Lange Clinical Neurology And Neuroanatomy A Localization Ba Ed Approach Pdf
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The past decade has brought important advances in our understanding of the brain, particularly its influence on the behavior, emotions, and personality of children and adolescents. In the tradition of its predecessors, the third edition of the Handbook of Clinical Child Neuropsychology enhances this understanding by emphasizing current best practice, up-to-date science, and emerging theoretical trends for a comprehensive review of the field.
- HANKEY'S SECOND EDITION CLINICAL NEUROLOGY
- Handbook of Clinical Child Neuropsychology
- HANKEY'S SECOND EDITION CLINICAL NEUROLOGY
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HANKEY'S SECOND EDITION CLINICAL NEUROLOGY
Functional neurological conversion disorder FND is a condition at the interface of neurology and psychiatry. While useful for explanatory and treatment models, this framework may require more nuanced considerations in the context of quantitative structural neuroimaging findings in FND. Moreover, high co-occurrence of FND and somatic symptom disorders SSD as defined in DSM-IV somatization disorder, somatoform pain disorder, and undifferentiated somatoform disorder; referred to as SSD for brevity in this article raises the possibility of a partially overlapping pathophysiology.
In this systematic review, we use a transdiagnostic approach to review and appraise the structural neuroimaging literature in FND and SSD. While larger sample size studies are needed for definitive characterization, this article highlights that individuals with FND and SSD may exhibit sensorimotor, prefrontal, striatal-thalamic, paralimbic, and limbic structural alterations. The structural neuroimaging literature is contextualized within the neurobiology of stress-related neuroplasticity, gender differences, psychiatric comorbidities, and the greater spectrum of functional somatic disorders.
Furthermore, it remains unclear whether structural alterations relate to predisposing vulnerabilities or consequences of the disorder. Functional neurological conversion disorder FND is a complex condition at the interface of neurology and psychiatry Trimble and Reynolds, As such, patients with FND were marginalized for much of the 20th century, with limited clinical and neuroscientific interest Keynejad et al. By contrast, founders of modern neurology and psychiatry were immensely intrigued by FND.
Recently, there is renewed interest in FND, catalyzed by the DSM-5 diagnostic criteria and pathophysiology-based research Carson et al. Neurologically, emphasis is now given to identifying examination signs and semiologic features specific for FND Avbersek and Sisodiya, ; Daum et al.
Modern biopsychosocial formulations for FND incorporate the spectrum of predisposing vulnerabilities, acute precipitants, and perpetuating factors Keynejad et al. According to this framing, the hardware i. This framework is supported by the preservation of brain structure on clinical inspection of magnetic resonance imaging MRI scans at the macroscopic level.
In parallel, there has been considerable advance using task and resting-state functional neuroimaging to delineate the emerging neurobiology of FND, summarized in several reviews and meta-analyses Boeckle et al. Major themes across functional neuroimaging studies include: 1 heightened amygdalar reactivity to affectively valenced stimuli Aybek et al.
Other abnormalities include implicit attentional biases Pick et al. In addition, FND frequently co-exists clinically with the somatic symptom disorders SSD as largely defined in DSM-IV somatization disorder, somatoform pain disorder, and undifferentiated somatoform disorder Kozlowska et al. The SSD category in the DSM-5 was designed to consolidate the DSM-IV diagnostic categories of somatization disorder, somatoform pain disorder, and undifferentiated somatoform disorder, although this reconceptualization has markedly different criteria based on cognitive-affective and behavioral aspects and is more explicit about including patients with defined medical conditions Dimsdale et al.
We acknowledge that this is not a one to one translation see limitation section. The explicit co-occurrence of FND and SSD was previously codified in part by the DSM-IV somatization disorder diagnostic category that encompassed individuals with functional neurological symptoms and other prominent somatic symptoms.
Comorbid somatic symptoms in patients with FND also negatively impact healthcare utilization and prognosis Ettinger et al. Reviews and meta-analyses have summarized the functional neurobiology of SSD compared to healthy controls Boeckle et al. To aid the early-phase incorporation of structural neuroimaging findings in the development of biological models for FND and other functional somatic disorders, we used a transdiagnostic approach to conduct a systematic review and critically appraise the structural MRI literature in FND and SSD.
We contextualized the structural neuroimaging literature within the neurobiology of stress-related neuroplasticity, gender differences, psychiatric comorbidities, and the greater spectrum of functional somatic disorders. Lastly, future directions were outlined that may help accelerate the characterization of the pathophysiology of these enigmatic conditions. Exclusion criteria were: 1 Studies without quantitative analyses of imaging data; 2 Investigations of body dysmorphic disorder, hypochondriasis and illness anxiety disorder; 3 Studies of other functional somatic disorders such as fibromyalgia and irritable bowel syndrome; 4 Mixed cohorts that included individuals with major neurological comorbidities e.
References of selected articles were also reviewed to ensure the search was comprehensive. This yielded items for a total of articles after removing duplicates see Fig. This resulted in records. To identify articles for final inclusion, two raters I. This step resulted in 37 potentially eligible studies. In step 2, the same raters reviewed the full articles to determine if the article met inclusion criteria and any differences were reconciled.
Of 37 original selections, 29 were included. Healthy controls in all studies have no neurologic, psychiatric, or general medical conditions, unless mentioned otherwise. Ages provided in years. Structural MRI studies in somatization disorder, somatoform pain disorder, and undifferentiated somatoform disorder.
Overview of structural neuroimaging findings in functional neurological disorder FND and somatic symptom disorders SSD; DSM-IV somatization disorder, somatoform pain disorder, and undifferentiated somatoform disorder.
Directions of arrows show increases or decreases in regional brain structural measures compared to healthy controls. Several studies found no between group differences. Atmaca and colleagues reported that 12 women with unilateral functional motor symptoms compared to controls showed smaller bilateral caudate and right thalamic volumes Atmaca et al. Age of symptom onset positively correlated with left caudate volumes. In another study, 20 women with somatization disorder compared to controls showed smaller bilateral amygdalar volumes Atmaca et al.
Reduced pituitary volumes have been characterized in FND and somatization disorder populations compared to controls Atmaca et al. Overall, manual tracing MRI studies identified smaller pituitary volumes across individuals with FND and somatization disorder, suggesting disturbances in stress-related neuroendocrine systems.
Volumetric investigations performed in FND and SSD cohorts identified structural alterations across prefrontal-subcortical-limbic areas Aybek et al.
An early VBM study in 14 women with chronic somatoform pain disorder and high emotional pain responses showed decreased paralimbic cingulo-insular, parahippocampal, orbitofrontal , prefrontal, inferior temporal, and cerebellar gray matter GM volumes compared to controls Valet et al. Illness duration negatively correlated with left parahippocampal volumes and positively correlated with right thalamic volumes.
A VBM study in 25 patients with somatization disorder compared to controls showed decreased GM volume in the right cerebellum Crus I, and increased GM volumes in the left anterior cingulate cortex ACC , right middle frontal gyrus, and left angular gyrus Li et al.
Middle frontal gyrus GM volume inversely correlated with somatization subscale scores, while left ACC GM volume negatively correlated with set-shifting executive function errors. Collectively, these two studies indicate possible structural changes within cortico-limbic-cerebellar circuits in patients with SSD, though volumetric research in these populations is in its early stages.
By contrast, quantitative volumetric studies in FND populations have been performed by several groups. A dual VBM and voxel-based cortical thickness CTH study conducted in 15 patients with functional limb weakness showed no group-level differences compared to controls Aybek et al. In secondary analyses, however, the functional hemiparesis subgroup exhibited increased bilateral premotor CTH compared to controls.
In another study, Nicholson and colleagues used region-of-interest ROI FreeSurfer volumetric analyses to show that 14 patients with functional limb weakness exhibited smaller left thalamic and lentiform nucleus GM volumes compared to controls Nicholson et al. A within-group VBM study investigated structural associations with indices of patient-reported symptom severity, post-traumatic stress disorder PTSD , and adverse life event burden in 23 patients with mixed FND Perez et al.
Across all patients, there were no associations with FND symptom severity. However, in the 18 women with FND, parallel decreases in left anterior insular volume correlated with patient-reported symptom severity in ROI analyses. In women, the magnitude of childhood abuse burden also inversely correlated with left anterior insular volume. Each of these relationships held adjusting for trait anxiety, but did not remain significant controlling for depression.
Lifetime adverse event burden correlated with reduced left hippocampal volume across the entire cohort. In a related study, Perez and colleagues expanded their cohort to 26 FND patients and 27 controls to investigate between-group and within-group associations with health-related quality of life, trait anxiety, and depression Perez et al.
There were no volumetric differences between the complete FND cohort and controls. However, the sub-group of 13 FND patients with the most impaired physical health showed reduced left anterior insular GM volume compared to controls in ROI analyses; the sub-group of 13 patients with the greatest mental health impairments showed whole-brain corrected posterior lateral cerebellar volumetric increases implicated in aversive responses compared to controls.
Within-group analyses showed that individual-differences in right amygdalar volume correlated with elevated trait anxiety and impaired mental health.
In a pilot follow-up study performed on 22 of the initial 26 FND subjects, individual differences in baseline anterior hippocampal GM volume positively correlated with 6-month mental health outcomes; there were no volumetric associations with physical health outcomes Perez et al.
In additional support for structural alterations in limbic areas, 48 patients with functional movement disorders 17 also with functional limb weakness exhibited increased left amygdalar GM volumes compared to controls in whole-brain corrected analyses Maurer et al.
Furthermore, increased left striatal, fusiform gyrus, cerebellar and bilateral thalamic GM volumes, alongside reduced left sensorimotor cortical volumes were observed in patients with functional movement disorders. Female gender, symptom lateralization, psychotropic medication use, and individuals with functional limb weakness vs. In within-group analyses, childhood trauma burden positively correlated with left caudate and cerebellar tonsil volumes; patients with higher anxiety exhibited smaller left fusiform gyrus volumes and those with more depression displayed larger cerebellar tonsil volumes.
In this study, volumetric profiles did not correlate with illness duration or symptom severity. By contrast, another recently published VBM study reported decreased left caudate and right postcentral GM volumes in 27 individuals with functional tremor compared to controls Espay et al.
These distinct striatal findings across functional movement disorder cohorts highlight the need for additional replication. Developmental trajectories are important in contextualizing volumetric profiles in patients with FND.
In addition, SMA volumes positively correlated with faster reaction times in an emotion recognition task, interpreted to reflect enhanced motor readiness and vigilance to others' emotional states. ROI analyses also identified increased right postcentral gyrus and left insular volumes in patients with NDSD compared to controls. Notably, patients with chronic pain without NDSD compared to healthy controls also showed post-central gyrus volumetric increases in ROI analyses.
Patients with FND also exhibited increased amygdalar volumes compared to controls Maurer et al. Across three questionnaires collected at one time point, left anterior insular volumes negatively correlated with patient-reported FND symptom severity using ROI analyses in one cohort Perez et al. These brain-symptom severity findings have not been independently replicated. Several studies have applied surface-based approaches to delineate precentral gyrus and paralimbic alterations among other findings in patients with PNES and other motor FND subtypes Labate et al.
In within-group analyses, depression scores negatively correlated with right dorsal premotor volumes. Depression scores correlated with right superior frontal and paracentral cortical thinning; somatoform dissociation severity inversely correlated with left inferior frontal and central sulcus CTH. Individuals with PNES also exhibited bilateral precentral and right entorhinal and lateral occipital cortical thinning; between-group sulcal depth abnormalities are described in Table 1.
There were no between-group gyrification differences. In a recently published study, 23 patients with PNES showed decreased bilateral inferior frontal, medial orbitofrontal, left caudal middle frontal, right precentral gyri and left insular surface area compared to controls; increased left posterior cingulate surface area was also observed in patients with PNES Vasta et al. Another study in the same cohort showed that individual differences in dismissing attachment style correlated with reduced left parahippocampal CTH in women with FND Williams et al.
In addition, individual differences in confrontative coping and adaptive coping through accepting responsibility were associated with decreased right hippocampal volumes and increased ventral precentral gyrus CTH in women with FND, respectively.
Fourteen patients with chronic somatoform pain disorder showed thinning of left sensorimotor cortices pre and postcentral gyri and the left inferior temporal sulcus compared to controls Magon et al. These results were interpreted as identifying brain areas implicated in sensory and affective processing of pain. Overall, while the directionality of effects requires clarification, early evidence suggests that individual differences in caudal ACC and inferior frontal gyrus CTH in FND may be linked to somatoform dissociation Labate et al.
Several studies have used diffusion tensor imaging DTI to investigate white matter integrity in FND and somatization disorder Ding et al. Lee and colleagues used tract-based spatial statistics TBSS to characterize increased fractional anisotropy FA in the left internal and external capsules, corona radiata, uncinate fasciculus, and white matter tracts adjacent to the superior temporal gyrus in 16 PNES patients 15 women compared to controls Lee et al.
In a tractography study, a rightward asymmetry of the uncinate fasciculus was observed in 8 patients with PNES compared to controls Hernando et al. Age of PNES onset inversely correlated with the magnitude of uncinate fasciculus asymmetry.
In both DTI studies, data was acquired on multiple scanners, introducing a potential confound. A graph-theory study identified that 17 patients with PNES exhibited a more lattice-like small world white matter organization and decreased coupling strength of structural and functional connectivity profiles compared to controls Ding et al. In this study, structural connectivity was also altered across sensorimotor, attentional, subcortical, and default mode networks in patients with PNES compared to controls.
Handbook of Clinical Child Neuropsychology
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Functional neurological conversion disorder FND is a condition at the interface of neurology and psychiatry. While useful for explanatory and treatment models, this framework may require more nuanced considerations in the context of quantitative structural neuroimaging findings in FND. Moreover, high co-occurrence of FND and somatic symptom disorders SSD as defined in DSM-IV somatization disorder, somatoform pain disorder, and undifferentiated somatoform disorder; referred to as SSD for brevity in this article raises the possibility of a partially overlapping pathophysiology. In this systematic review, we use a transdiagnostic approach to review and appraise the structural neuroimaging literature in FND and SSD. While larger sample size studies are needed for definitive characterization, this article highlights that individuals with FND and SSD may exhibit sensorimotor, prefrontal, striatal-thalamic, paralimbic, and limbic structural alterations. The structural neuroimaging literature is contextualized within the neurobiology of stress-related neuroplasticity, gender differences, psychiatric comorbidities, and the greater spectrum of functional somatic disorders.
Morality is among the most sophisticated features of human judgement, behaviour and, ultimately, mind. In recent years, neuroscience has shown a growing interest in human morality, and has advanced our understanding of the cognitive and emotional processes involved in moral decisions, their anatomical substrates and the neurology of abnormal moral behaviour. In this article, we review research findings that have provided a key insight into the functional and clinical neuroanatomy of the brain areas involved in normal and abnormal moral behaviour. Because morality is a complex process, some of these brain structures share their neural circuits with those controlling other behavioural processes, such as emotions and theory of mind. Among the anatomical structures implicated in morality are the frontal, temporal and cingulate cortices.
HANKEY'S SECOND EDITION CLINICAL NEUROLOGY
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Выбегая из собора в маленький дворик, он зацепился пиджаком за дверь, и плотная ткань резко заставила его остановиться, не сразу разорвавшись. Он потерял равновесие, шатаясь, выскочил на слепящее солнце и прямо перед собой увидел лестницу. Перепрыгнув через веревку, он побежал по ступенькам, слишком поздно сообразив, куда ведет эта лестница. Теперь Дэвид Беккер стоял в каменной клетке, с трудом переводя дыхание и ощущая жгучую боль в боку.
Он. Он должен быть .
В первый раз в жизни. Мидж стояла на своем: - Но, сэр. Коммандер Стратмор обошел систему Сквозь строй. Фонтейн подошел к ней, едва сдерживая гнев.
Кольцо. Беккер смотрел на него в полном недоумении. Человек сунул руку в карман и, вытащив пистолет, нацелил его Беккеру в голову. - El anillo. Внезапно Беккера охватило чувство, которого он никогда прежде не испытывал.
Он скрыл информацию от директора, запустил вирус в самый защищенный компьютер страны, и, разумеется, ему придется за это дорого заплатить. Он исходил из самых патриотических соображений, но все пошло вкривь и вкось. Результатом стали смерть и предательство. Теперь начнутся судебные процессы, последуют обвинения, общественное негодование. Он много лет служил своей стране верой и правдой и не может допустить такого конца.
Так что вы хотите сказать. Джабба заглянул в распечатку. - Вот что я хочу сказать. Червь Танкадо не нацелен на наш банк данных. - Он откашлялся.
Она перенеслась мыслями в тот вечер, когда президент Джорджтаунского университета предложил Дэвиду повышение - должность декана факультета лингвистики.
Что с тобой? - удивленно спросил Хейл. Сьюзан встретилась с ним взглядом и прикусила губу. - Ничего, - выдавила. Но это было не .
И все же… секрет Цифровой крепости будет служить Хейлу единственной гарантией, и он, быть может, будет вести себя благоразумно. Как бы там ни было, Стратмор знал, что Хейла можно будет всегда ликвидировать в случае необходимости. - Решайтесь, приятель! - с издевкой в голосе сказал Хейл. - Мы уходим или нет? - Его руки клещами сжимали горло Сьюзан.
Беккер почувствовал тошноту. Это какая-то глупая шутка. Он не находил слов. - Ты знаешь ее фамилию. Двухцветный задумался и развел руками.
Он знал: все уверены, что он ушел. В шуме, доносившемся из-под пола шифровалки, в его голове звучал девиз лаборатории систем безопасности: Действуй, объясняться будешь. В мире высоких ставок, в котором от компьютерной безопасности зависело слишком многое, минуты зачастую означали спасение системы или ее гибель.
Стратмор посмотрел на ее залитое слезами лицо, и ему показалось, что вся она засветилась в сиянии дневного света.