed-head injury (CHI), deficits of the communicative function of language, particularly sentenial and suprasentential pragmatic aspects, have been suggested, but not demonstrated, to occur. This study compared 31 normals and 31 severely closed-head injured patients matched for age, sex and education. The dependent measures consisted of a facial test of emotion (FTE) and a contextual test of emotion (CTE). The former task consisted of 36 slides representing facial expressions of the six emotions demonstrated by Ekman and colleagues to be transcultural, namely, job, sadness, fear, anger, surprise and disgust. The subject was required to name the appropriate emotion for each slide. The latter task consisted of correctly identifying the appropriate emotion for each of 36 brief verbal narratives representing contexts connotative of the same six transcultural emotions. The CHI patients were impaired overall on the FTE but not the CTE. However, the ability to identify anger was significantly impaired on both tasks when considered in isolation from the other emotions. It was concluded that a processing deficit of primary emotional material, particularly anger, does exist following CHI, but that this deficit is not necessarily independent of task and/or modality parameters. It was also concluded that evidence of a pragmatic deficit of the language function following CHI remains to be provided at this time.

Color discrimination testing reveals early printshop solvent neurotoxicity better than a neuropsychological test battery

Twenty standardized neuropsychological tests were compared to the Lanthony D-15 desaturated panel test of chromotopsia to determine which measures would most effectively discriminate solvent-exposed print workers from controls. All the workers of the printing services of Université du Québec a Montréal (N = 29) were assessed excepted one who refused to participate. Twenty-nine workers (employed on a full time basis) matched for occupation, age, sex, education, vocabulary, and written arithmetic (p >.13) with the print workers served as controls. Air samples revealed exposure to ethanol, perchloroethylene, methyl chloride, xylene, toluene, and stoddard solvent in the print shop. None of the 20 neuropsychological measures yielded a statistically significant decrement in the print workers. On the other hand, the Lanthony D-15 test revealed a significant group difference (p <.01) and a highly significant interaction between job category within the print shop and dyschromatopsia (p <.001) - the graphists, photocopiers, and printers/binders manifesting increasing severity of impairment as a function of increasing magnitude, and/or type, of dose. The results were interpreted to mean that in a cohort of printers with low seniority (10.42 years) such as this one, neuro-opthalmotoxic effects can be observed earlier than putative neuropsychotoxic effects with the tools at hand.