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PubMed2006

Lateralization of emotional prosody in the brain: an overview and synopsis on the impact of study design.

Recently, research on the lateralization of linguistic and nonlinguistic (emotional) prosody has experienced a revival. However, both neuroimaging and patient evidence do not draw a coherent picture substantiating right-hemispheric lateralization of prosody and emotional prosody in particular. The current overview summarizes positions and data on the lateralization of emotion and emotional prosodic processing in the brain and proposes that: (1) the realization of emotional prosodic processing in the brain is based on differentially lateralized subprocesses and (2) methodological factors can influence the lateralization of emotional prosody in neuroimaging investigations. Latter evidence reveals that emotional valence effects are strongly right lateralized in studies using compact blocked presentation of emotional stimuli. In contrast, data obtained from event-related studies are indicative of bilateral or left-accented lateralization of emotional prosodic valence. These findings suggest a strong interaction between language and emotional prosodic processing.

Cerebral Cortex↗
PubMed2003

Lateralized and focal clinical, EEG, and FLAIR MRI abnormalities in Creutzfeldt-Jakob disease.

OBJECTIVE: Creutzfeldt-Jakob disease (CJD) is a rapidly progressive fatal prion disorder with typical clinical findings of dementia, motor dysfunction, and myoclonus and characteristic electroencephalographic (EEG) findings of bilateral synchronous periodic sharp waves. Advances in neuroimaging capabilities with diffusion-weighted and fluid-attenuated inversion recovery (FLAIR) magnetic resonance imaging (MRI) techniques have shown promise in the non-invasive diagnosis of CJD. This series illustrates the correlation between the lateralized and focal clinical, EEG, and MRI FLAIR sequence abnormalities in 8 patients (7 men and one woman 55-73 years old) with CJD. METHODS: A case series of 8 patients, evaluated at Mayo Clinic, who had a history of rapidly progressive lateralized or focal neurologic dysfunction and laboratory findings consistent with CJD between 1996 and 1999 were identified. EEG, MRI of the head with FLAIR sequence, and cerebrospinal fluid studies were performed in all patients. RESULTS: Mean time to death from symptom onset was 4 months. Symptoms were lateralized to the left hemisphere in 5 patients and to the right hemisphere in two. One patient showed bilateral occipital lobe involvement. In all patients, the EEG showed lateralized or focal periodic sharp waves that colocalized with clinical cerebral dysfunction. FLAIR MRI images revealed increased signal in the cortical ribbon and deep gray matter corresponding to the lateralized clinical and EEG findings in 7 patients. The other patient had bilateral occipital increased signal on FLAIR MRI. CONCLUSIONS: CJD may present with lateralized or focal cortical syndromes with colocalizing EEG and MRI findings. With the appropriate clinical history and laboratory evaluation, the corresponding areas of increased signal on FLAIR MRI provide supportive evidence of the disease. SIGNIFICANCE: CJD can sometimes present with more focal or lateralized clinical findings, and the colocalizing EEG and MRI findings can help make or confirm the diagnosis of CJD.

14-3-3 Proteins↗
PubMed2001

Verbal retention lateralizes patients with unilateral temporal lobe epilepsy and bilateral hippocampal atrophy.

PURPOSE: To examine the lateralization utility of preoperative verbal retention in patients with and without bilateral hippocampal atrophy. METHODS: The sample consisted of 74 patients with EEG-defined unilateral temporal lobe epilepsy (TLE) who had also undergone volumetric magnetic resonance imaging (MRI). Verbal retention was operationalized by the Logical Memory percentage retention subtest (LM%) of the Wechsler Memory Scale. Patients were divided into groups with (a) bilaterally normal hippocampal volumes, (b) unilateral atrophy, or (c) bilateral atrophy. Two different thresholds (empirically derived vs. normative) were used to lateralize on the basis of LM%. LM% lateralization was then examined by group using chi2, sensitivity, positive predictive values, and odds ratios. Analyses were also conducted separately in the subset of patients who were seizure free after surgery. RESULTS: Mean LM% performance was significantly lower in patients with left versus right TLE in the subset with bilateral hippocampal atrophy (p = 0.018), but not in patients with a normal MRI (p = 0.918) or unilateral atrophy (p = 0.087). The odds of a correct lateralization by LM% increased from 1.67 in patients with normal MRI to 36.11 in patients with bilateral hippocampal atrophy. The power of a right and left lateralization prediction by LM% was 100% and 75%, respectively, in patients with bilateral hippocampal atrophy. Similar results were obtained when analysis was restricted to patients who were seizure free after surgery. CONCLUSIONS: Preoperative verbal retention as measured by LM% may provide meaningful lateralization information in patients who are difficult to lateralize via MRI.

Adolescent↗
PubMed2001

Lateralizing and localizing values of ictal onset recorded on the scalp: evidence from simultaneous recordings with intracranial foramen ovale electrodes.

PURPOSE: The value of scalp recordings to localize and lateralize seizure onset in temporal lobe epilepsy has been assessed by comparing simultaneous scalp and intracranial foramen ovale (FO) recordings during presurgical assessment. The sensitivity of scalp recordings for detecting mesial temporal ictal onset has been compared with a "gold standard" provided by simultaneous deep intracranial FO recordings from the mesial aspect of the temporal lobe. As FO electrodes are introduced via anatomic holes, they provide a unique opportunity to record simultaneously from scalp and mesial temporal structures without disrupting the conducting properties of the brain coverings by burr holes and wounds, which can otherwise make simultaneous scalp and intracranial recordings unrepresentative of the habitual EEG. METHODS: Simultaneous FO and scalp recordings from 314 seizures have been studied in 110 patients under telemetric presurgical assessment for temporal lobe epilepsy. Seizure onset was identified on scalp records while blind to recordings from FO electrodes and vice versa. RESULTS: Bilateral onset (symmetric or asymmetric) was more commonly found in scalp than in FO recordings. The contrary was true for unilateral seizure onset. In seizures with bilateral asymmetric onset on the scalp, the topography of largest-amplitude scalp changes at onset does not have localizing or lateralizing value. However, 75-76% of seizures showing unilateral scalp onset with largest amplitude at T1/T2 or T3/T4 had mesial temporal onset. This proportion dropped to 42% among all seizures with a unilateral scalp onset at other locations. Of those seizures with unilateral onset on the scalp at T1/T2, 65.2% showed an ipsilateral mesial temporal onset, and 10.9% had scalp onset incorrectly lateralized with respect to the mesial temporal onset seen on FO recordings. In seizures with a unilateral onset on the scalp at electrodes other than T1/T2, the proportions of seizures with correctly and incorrectly lateralized mesial temporal onset were 37.5 and 4.2%, respectively. Thus the ratio between incorrectly and correctly lateralized mesial temporal onsets is largely similar for seizures with unilateral scalp onset at T1/T2 (16.7%) and for seizures with unilateral scalp onset at electrodes other than T1/T2 (11.2%). The onset of scalp changes before the onset of clinical manifestations is not associated with a lower proportion of seizures with bilateral onset on the scalp, or with a higher percentage of mesial temporal seizures or of mesial temporal seizures starting ipsilateral to the side of scalp onset. In contrast, the majority (78.4%) of mesial temporal seizures showed clinical manifestations starting after ictal onset on FO recordings. CONCLUSIONS: A bilateral scalp onset (symmetric or asymmetric) is compatible with a mesial temporal onset, and should not deter further surgical assessment. Although a unilateral scalp onset at T1/T2 or T3/T4 is associated with a higher probability of mesial temporal onset, a unilateral onset at other scalp electrodes does not exclude mesial temporal onset. A unilateral scalp onset at electrodes other than T1/T2 is less likely to be associated with mesial temporal onset, but its lateralizing value is similar to that of unilateral scalp onset at T1/T2. The presence of clinical manifestations preceding scalp onset does not reduce the localizing or lateralizing values of scalp recordings.

Adolescent↗
PubMed2000

Corpus callosum and cerebral laterality in a modular brain model.

This paper elaborates the function of corpus callosum in the brain model that contains encoding and modulating axons: the former encode data as presynaptic axonal 'on-off' patterns, and the latter help the former convert data into long-term memory through the development of long-term potentiation and depression. It is hypothesized that callosal axons transfer data codes as interhemispheric memory. Bisection of corpus callosum cuts off interhemispheric data transfer and results in strange-hand syndrome, decreased attention and difficulties in acquiring new interdependent bimanual skills. While uniting two hemispheres for a unitary consciousness, corpus callosum contributes to two similar sets of integrated abstract memory, one in each hemisphere. Therefore, it takes bilateral cerebral lesions to manifest a failure of converting short-term memory into long-term memory. The asymmetric callosal data transfer may correlate with cerebral laterality where a cerebral function, such as language, is conducted mainly in one hemisphere for the benefit of less interhemispheric data-traffic. Complete lateralization of a cerebral function is the rare occasion when the specialized neuron groups (modules) for that function all reside in one hemisphere. It is possible that many cerebral functions including language are incompletely lateralized, and corpus callosum links the non-lateralized modules with the lateralized ones. The more the cerebral lateralization, the fewer the non-lateralized modules to be linked, and the smaller the corpus callosum.

Corpus Callosum↗
PubMed1993

Changes in shapes of surviving motor neurons in amyotrophic lateral sclerosis.

In amyotrophic lateral sclerosis, motor neurons in the spinal cord and brainstem shrink before they die. In 12 cases of sporadic amyotrophic lateral sclerosis, and in 11 control subjects, we have measured the neurons in the second sacral segment and the hypoglossal nucleus, and have calculated a 'shape index' that shows the convexity or concavity of the cell body. (The shape index, SI = 100 x C/P, where C is the circumference of the largest circle that can be inscribed in the neuron and P is the perimeter of the perikaryon, including the bases of the dendrites as seen in a Nissl preparation. The shape index increases with increasing convexity of the cell.) In the ventral horn of segment S2 and in the hypoglossal nucleus, the surviving motor neurons in amyotrophic lateral sclerosis showed significantly decreased size and increased shape index (convexity) of the cell bodies. By contrast, the nucleus of Onuf in segment S2, consisting of neurons that supply the pelvic floor muscles, was preserved in amyotrophic lateral sclerosis. Its cells did not differ significantly in size or convexity between the amyotrophic lateral sclerosis and control groups. In both the hypoglossal and S2 neuronal populations in amyotrophic lateral sclerosis, the sizes of the cells were positively correlated with the numbers of surviving motor neurons. However, there was no correlation of the shape index with numbers of cells. This is interpreted as due to shrinkage of neurons still taking place at the time of death, when the changes in shape were probably largely completed. These observations indicate that the mechanism of neuronal atrophy in amyotrophic lateral sclerosis may involve both reduced protein synthesis and enzymatic degradation of the cytoskeleton within the larger dendrites.

Aged↗
PubMed1998

Late lateralizing and localizing EEG features of scalp-recorded temporal lobe seizures.

The authors studied the lateralizing value for temporal epileptogenesis of focal or hemispheric EEG ictal features that first appear > or = 5 seconds after hemispheric or diffuse EEG changes or after an artifact-obscured onset, by correlation with side of lobectomy abolishing or producing > or = 90% improvement of complex partial seizures (CPS). One hundred forty-eight seizures in 39 patients rendered seizure-free (SF) by lobectomy lacked early localizing features of which 91 (61%) seizures in 37 (95%) patients had late lateralizing or localizing phenomena. Eighty-seven (96%) of 91 late localizing or lateralizing seizures occurred ipsilateral to lobectomy, involving 35 (95%) of 37 patients. Late contralateral and shifting phenomena occurred in a total of 4 seizures of 2 patients. Among 17 non-SF but > or = 90% improved patients, 30 (48%) of 63 seizures lacking early localizing features showed late localizing or lateralizing phenomena. Of these, twenty (67%) involving 12 (71%) patients occurred ipsilateral to lobectomy. Among the remaining 5 (29%) patients, a total of 5 seizures (17%) were contralateral while 5 (17%) exhibited shifting laterality. These data indicate that seizures with late (> or = 5 seconds) localizing or lateralizing features cannot be discounted when assessing laterality of temporal epileptogenesis but cannot be used as the sole electrographic criterion.

Adolescent↗
PubMed2003

Mixed lateral preference and parental left-handedness: possible markers of risk for PTSD.

Degree of lateral preference (mixed versus consistent), family history of parental left-handedness, and presence of posttraumatic stress disorder (PTSD) were measured in 118 right-handed male U.S. combat veterans. Right-handed participants with mixed lateral preference were more likely to have PTSD than were right-handers with consistent lateral preference. Respondents reporting a left-handed parent were also more likely to have PTSD. Finally, there was a significant difference in the proportion of participants with PTSD for three groups: participants with parental left-handedness and mixed lateral preference (100% PTSD), participants with parental left-handedness or mixed lateral preference (70% PTSD), and participants with neither parental left-handedness nor mixed lateral preference (44% PTSD). These findings suggest the possible usefulness of further examining the relationship between mixed lateral preference, parental left-handedness, and other possible indicators of risk for PTSD.

Biomarkers↗
PubMed2006

Design complexity and strength of laterality are correlated in New Caledonian crows' pandanus tool manufacture.

Population-level laterality is generally considered to reflect functional brain specialization. Consequently, the strength of population-level laterality in manipulatory tasks is predicted to positively correlate with task complexity. This relationship has not been investigated in tool manufacture. Here, we report the correlation between strength of laterality and design complexity in the manufacture of New Caledonian crows' three pandanus tool designs: wide, narrow and stepped designs. We documented indirect evidence of over 5,800 tool manufactures on 1,232 pandanus trees at 23 sites. We found that the strength of laterality in tool manufacture was correlated with design complexity in three ways: (i) the strongest effect size among the population-level edge biases for each design was for the more complex, stepped design, (ii) the strength of laterality at individual sites was on average greater for the stepped design than it was for the simpler wide and narrow, non-stepped designs, and (iii) there was a positive, but non-significant, trend for a correlation between the strength of laterality and the number of steps on a stepped tool. These three aspects together indicate that greater design complexity generally elicits stronger lateralization of crows' pandanus tool manufacture.

Animals↗
PubMed1985

Lateral preference in mastication: a feasibility study.

To study lateral bolus placement during mastication, referred to as masticatory lateral preference, fifteen males and ten females chewed sugarless gum for 15, 20 and 25 s, and visual inspections were done of either right or left side bolus placements. In each of three series of observations, there were no significant differences between right or left side bolus placements. Three consecutive spot checks, in single subjects, showed that lateral preference occurred at random. However, information on a favoured chewing side predicted fairly reliably the side of observed masticatory lateral preference. Observed lateral preference could not be predicted from hand laterality. Consistent and predominant right or left lateral preference was, presumably, an expression of mainly motivational chewing behaviour.

Adult↗
PubMed2000

Lateralization of temporal lobe epilepsy (TLE) and discrimination of TLE from extra-TLE using pattern analysis of magnetic resonance spectroscopic and volumetric data.

PURPOSE: To examine whether or not pattern analysis of magnetic resonance volumetric (MRVol) and proton magnetic resonance spectroscopic imaging (1H-MRSI) data would enable (a) the accurate lateralization of temporal lobe epilepsy (TLE) and (b) the discrimination of TLE from extratemporal epilepsy (E-TLE). METHODS: For lateralization analysis, we used data from 150 nonforeign tissue lesional TLE patients [88 left-sided (L-TLE), 46 right-sided (R-TLE), and 16 bilateral (Bi-TLE)]. For the discrimination of TLE from E-TLE, we used data from 174 patients (145 with unilateral TLE, 14 with unilateral E-TLE, and 15 with widespread epileptogenic zones involving both the TL and extra-TL regions-multilobar epilepsy). A series of "leave-one-out" cross-validated linear discriminant analyses were performed using the MRVol and 1H-MRSI data sets to lateralize TLE and discriminate it from E-TLE. RESULTS: Lateralization: The leave-one-out linear discriminant analyses were able to correctly lateralize (with a posterior probability >0.50) 120 (90%) of the 134 L-TLE and R-TLE patients. Imposing higher posterior probability (>0.95) increased accuracy of lateralization to 98%, with only two discordant cases who underwent surgery on the side of electroencephalogram, and both had bad outcome. Discrimination: the leave-one-out linear discriminant analyses were able to correctly classify (with a posterior probability >0.50) 142 (89%) of the 159 TLE and E-TLE patients. Accuracy increased slightly as higher posterior probability cutoffs were imposed, with fewer patients being classified. CONCLUSIONS: Pattern analysis of 1H-MRSI and MRVol data can accurately lateralize TLE. Discriminating TLE from E-TLE was less accurate, probably due to the presence of temporal lobe damage in some patients with E-TLE reflecting dual pathology.

Amygdala↗
PubMed2001

Hemispheric lateralization of somatosensory processing.

Processing of both painful and nonpainful somatosensory information is generally thought to be subserved by brain regions predominantly contralateral to the stimulated body region. However, lesions to right, but not left, posterior parietal cortex have been reported to produce a unilateral tactile neglect syndrome, suggesting that components of somatosensory information are preferentially processed in the right half of the brain. To better characterize right hemispheric lateralization of somatosensory processing, H(2)(15)O positron emission tomography (PET) of cerebral blood flow was used to map brain activation produced by contact thermal stimulation of both the left and right arms of right-handed subjects. To allow direct assessment of the lateralization of activation, left- and right-sided stimuli were delivered during separate PET scans. Both innocuous (35 degrees C) and painful (49 degrees C) stimuli were employed to determine whether lateralized processing occurred in a manner related to perceived pain intensity. Subjects were also scanned during a nonstimulated rest condition to characterize activation that was not related to perceived pain intensity. Pain intensity-dependent and -independent changes in activation were identified in separate multiple regression analyses. Regardless of the side of stimulation, pain intensity--dependent activation was localized to contralateral regions of the primary somatosensory cortex, secondary somatosensory cortex, insular cortex, and bilateral regions of the cerebellum, putamen, thalamus, anterior cingulate cortex, and frontal operculum. No hemispheric lateralization of pain intensity-dependent processing was detected. In sharp contrast, portions of the thalamus, inferior parietal cortex (BA 40), dorsolateral prefrontal cortex (BA 9/46), and dorsal frontal cortex (BA 6) exhibited right lateralized activation during both innocuous and painful stimulation, regardless of the side of stimulation. Thus components of information arising from the body surface are processed, in part, by right lateralized systems analogous to those that process auditory and visual spatial information arising from extrapersonal space. Such right lateralized processing can account for the left somatosensory neglect arising from injury to brain regions within the right cerebral hemisphere.

Adult↗
PubMed2000

[What's new in primary lateral sclerosis?].

Primary lateral sclerosis as a nosological entity distinct from amyotrophic lateral sclerosis has been the subject of controversy since it was first described in the nineteenth century. Primary lateral sclerosis has been defined as a rare, non-hereditary disease characterized by highly progressive spinobulbar spasticity, related to the exclusive loss of precentral pyramidal neurons, with secondary pyramidal tract degeneration and preservation of anterior horn motor neurons. We carried out a study in nine patients with a diagnosis of primary lateral sclerosis. Our clinical, electrophysiological and pathological investigations provide evidence that the disease has a heterogeneous clinical presentation and that degeneration is not restricted to the central motor system but also affects the lower motor neuron. In view of this similarity with amyotrophic lateral sclerosis, primary lateral sclerosis may represent a slowly progressive syndrome closely related to motor neuron disease and amyotrophic lateral sclerosis.

Adult↗
PubMed2004

Prominent laterality of the posterior cerebral artery at three-dimensional time-of-flight MR angiography in M1-segment middle cerebral artery occlusion.

BACKGROUND AND PURPOSE: Three-dimensional time-of-flight MR angiography (3D TOF MRA) often discloses prominent posterior cerebral artery (PCA) laterality in the setting of M1-segment middle cerebral artery (MCA) occlusion. We sought to analyze the implications of prominent PCA laterality at 3D TOF MRA. METHODS: We retrospectively reviewed 3D TOF MRA and digital subtraction angiography (DSA) findings in 25 patients (12 male, 13 female; mean age, 68.8 years [age range, 29-94 years]) with M1-segment occlusion. The observable laterality of the PCA, determined on the basis of 3D TOF MRA findings, was scored according to distal signal extent and compared with findings of collateral flow from the ipsilateral PCA via the leptomeningeal anastomosis (LMA) at DSA. Frequency of PCA laterality at 3D TOF MRA in patients and that in 56 healthy control subjects was also compared. RESULTS: The positive predictive value of PCA laterality for the existence of collateral flow was 99.9% and the negative predictive value 30.7%. The distal extent of ipsilateral PCA signal at 3D TOF MRA positively correlated with the grade of collateral flow from the PCA via the LMA (r = 0.802; P <.01). PCA laterality was significantly less common in control subjects (P <.01). CONCLUSION: Prominent PCA laterality at 3D TOF MRA in patients with M1-segment occlusion represents the existence of collateral flow from the PCA via the LMA.

Adult↗
PubMedDate not supplied

The lateral transorbital canthopexy for correction and prevention of ectropion: report of a procedure, grading system, and outcome study.

BACKGROUND: There are numerous approaches to correcting laxity of the lateral canthal tendon, each with advantages and drawbacks. Critical evaluation of these techniques is not possible, however, as there is no grading system currently in use to describe this condition or to report outcomes, and prospective trials are lacking. OBJECTIVES: To report and assess a new procedure for repair of the lateral canthus (lateral transorbital canthopexy) and to describe the Ectropion Grading Scale (EGS), with a prospective outcome analysis of their use. DESIGN: Prospective outcome study of 15 consecutive patients (16 procedures). SETTING: Tertiary referral center in Zurich, Switzerland. PATIENTS: Consecutive sample of patients referred for treatment of ectropion of various causes. INTERVENTIONS: Preoperative and postoperative EGS grades were recorded, a preoperative and postoperative patient-based questionnaire was administered, and lateral transorbital canthopexy was performed. MAIN OUTCOME MEASURES: Outcome was determined by improvement in EGS grade and results of the patient-based symptom questionnaire. RESULTS: There were no surgical failures or complications in the study. An average of 83% reduction in patient-reported discomfort was achieved. Two patients with facial paralysis needed medial canthal repositioning. The EGS allowed clear recording of lower eyelid position before and after lateral transorbital canthopexy, and the procedure was uncomplicated to perform. CONCLUSIONS: Lateral transorbital canthopexy is an effective technique for the correction of lower eyelid laxity and appears to allow refined, durable adjustment of the lateral canthus. Self-reported patient satisfaction confirmed the high rate of success of the procedure in this study. The EGS permits critical evaluation and reporting of results and may assist in predicting which patients will need concomitant correction of the medial canthus. Arch Facial Plast Surg. 2000;2:9-15

Aged↗
PubMed1979

Alterations in cerebral laterality during acute psychotic illness.

A dichotic listening test was used to assess cerebral laterality in 26 right-handed patients with schizophrenic, schizoaffective, or primary major depressive illness and in 23 controls. Clinical state was assessed by twice-daily nurses' ratings and patient self-ratings. Ratings of psychotic thought and behavior were lower during the week of highest laterality than during the week of lowest laterality (P less than .01). Similarly, when most improved, patients had higher laterality than when most ill (P less than .01). Changes in laterality were not specific to diagnostic group, were not present in control subjects, could not be related to direct drug effects, and were independent of changes in accuracy of performance. There were large, stable, interindividual differences in degree of lateralization, but no differences between patients and controls. These results are consistent with the hypothesis that in acute psychotic illness there is a breakdown in the interhemisphere inhibition that normally mediates cerebral laterality.

Acute Disease↗
PubMed2000

Propriospinal afferent and efferent connections of the lateral and medial areas of the dorsal horn (laminae I-IV) in the rat lumbar spinal cord.

The different subdivisions along the mediolateral extent of the superficial dorsal horn of the spinal cord are generally regarded as identical structures that execute the function of sensory information processing without any significant communication with other regions of the spinal gray matter. In contrast to this standing, here we endeavor to show that neural assemblies along the mediolateral extent of laminae I-IV cannot be regarded as identical structures. After injecting Phaseolus vulgaris leucoagglutinin and biotinylated dextran amine into various areas of the superficial dorsal horn (laminae I-IV) at the level of the lumbar spinal cord in rats, we have demonstrated that the medial and lateral areas of the superficial dorsal horn show the following distinct features in their propriospinal afferent and efferent connections: 1) A 300- to 400-microm-long section of the medial aspects of laminae I-IV projects to and receives afferent fibers from a three segment long compartment of the spinal dorsal gray matter, whereas the same length of the lateral aspects of laminae I-IV projects to and receives afferent fibers from the entire rostrocaudal extent of the lumbar spinal cord. 2) The medial aspects of laminae I-IV project extensively to the lateral areas of the superficial dorsal horn. In contrast to this, the lateral areas of laminae I-IV, with the exception of a few fibers at the segmental level, do not project back to the medial territories. 3) There is a substantial direct commissural connection between the lateral aspects of laminae I-IV on the two sides of the lumbar spinal cord. The medial part of laminae I-IV, however, does not establish any direct connection with the gray matter on the opposite side. 4) The lateral aspects of laminae I-IV appear to be the primary source of fibers projecting to the ipsi- and contralateral ventral horns and supraspinal brain centers. Projecting fibers arise from the medial subdivision of laminae I-IV in a substantially lower number. The findings indicate that the medial and lateral areas of the superficial spinal dorsal horn of rats may play different roles in sensory information processing.

Afferent Pathways↗
PubMed1997

The distally based lateral arm flap for intraoral soft tissue reconstruction.

BACKGROUND: The radial forearm flap is probably the most frequently used among free flaps for intraoral soft tissue reconstruction. However, this flap is not always available. The other fasciocutaneous flaps may be too bulky or less pliable or may have a short vascular pedicle; their use is therefore less than ideal. We present a variant of the lateral arm flap located distally to the lateral epicondyle and having the same advantages as the radial forearm flap. METHODS: Vascular study (dissection and radiography) was previously undertaken to determine the vascular anastomotic network in the epicondylar area, between the posterior radial collateral artery and recurrent arteries running in front of the lateral epicondyle. This demonstrated the possibility of taking a skin paddle on and below the lateral epicondyle, based on the proximal pedicle. RESULTS: We used this flap on three patients for intraoral soft tissue reconstruction (tonsil, floor of the mouth, and piriform sinus). No complication with the flap itself was encountered. In all cases, direct closure of the donor site was possible, with no local complication. CONCLUSION: The distal lateral arm flap (LAF) represents an interesting and reliable alternative to the fasciocutaneous radial forearm flap. The positioning of the skin paddle over the lateral epicondyle and the proximal third of the lateral aspect of the forearm increases pedicle length, thus avoiding the use of vein grafts. Dissection is straightforward with a reliable vascular anatomy. Moreover, in this area, the limited amount of subcutaneous fatty tissue ensures easier placement and more pliability when compared with the standard LAF.

Humans↗