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Biomedical subjects

R M Lazar

Publications and source records attributed to R M Lazar.

14 recordsLinked to original sources
PubMed1997

Central poststroke pain and Wallenberg's lateral medullary infarction: frequency, character, and determinants in 63 patients.

UNLABELLED: Central poststroke pain (CPSP) is an infrequently recognized complication of lateral medullary infarction (LMI). We determined the frequency, nature, and predictors of this complication in 63 patients with LMI. The hypothesis tested was that the degree of clinical sensory loss and extent of infarction seen on MRI, both graded by a predetermined scoring scale, would be predictive of CPSP. We also performed quantitative sensory testing (QST) of thermal and pressure sensation thresholds in a subgroup of 19 patients (nine with CPSP and 10 without) to analyze in detail the spinothalamic and trigeminothalamic systems mediating these modalities from both sides of the face and body. We analyzed these results for specific markers of CPSP. RESULTS: CPSP developed in 25% (16/63) of the patients, all within 6 months. This was constant and severe with frequent allodynia, but responded in all cases to amitriptyline and recurred promptly on attempted weaning. CPSP affected the ipsilateral peri-orbital region most commonly, either alone or in combination with the contralateral limbs. Ipsilateral neurotrophic facial ulceration developed in two cases. CPSP correlated significantly (Fisher's exact test, p < 0.0002) with the degree of clinical sensory loss but not with the size of infarction seen on MRI (Fisher's exact test, p = 0.7). QST revealed a highly specific (100%) and sensitive (89%) finding for CPSP-thresholds from the check contralateral to the LMI were normal in eight of nine cases with CPSP and abnormal in all of the 10 cases without CPSP. Abnormalities in the face contralateral to the infarct are referable to the crossed trigeminothalamic tract in the medullary reticular formation medial to the infarcted lateral medulla. We conclude that this argues for the theory that central pain is caused by denervation sensitivity of the "paleo"-reticulothalamic connections due to a selective "neo"-spinothalamic lesion.

Adult↗
PubMed1996

"Semantic" conduction aphasia from a posterior insular cortex infarction.

A unique infarction limited to the posterior insula and intrasylvian parietal opercular cortex produced a subtype of conduction aphasia, characterized by a predominance of semantic paraphasias. Temporal lobe hypoperfusion seen on hexamethylpropyleneamineoxime single-photon emission computed tomography in the absence of any signs of ischemia suggested that cortical diaschisis played a role in the emergence of this syndrome.

Aphasia, Conduction↗
PubMed1996

Continuous time estimation as a behavioural index of human cerebral ischaemia during temporary occlusion of the internal carotid artery.

OBJECTIVE: To determine whether a continuous time estimation task during test occlusions of either internal carotid artery would increase the ability to detect the earliest signs of cerebral ischaemia in the anterior circulation. METHODS: Four patients were involved in real time measurement of their timing accuracy before, during, and after each test occlusion. While under each test condition, patients were instructed to press a mouse button connected to a computer and then to press it again no sooner than 10 seconds from the previous response but no longer than 13 seconds later. While being given automated feedback on accuracy, patients were instructed to continually press the mouse on the target schedule to maximise correct responses until told to stop. RESULTS: The data showed deterioration of timing accuracy during carotid occlusion (P < 0.05), which always preceded the onset of physical signs and correlated in one patient with the presence of reduced regional cerebral blood flow. CONCLUSION: Decline of sustained attention under conditions of test balloon occlusion of either internal carotid artery was an indicator of failure to maintain adequate cerebral blood flow to sustain normal neurological function. The demonstration of the behavioural effects of early cerebral ischaemia shows the feasibility of an experimental model for the study of human brain function, and may now make it possible to quantify more precisely the time course of acute ischaemic events.

Arterial Occlusive Diseases↗
PubMed1995

'Steal' is an unestablished mechanism for the clinical presentation of cerebral arteriovenous malformations.

BACKGROUND AND PURPOSE: Focal neurological deficits (FNDs) in patients with arteriovenous malformations (AVMs) have been widely attributed to the phenomenon of "cerebral steal." The incidence of focal deficits was investigated in a large prospective sample. METHODS: Using data from patient history and examination, CT or MRI, and transcranial Doppler sonography, we studied 152 consecutive, prospective AVM patients for evidence of FNDs unrelated to a hemorrhagic event. Feeding mean arterial pressure was measured during superselective angiography. RESULTS: Two (1.3%) of 152 patients met the criteria for a progressive FND. Nonprogressive FNDs were seen in 11 (7.2%) patients (stable in 4.6%, reversible in 2.6%). The median observation time period was 17 months (range, 1 to 60 months). There were no differences in transcranial Doppler mean velocities in feeding arteries in FND versus non-FND groups (118 +/- 44 versus 112 +/- 37 cm/s, P > .05) or pulsatility indexes (0.53 +/- 0.20 versus 0.55 +/- 0.15, P > .05). Feeding artery pressure was similar in FND (n = 10) and non-FND (n = 96) groups (39 +/- 16 versus 39 +/- 16 mm Hg at a systemic pressure of 82 +/- 18 versus 75 +/- 14 mm Hg, NS). CONCLUSIONS: Nonhemorrhagic focal neurological syndromes in AVM patients are infrequent. Progressive deficits are especially rare. There was no relation between feeding artery pressure or flow velocities and FND. There does not appear to be sufficient evidence to assign steal as an operative pathophysiological mechanism in the vast majority of AVM patients.

Adult↗
PubMed1994

Intrahemispheric localization of drawing dysfunction.

We evaluated drawing disability in 37 patients with right hemispheric stroke and in eight controls with no brain disease. Blinded evaluations included measures of overall recognizability and hemineglect. By mapping the CT lesions of patients, we found that damage to parieto-occipital cortex in poor drawers correlated with poor performance on a line bisection task whereas frontal, subcortical damage in poor drawers did not. We propose that drawing disability may be produced by visual-spatial dysfunction in patients with posterior lesions and by a disturbance of integrated motor function in those with frontal, subcortical damage.

Adult↗
PubMed1993

Anxiety disorders in a neuromuscular clinic.

Twenty patients with myasthenia gravis and 15 patients with polymyositis/dermatomyositis were assessed with a structured interview. Fifteen patients (43%) were diagnosed with an anxiety disorder. Significantly more myasthenic patients (40%) than polymyositis/dermatomyositis patients (7%) were diagnosed with panic disorder/agoraphobia. These findings suggest that the symptoms of myasthenia gravis may predispose vulnerable individuals to panic disorder/agoraphobia.

Adolescent↗
PubMed1992

Use of a structured interview to diagnose anxiety disorders in a minority population.

A structured interview--the Anxiety Disorder Interview Schedule--Revised (ADIS-R)--was used to assess the presence of panic disorder and other anxiety disorders in 100 psychiatric outpatients at an inner-city municipal hospital, most of whom were black and of low socioeconomic status. The ADIS-R identified seven patients as having a primary diagnosis of panic disorder and 16 as having a secondary diagnosis of panic disorder. None of the patients received a primary diagnosis of panic disorder from the outpatient clinical staff, who did not use the ADIS-R. The authors conclude that a structured interview is an effective tool for identifying panic disorder in a minority population, in whom the disorder is generally underdiagnosed.

Adolescent↗
PubMed1992

Left hemiparalexia.

Three patients with left splenial lesions made paralexic errors restricted to the left end of words. Errors appeared more frequently when a correct response was highly dependent on the initial letter of the stimulus. One patient had full visual fields with hemialexia affecting the left visual field. The other two patients had complete right hemianopia. We attribute left-sided reading errors in the hemianopic patients to a retinotopically restricted disconnection pattern that selectively disrupts transfer of information originating from the peripheral left visual field. Functional resistance of the more numerous transcallosal projections representing visual field adjacent to the vertical meridian may account for such a pattern. The emergence of positional reading errors from retinotopically restricted left hemifield disconnection suggests that callosal information transfer during normal reading may primarily involve elemental sensory rather than lexical/semantic information.

Adult↗
PubMed1992

Teaching arbitrary matching via sample stimulus-control shaping to young children and mentally retarded individuals: a methodological note.

Two experiments demonstrated the efficacy of sample stimulus-control shaping programs for teaching arbitrary matching to 4 subjects who did not acquire the performances via standard methods (i.e., differential reinforcement and, in two cases, comparison intensity fading). All 4 had previously demonstrated identity matching with two-dimensional forms. Identity matching performances were then transformed into arbitrary matching by gradually changing the sample stimuli until they no longer resembled the comparison stimuli. Where applicable, these methods may have advantages over others that have been used after the failure of standard techniques.

Adolescent↗
PubMed1984

The formation of visual stimulus equivalences in children.

Four normal children were presented a series of matching-to-sample tasks, using five sets of visual stimuli designated A, B, C, D, and E. Stimulus equivalences were established by matching stimuli from one set to those from another set. Each set consisted of three stimuli, so matching set A to set D meant that each stimulus in set A served as a sample with all three stimuli in set D as comparisons. Subjects were first taught AD and DC matching and were then able to perform AC/CA matching without additional training. After ED was taught directly, CE/EC and AE/EA performances emerged. Following CB training, three new equivalences were demonstrated: AB/BA, EB/BE, and DB/BD. Oral naming of each stimulus showed that subjects had not assigned a common label to stimuli in the same class, indicating that naming is not necessary for the formation of stimulus equivalences. The absence of response mediation suggests that matching to sample can form direct stimulus-stimulus associations. The data also provide support for the notion that generative performances are outcomes of existing stimulus-control relationships.

Child↗
PubMed1983

Effects of frontal lobe lesions on hypothesis sampling during concept formation.

Thirty-two subjects with unilateral cerebral tumors were assessed for the use of hypotheses and cognitive strategies during a visual discrimination task. Subjects with frontal lobe lesions attained fewer concepts and used fewer appropriate hypotheses than subjects with tumors confined to the posterior hemisphere, although there was no difference in total hypotheses used. Lose-stay errors were committed with greater frequency among patients with frontal lobe lesions, although not all subjects with frontal lobe tumors exhibited this error tendency. The results of hypothesis sampling and a second visual discrimination transfer task suggested that the frontal lobe deficit was related to difficulty in attending to multiple cues and in monitoring feedback to segregate relevant from irrelevant sources of information.

Adult↗