Anteromedian, central, and posterolateral infarcts of the thalamus : three variant types

Résumé Introduction et but: Les accidents vasculaires cérébraux (AVC) ischémiques thalamiques sont traditionnellement classés en quatre territoires : antérieur (polaire ou tubérothalamique), paramédian (ou thalamo-perforant), inférolatéral (ou thalamo-genouillé) et postérieur. Le but de cette thèse est de déterminer, à l'aide des techniques d'imagerie actuelles, si cette classification est appropriée ou si il existe d'autres territoires à la jonction entre les précédents territoires. Méthode: Nous avons étudié les 3712 patients hospitalisés pour un premier AVC dans le service de neurologie du CHUV à Lausanne et inclus dans le « Lausanne Stroke Registry » entre 1990 et 2002. Parmi les 71 patients avec un infarctus thalamique confirmé par IRM, nous avons sélectionné tous les patients présentant un AVC hors des quatre territoires classiques en étudiant leur tableau clinique, étiologique et radiologique. Résultats: 21 patients (30% des patients avec AVC thalamiques) avaient un AVC hors des quatre territoires classiques, permettant de délimiter trois nouveaux territoires. 1) territoire anteromédian (9 patients (13%)), atteignant la partie postérieure du territoire antérieur et la partie antérieure du territoire paramédian, avec en premier lieu des troubles cognitifs (principalement troubles dysexecutifs, amnésie antérograde ainsi qu'une aphasie dans les lésions gauches). L'étiologie principale était cardio-embolique. 2) territoire central (4 patients (6%)), atteignant la partie centrale du thalamus provoquant différents signes neurologiques et neuropsychologiques, reflétant l'atteinte de différentes structures. La cause la plus fréquente était microangiopathique. 3) territoire posterolateral (8 patients (8%)), atteignant la partie postérieure du territoire inférolatéral et la partie antérieure du territoire postérieur provoquant en premier lieu une hémihypesthesie mais aussi une hémiataxie ainsi que des troubles dysexécutifs et une aphasie dans les lésions gauches. Les étiologies les plus fréquentes étaient artério-artérielle et microangiopathique. Conclusions: Nous décrivons trois nouvelles variantes topographiques d'AVC thalamiques avec des tableaux cliniques et étiologiques distincts. Nous postulons que ces variantes sont le résultat de variations de la vascularisation thalamique ou reflètent une atteinte ischémique jonctionnelle. Abstract Background and Purpose -Thalamic infarcts have traditionally been classified into 4 territories: anterior, paramedian, inferolateral, and posterior. The purpose of this study was to review this classical versus variant distribution in patients with thalamic stroke. Methods - We reviewed all patients with a first clinical stroke included in the Lausanne Stroke Registry between 1990 and 2002. Among 71 patients with an acute stroke isolated to the thalamus confirmed by MRI, we selected all patients with lesions outside the classical territories and studied their clinical, etiological, and radiological features. Results - A total of 21 patients (30% of all thalamic stroke patients) showed infarction outside the classical territories, allowing us to delineate 3 variant distributions: (1) Anteromedian territory (9 patients [13%]) involving anterior and paramedian territories, with predominantly cognitive impairment, including executive dysfunction, anterograde amnesia, and aphasia in left-sided or bilateral lesions. The most frequent stroke mechanism was cardiac embolism. (2) Central territory (4 patients [6%]), with lesions on the central part of the thalamus, resulting in a variety of neurological and neuropsychological signs, reflecting the involvement of several adjacent structures. Microangiopathy was the most frequent etiology. (3) Posterolateral territory (8 patients [11%]), involving inferolateral and posterior territories, with hemihypesthesia as the most frequent manifestation, followed by hemiataxia, executive dysfunction, and aphasia in left-sided lesions. Artery-to-artery embolism and microangiopathy were the main stroke mechanisms. Conclusions - We describe 3 variant topographic patterns of thalamic infarction with distinct manifestations and etiologies. We postulate that these infarcts are the result of a variation in thalamic arterial supply or reflect borderzone ischemia.

Electrophysiological markers of rapid cognitive decline in mild cognitive impairment

Electroencephalography (EEG) is an easily accessible and low-cost modality that might prove to be a particularly powerful tool for the identification of subtle functional changes preceding structural or metabolic deficits in progressive mild cognitive impairment (PMCI). Most previous contributions in this field assessed quantitative EEG differences between healthy controls, MCI and Alzheimer's disease(AD) cases leading to contradictory data. In terms of MCI conversion to AD, certain longitudinal studies proposed various quantitative EEG parameters for an a priori distinction between PMCI and stable MCI. However, cross-sectional comparisons revealed a substantial overlap in these parameters between MCI patients and elderly controls. Methodological differences including variable clinical definition of MCI cases and substantial interindividual differences within the MCI group could partly explain these discrepancies. Most importantly, EEG measurements without cognitive demand in both cross-sectional and longitudinal designs have demonstrated limited sensitivity and generally do not produce significant group differences in spectral EEG parameters. Since the evolution of AD is characterized by the progressive loss of functional connectivity within neocortical association areas, event-modulated EEG dynamic analysis which makes it possible to investigate the functional activation of neocortical circuits may represent a more sensitive method to identify early alterations of neuronal networks predictive of AD development among MCI cases. The present review summarizes clinically significant results of EEG activation studies in this field and discusses future perspectives of research aiming to reach an early and individual prediction of cognitive decline in healthy elderly controls.

Robust Detection of Incumbents in Cognitive Radio Networks Using Groups

Cognitive radio is a wireless technology aimed at improvingthe efficiency use of the radio-electric spectrum, thus facilitating a reductionin the load on the free frequency bands. Cognitive radio networkscan scan the spectrum and adapt their parameters to operate in the unoccupiedbands. To avoid interfering with licensed users operating on a givenchannel, the networks need to be highly sensitive, which is achieved byusing cooperative sensing methods. Current cooperative sensing methodsare not robust enough against occasional or continuous attacks. This articleoutlines a Group Fusion method that takes into account the behavior ofusers over the short and long term. On fusing the data, the method is basedon giving more weight to user groups that are more unanimous in their decisions.Simulations have been performed in a dynamic environment withinterferences. Results prove that when attackers are present (both reiterativeor sporadic), the proposed Group Fusion method has superior sensingcapability than other methods.

Fully Distributed Cooperative Spectrum Sensing for Cognitive Radio Networks

Cognitive radio networks (CRN) sense spectrum occupancy and manage themselves to operate in unused bands without disturbing licensed users. The detection capability of a radio system can be enhanced if the sensing process is performed jointly by a group of nodes so that the effects of wireless fading and shadowing can be minimized. However, taking a collaborative approach poses new security threats to the system as nodes can report false sensing data to force a wrong decision. Providing security to the sensing process is also complex, as it usually involves introducing limitations to the CRN applications. The most common limitation is the need for a static trusted node that is able to authenticate and merge the reports of all CRN nodes. This paper overcomes this limitation by presenting a protocol that is suitable for fully distributed scenarios, where there is no static trusted node.

A Secure and Anonymous Cooperative Sensing Protocol for Cognitive Radio Networks

Spectrum is an essential resource for the provision of mobile services. In order to control and delimit its use, governmental agencies set up regulatory policies. Unfortunately, such policies have led to a deficiency of spectrum as only few frequency bands are left unlicensed, and these are used for the majority of new emerging wireless applications. One promising way to alleviate the spectrum shortage problem is adopting a spectrum sharing paradigm in which frequency bands are used opportunistically. Cognitive radio is the key technology to enable this shift of paradigm.Cognitive radio networks are self-organized systems in which devices cooperate to use those spectrum ranges that are not occupied by licensed users. They carry out spectrum sensing in order to detect vacant channels that can be used for communication. Even though spectrum sensing is an active area of research, an important issue remains unsolved: the secure authentication of sensing reports. Not providing security enables the input of false data in the system thus empowering false results. This paper presents a distributed protocol based on wireless physical layer security, symmetric cryptography and one-way functions that allows determining a final sensing decision from multiple sources in a quick and secure way, as well as it preserves users¿ privacy.

Spectrum Sharing Models in Cognitive Radio

Spectrum scarcity demands thinking new ways tomanage the distribution of radio frequency bands so that its use is more effective. The emerging technology that can enable this paradigm shift is the cognitive radio. Different models fororganizing and managing cognitive radios have emerged, all with specific strategic purposes. In this article we review the allocation spectrum patterns of cognitive radio networks andanalyse which are the common basis of each model.We expose the vulnerabilities and open challenges that still threaten the adoptionand exploitation of cognitive radios for open civil networks.

A Secure Cooperative Sensing Protocol for Cognitive Radio Networks

Cognitive radio networks sense spectrum occupancyand manage themselves to operate in unused bands without disturbing licensed users. Spectrum sensing is more accurate if jointly performed by several reliable nodes. Even though cooperative sensing is an active area of research, the secureauthentication of local sensing reports remains unsolved, thus empowering false results. This paper presents a distributed protocol based on digital signatures and hash functions, and ananalysis of its security features. The system allows determining a final sensing decision from multiple sources in a quick and secure way.

Inhibition of bicarbonate transport protects embryonic heart against reoxygenation-induced dysfunction.

It has not been well established whether the mechanisms participating in pH regulation in the anoxic-reoxygenated developing myocardium resemble those operating in the adult. We have specially examined the importance of Na+/H+ exchange (NHE) and HCO3-dependent transports in cardiac activity after changes in extracellular pH (pHo). Spontaneously contracting hearts isolated from 4-day-old chick embryos were submitted to single or repeated anoxia (1 min) followed by reoxygenation (10 min). The chronotropic, dromotropic and inotropic responses of the hearts were determined in standard HCO3- buffer at pHo 7.4 and at pHo 6.5 (hypercapnic acidosis). In distinct experiments, acidotic anoxia preceded reoxygenation at pHo 7.4. NHE was blocked with amiloride derivative HMA (1 micro mol/l) and HCO3-dependent transports were inactivated by replacement of HCO3 or blockade with stilbene derivative DIDS (100 micro mol/l). Anoxia caused transient tachycardia, depressed mechanical function and induced contracture. Reoxygenation temporarily provoked cardiac arrest, atrio-ventricular (AV) block, arrhythmias and depression of contractility. Addition of DIDS or substitution of HCO3 at pHo 7.4 had the same effects as acidosis per se, i.e. shortened contractile activity and increased incidence of arrhythmias during anoxia, prolonged cardioplegia and provoked arrhythmias at reoxygenation. Under anoxia at pHo 6.5/reoxygenation at pHo 7.4, cardioplegia, AV block and arrhythmias were all markedly prolonged. Interestingly, in the latter protocol, DIDS suppressed AV block and arrhythmias during reoxygenation, whereas HMA had no effect. Thus, intracellular pH regulation in the anoxic-reoxygenated embryonic heart appears to depend predominantly on HCO3 availability and transport. Furthermore, pharmacological inhibition of anion transport can protect against reoxygenation-induced dysfunction.

Occasional adnominal idiom modification : a cognitive linguistic approach

abstract:occasional Adnominal Idiom Modification - A Cognitive Linguistic Approach From a cognitive-linguistic perspective, this paper explores alternative types of adnoniinal modification in occasional variants of English verbal idioms. Being discussed against data extracted from the British National Corpiis (BNC), the model claims that in idioni-production idiomatic constructions are activated as complex linguistic schemas to code a context-specific target-conceptualisation. Adnominal pre- and postmodifications are one specific form of creative alteration to adapt the idiom for this purpose. Semantically, idiom-interna1 NPextension is not a uniforni process. It is necessary to distinguish two systematic types of adnominal modification: external and internal modification (Ernst 1981). While external NPmodification has adverbial function, ¡.e. it modifies the idiom as a unit, internal modification directly applies to the head-noun and thus depends on the degree of motivation and analysability of a given idiom. Following the cognitive-linguistic framework, these dimensions of idiom-transparency result from the language user's ability to remotivate the bipartite semantic structure by conceptual metaphors and metonymies.

Hemispheric language asymmetry in first episode psychosis and schizotypy : the role of cannabis consumption and cognitive disorganization

Cannabis use has been related to an elevated psychosis risk and attenuated cognitive functioning. Cannabis-related cognitive impairments are also observed in populations along the psychosis dimension. We here investigated whether a potential behavioural marker of the psychosis dimension (attenuated functional hemispheric asymmetry) is even further attenuated in individuals using cannabis (CU) versus those not using cannabis (nCU). We tested 29 patients with first episode psychosis (FEP; 11 CU) and 90 healthy controls (38 CU) on lateralized lexical decisions assessing left hemisphere language dominance. In patients, psychotic symptoms were assessed (PANSS). In controls, self-reported schizotypy was assessed (O-LIFE questionnaire). Results indicated that nCU FEP patients had a relative reduced hemispheric asymmetry, as did controls with increasing cognitive disorganisation scores, in particular when belonging to the group of nCU controls. Positive, disorganised and negative PANSS scores in patients and negative and positive schizotypy in controls were unrelated to hemispheric asymmetry. These findings suggest that cannabis use balances rather than exacerbates uncommon hemispheric laterality patterns. Moreover, in healthy populations, the potential stabilisation of typical hemispheric asymmetry in CU might be most relevant to individuals with elevated cognitive disorganisation. We discuss the potential beneficial and harmful effects of cannabis use along the psychosis dimension together with propositions for future studies that should account for the mediating role of additional substances (e.g. nicotine), cannabis composition (e.g. cannabidiol content), and individual differences (e.g. physical health, or absence of significant polysubstance use).