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4 results

  • Motor abnormalities and basal ganglia in first-episode psychosis (FEP)

  • Manuel J. Cuesta, Pablo Lecumberri, Lucia Moreno-Izco, Jose M. López-Ilundain, María Ribeiro, Teresa Cabada, Ruth Lorente-Omeñaca, Gabriel de Erausquin, Gracian García-Martí, Julio Sanjuan, Ana M. Sánchez-Torres, Marisol Gómez, Victor Peralta
  • Journal:
    Psychological Medicine / Volume 51 / Issue 10 / July 2021
    Published online by Cambridge University Press:
    02 March 2020, pp. 1625-1636
  • Background

    Motor abnormalities (MAs) are the primary manifestations of schizophrenia. However, the extent to which MAs are related to alterations of subcortical structures remains understudied.

    Methods

    We aimed to investigate the associations of MAs and basal ganglia abnormalities in first-episode psychosis (FEP) and healthy controls. Magnetic resonance imaging was performed on 48 right-handed FEP and 23 age-, gender-, handedness-, and educational attainment-matched controls, to obtain basal ganglia shape analysis, diffusion tensor imaging techniques (fractional anisotropy and mean diffusivity), and relaxometry (R2*) to estimate iron load. A comprehensive motor battery was applied including the assessment of parkinsonism, catatonic signs, and neurological soft signs (NSS). A fully automated model-based segmentation algorithm on 1.5T MRI anatomical images and accurate corregistration of diffusion and T2* volumes and R2* was used.

    Results

    FEP patients showed significant local atrophic changes in left globus pallidus nucleus regarding controls. Hypertrophic changes in left-side caudate were associated with higher scores in sensory integration, and in right accumbens with tremor subscale. FEP patients showed lower fractional anisotropy measures than controls but no significant differences regarding mean diffusivity and iron load of basal ganglia. However, iron load in left basal ganglia and right accumbens correlated significantly with higher extrapyramidal and motor coordination signs in FEP patients.

    Conclusions

    Taken together, iron load in left basal ganglia may have a role in the emergence of extrapyramidal signs and NSS of FEP patients and in consequence in the pathophysiology of psychosis.

  • 23 - Intracerebral haemorrhage

  • from Section 4 - Neurointensive care
  • Edited by Basil F. Matta, David K. Menon, Martin Smith
  • Book:
    Core Topics in Neuroanaesthesia and Neurointensive Care
    Published online:
    05 December 2011
    Print publication:
    13 October 2011, pp 359-368

  • Summary

    Space-occupying lesions such as tumours, intracranial haematomas and abscesses are the most common indications for supratentorial surgery. Anaesthesia management is directed towards haemodynamic stability, facilitation of electrophysiological monitoring, and provision of optimal operative conditions and a rapid, high-quality recovery. The aim of pre-operative assessment is to identify potential anaesthetic problems and coexisting medical conditions, quantify risk and plan perioperative care. The assessment of the neurosurgical patient is identical to that of other patient groups but must additionally include a complete neurological assessment. Neuroanaesthesia is a specialty where the knowledge and skill of the anaesthetist affects both the operative field and ultimate outcome for the patient. Awake craniotomy allows the intraoperative assessment of a patient's neurological status and the identification of safe resection margins during epilepsy surgery and excision of space-occupying lesions in eloquent cortex, as well as the accurate localization of electrodes for deep brain stimulation.

  • 21 - Traumatic brain injury

  • from Section 4 - Neurointensive care
  • Edited by Basil F. Matta, David K. Menon, Martin Smith
  • Book:
    Core Topics in Neuroanaesthesia and Neurointensive Care
    Published online:
    05 December 2011
    Print publication:
    13 October 2011, pp 315-340

  • Summary

    The risk of morbidity/mortality exists with any surgical/ anaesthetic procedure, but the risk to the central nervous system may be compounded in a patient undergoing a major neurosurgical procedure. The purpose of the pre-operative assessment includes the identification of modifiable risk factors, optimization of the patient's condition, explanation of the risks and formulating the best possible anaesthetic plan for the patient. The general physical examination should focus on the patient's level of consciousness, degree of neurological impairment, mental status, nutrition and vital parameters for baseline. Focused neurological assessment and careful documentation allow the establishment of baseline status and facilitate anaesthetic planning, as well as anticipation of potential perioperative complications. The risk of perioperative respiratory complications is increased in the presence of pre-existing obstructive or restrictive pulmonary disease. Patients at risk of aspiration include those with full stomachs, delayed gastric emptying, bowel obstruction, and gastro-oesophageal reflux.

  • 6 - The multidisciplinary memory clinic approach

  • from Part II
  • Edited by German E. Berrios, University of Cambridge, John R. Hodges, University of Cambridge
  • Book:
    Memory Disorders in Psychiatric Practice
    Published online:
    06 January 2010
    Print publication:
    16 March 2000, pp 101-121

  • Summary

    This chapter describes the origins, principles and organization of the Cambridge Memory Clinic (CMC). The main objective of CMC was to assess patients complaining of memory impairment and patients whose memory is considered as impaired by others, even when the patient has no awareness of deficit. Clinical neuropsychology is concerned with the evaluation of cognitive function in patients with known or suspected neurological disease. It is often used as a tool for monitoring a change in function, to provide guidelines for rehabilitation and it plays a major role in the differential diagnosis between neurological and psychiatric disorders. The assessment of general intellectual skills gives information regarding the integrity of cortical functioning as a whole and this in itself can be of diagnostic significance. Knowledge of occupational and educational background can give an idea of an individual's optimal or premorbid level of ability.