Left temporal lobe epilepsy revealing left posterior cortical atrophy due to Alzheimer's disease.

Seizures can be an early symptom of Alzheimer's disease (AD) and can precede cognitive decline. Early epilepsy in AD can mimic transient epileptic amnesic syndrome (TEAS) or epileptic amnesic syndrome. We report the case of a patient who started a cerebrospinal fluid (CSF)-proven AD with partial seizures and TEAS that secondarily became a cortical posterior atrophy syndrome. CSF biomarkers showed a high amyloid production, amyloidopathy, and high level of total tau and p-Tau. This observation adds data to the complex AD-early epilepsy interactions and illustrates that atypical AD can cause a TEAS. Possible red flags for an underlying neurodegenerative process in TEAS are discussed.

Arte mueble en el AuriÑaciense Cantabrico. Nuevas aportaciones a la contextualizacion del frontal grabado de la cueva de Hornos de la PeÑa (San Felices de Buelna, Cantabria).

El hueso frontal de équido grabado con una representación de este mismo animal procedente de la Cueva de Hornos de la Peña (Cantabria), se recuperó a principios del pasado siglo XX en las excavaciones de H. Breuil, H. Obermaier y H. Alcalde del Río. A pesar de la atribución auriñaciense de sus excavadores, las diferentes publicaciones posteriores en que la pieza ha sido objeto de análisis, han mantenido siempre la duda de su pertenencia a este tecnocomplejo. A ello ha contribuido el hecho de que la estratigrafía de Hornos de la Peña no ha podido ser hasta el presente estudiada en profundidad, como también, muy probablemente, el carácter naturalista de su representación que parece alejarlo de los presupuestos artísticos del Paleolítico Superior inicial cantábrico. En este trabajo presentamos una serie de datos sobre la estratigrafía del yacimiento, obtenidos de diversos documentos inéditos conservados en el archivo del Museo Arqueológico Nacional de Madrid que, a nuestro juicio, corroboran la pertenencia de esta pieza de arte mueble al Auriñaciense.

Atypical language organization in temporal lobe epilepsy revealed by a passive semantic paradigm

Background Mesial temporal lobe epilepsy (MTLE) is the most common type of focal epilepsy in adults and can be successfully cured by surgery. One of the main complications of this surgery however is a decline in language abilities. The magnitude of this decline is related to the degree of language lateralization to the left hemisphere. Most fMRI paradigms used to determine language dominance in epileptic populations have used active language tasks. Sometimes, these paradigms are too complex and may result in patient underperformance. Only a few studies have used purely passive tasks, such as listening to standard speech. Methods In the present study we characterized language lateralization in patients with MTLE using a rapid and passive semantic language task. We used functional magnetic resonance imaging (fMRI) to study 23 patients [12 with Left (LMTLE), 11 with Right mesial temporal lobe epilepsy (RMTLE)] and 19 healthy right-handed controls using a 6 minute long semantic task in which subjects passively listened to groups of sentences (SEN) and pseudo sentences (PSEN). A lateralization index (LI) was computed using a priori regions of interest of the temporal lobe. Results The LI for the significant contrasts produced activations for all participants in both temporal lobes. 81.8% of RMTLE patients and 79% of healthy individuals had a bilateral language representation for this particular task. However, 50% of LMTLE patients presented an atypical right hemispheric dominance in the LI. More importantly, the degree of right lateralization in LMTLE patients was correlated with the age of epilepsy onset. Conclusions The simple, rapid, non-collaboration dependent, passive task described in this study, produces a robust activation in the temporal lobe in both patients and controls and is capable of illustrating a pattern of atypical language organization for LMTLE patients. Furthermore, we observed that the atypical right-lateralization patterns in LMTLE patients was associated to earlier age at epilepsy onset. These results are in line with the idea that early onset of epileptic activity is associated to larger neuroplastic changes.

Diagonal ear lobe crease and atherosclerosis: a review of the medical literature and dental implications

In Spain a significant number of individuals die from atherosclerotic disease of the coronary and carotid arteries without having classic risk factors and prodromal symptoms. The diagonal ear lobe crease (DELC) has been characterized in the medical literature as a surrogate marker which can identify high risk patients having occult atherosclerosis. This topic however has not been examined in either the medical or dental literature emanating from Spain. The majority of clinical, angiography and postmortem reports support the premise that DELC is a valuable extravascular physical sign able to distinguish some patients at risk of succumbing to atherosclerosis of the coronary arteries. A minority of studies have however failed to support this hypothesis. More recently reports using B mode ultrasound have also linked DELC to atherosclerosis of the carotid artery and another report has related DELC to the presence of calcified carotid artery atheromas on panoramic radiographs. DELC is readily visible during head and neck cancer screening examinations. In conjunction with the patient"s medical history, vital signs, and panoramic radiograph, the DELC may assist in atherosclerotic risk assessment

Differential patterns of functional and structural plasticity within and between inferior frontal gyri support training-induced improvements in inhibitory control proficiency.

Ample evidence indicates that inhibitory control (IC), a key executive component referring to the ability to suppress cognitive or motor processes, relies on a right-lateralized fronto-basal brain network. However, whether and how IC can be improved with training and the underlying neuroplastic mechanisms remains largely unresolved. We used functional and structural magnetic resonance imaging to measure the effects of 2 weeks of training with a Go/NoGo task specifically designed to improve frontal top-down IC mechanisms. The training-induced behavioral improvements were accompanied by a decrease in neural activity to inhibition trials within the right pars opercularis and triangularis, and in the left pars orbitalis of the inferior frontal gyri. Analyses of changes in brain anatomy induced by the IC training revealed increases in grey matter volume in the right pars orbitalis and modulations of white matter microstructure in the right pars triangularis. The task-specificity of the effects of training was confirmed by an absence of change in neural activity to a control working memory task. Our combined anatomical and functional findings indicate that differential patterns of functional and structural plasticity between and within inferior frontal gyri enhanced the speed of top-down inhibition processes and in turn IC proficiency. The results suggest that training-based interventions might help overcoming the anatomic and functional deficits of inferior frontal gyri manifesting in inhibition-related clinical conditions. More generally, we demonstrate how multimodal neuroimaging investigations of training-induced neuroplasticity enable revealing novel anatomo-functional dissociations within frontal executive brain networks. Hum Brain Mapp 36:2527-2543, 2015. © 2015 Wiley Periodicals, Inc.

Galanin pathogenic mutations in temporal lobe epilepsy.

Temporal lobe epilepsy (TLE) is a common epilepsy syndrome with a complex etiology. Despite evidence for the participation of genetic factors, the genetic basis of TLE remains largely unknown. A role for the galanin neuropeptide in the regulation of epileptic seizures has been established in animal models more than two decades ago. However, until now there was no report of pathogenic mutations in GAL, the galanin-encoding gene, and therefore its role in human epilepsy was not established. Here, we studied a family with a pair of monozygotic twins affected by TLE and two unaffected siblings born to healthy parents. Exome sequencing revealed that both twins carried a novel de novo mutation (p.A39E) in the GAL gene. Functional analysis revealed that the p.A39E mutant showed antagonistic activity against galanin receptor 1 (GalR1)-mediated response, and decreased binding affinity and reduced agonist properties for GalR2. These findings suggest that the p.A39E mutant could impair galanin signaling in the hippocampus, leading to increased glutamatergic excitation and ultimately to TLE. In a cohort of 582 cases, we did not observe any pathogenic mutations indicating that mutations in GAL are a rare cause of TLE. The identification of a novel de novo mutation in a biologically-relevant candidate gene, coupled with functional evidence that the mutant protein disrupts galanin signaling, strongly supports GAL as the causal gene for the TLE in this family. Given the availability of galanin agonists which inhibit seizures, our findings could potentially have direct implications for the development of anti-epileptic treatment.

Correlação entre espessura cortical frontal e desempenho de funções executivas em pacientes com infecção pelo vírus da imunodeficiência humana

OBJETIVO: Investigar a relação entre a espessura cortical medida pela ressonância magnética em regiões frontais e o desempenho em instrumentos que avaliam funções executivas em pacientes com HIV positivo. MATERIAIS E MÉTODOS: Participaram deste estudo 22 pacientes HIV-positivos, com déficits em funções executivas, sob terapia antirretroviral, idades entre 45 e 65 anos e escolaridade entre 3 e 20 anos. Foi realizada ressonância magnética com sequências convencionais, T1 3D, processado pelo Freesurfer para verificar espessura cortical. Instrumentos de avaliação das funções executivas: Teste de Trilhas, Wisconsin, Hayling, Dígitos (WAIS-III), fluência verbal ortográfica e Stroop. Para análise da relação espessura versus cognição, utilizou-se coeficiente de correlação de Pearson. RESULTADOS: Correlações significativas foram encontradas entre escores de: Wisconsin e espessura das regiões pré-central e orbitofrontal lateral à direita e pré-central esquerda; Teste de Trilhas e espessura da área pré-central direita e cíngulo anterior caudal esquerdo; e Teste Hayling e espessura da área lateral orbitofrontal esquerda. CONCLUSÃO: As correlações existentes entre medidas de espessura cortical pela ressonância magnética e desempenho cognitivo sugerem que os déficits executivos em pacientes HIV-positivos relacionam-se a uma redução da espessura cortical das regiões frontais.

Connectivity and tissue microstructural alterations in right and left temporal lobe epilepsy revealed by diffusion spectrum imaging.

Focal epilepsy is increasingly recognized as the result of an altered brain network, both on the structural and functional levels and the characterization of these widespread brain alterations is crucial for our understanding of the clinical manifestation of seizure and cognitive deficits as well as for the management of candidates to epilepsy surgery. Tractography based on Diffusion Tensor Imaging allows non-invasive mapping of white matter tracts in vivo. Recently, diffusion spectrum imaging (DSI), based on an increased number of diffusion directions and intensities, has improved the sensitivity of tractography, notably with respect to the problem of fiber crossing and recent developments allow acquisition times compatible with clinical application. We used DSI and parcellation of the gray matter in regions of interest to build whole-brain connectivity matrices describing the mutual connections between cortical and subcortical regions in patients with focal epilepsy and healthy controls. In addition, the high angular and radial resolution of DSI allowed us to evaluate also some of the biophysical compartment models, to better understand the cause of the changes in diffusion anisotropy. Global connectivity, hub architecture and regional connectivity patterns were altered in TLE patients and showed different characteristics in RTLE vs LTLE with stronger abnormalities in RTLE. The microstructural analysis suggested that disturbed axonal density contributed more than fiber orientation to the connectivity changes affecting the temporal lobes whereas fiber orientation changes were more involved in extratemporal lobe changes. Our study provides further structural evidence that RTLE and LTLE are not symmetrical entities and DSI-based imaging could help investigate the microstructural correlate of these imaging abnormalities.

Giant cell tumor of the frontal sinus: case report

The authors report the case of a giant cell tumor of the frontal sinus in a 54-year-old male patient. This tumor location is rare, and this is the third case reported in the literature with radiographic documentation and histopathological confirmation. The patient underwent surgery, with curettage of frontal sinus and placement of a prosthesis. He died because a voluntary abrupt discontinuation of corticosteroids.

Frontal sinus pneumocele: case report and literature review

The authors report a rare case of frontal sinus pneumocele in a 26-year-old female patient assessed by computed tomography.

Tècnica d'execució del frontal gòtic de Sant Llorenç de Morunys: a propòsit del dibuix preparatori

Els traços primigenis del dibuix preparatori del Frontal de Sant Llorenç de Morunys, al Museu Diocesà i Comarcal de Solsona, s"observen a ull nu, sense haver d"emprar tècniques sofisticades, a causa d"una pèrdua important de l"estrat pictòric que, de conservar-se, impediria la lectura de les capes més profundes. S"han examinat aquestes traces, font de documentació privilegiada que se"ns ofereix per incrementar el coneixement de l"obra i també, per comprendre el procés d"elaboració d"una pintura sobre taula en el context del bisbat d"Urgell al tombant del segle XIII. Durant l"estudi ha estat possible reconstruir, amb el suport inestimable dels tractats medievals, la seqüència d"execució del dibuix preliminar: primer, la distribució provisional de les línies mestres a mà alçada, amb carbonet, seguit de la seva fixació amb una punta metàl·lica dura; segon, el traçat de l"esbós figuratiu, amb un estil tou, i el posterior repàs definitiu amb una agulla o punta afilada sobre l"estrat preparatori, creant un dibuix incís que romandria visible després de recobrir tota la superfície amb una làmina d"estany. Finalment, s"aplicaria una complexa policromia, que combinaria tècniques opaques i vernissos translúcids. La revisió d"un corpus d"obres catalanes de característiques similars, moltes en les reserves dels museus pel seu precari estat de conservació, podria aportar dades rellevants quant a les diferents tècniques del dibuix preparatori emprades en la pintura sobre taula d"època medieval.