INTRODUCTIONOnly few studies have investigated the effects of motor imagery training (MIT) on neglect symptoms.OBJECTIVETo investigate the imagery ability of patients with visuospatial neglect and the behavioral effects of MIT on neglect symptoms.METHODSIn an intense four-week course 10 patients with chronic visuospatial neglect symptoms resulting from right-hemisphere lesions practiced MIT by mentally envisaging positions and movements of the contralesional upper limb. Visual and kinesthetic MIT abilities as well as neglect-related disability were evaluated prior to and following therapy. Neglect symptoms were as well assessed at three-month follow-up.RESULTSResults suggest that (i) the ability to perform motor imagery is principally retained in patients with neglect and even patients that are seemingly incapable of motor imagery are able to relearn imagined activation via an individualized training approach. Furthermore, imagined activation of the left arm (ii) significantly reduces the severity of neglect in exploration, (iii) enhances temporal and spatial orientation, and (iiii) significantly improves the kinesthetic motor-imagery capacity and ability. These improvements were stable over a three-month period, indicating long-term training effects.CONCLUSIONOur data suggest that active kinesthetic-motor imagery is a feasible and effective training method for patients suffering from chronic visuospatial neglect symptoms.

Purpose. The aim of this study was to investigate the feasibility of mental practice of positions and movements of the contralesional upper limb in sub-acute neglect patients and the efficacy of the approach in modifying visuospatial and representational neglect symptoms.Method. Fifteen sub-acute neglect patients received two daily half-hour sessions of visuomotor-imagery therapy over a 3-week period as an add-on treatment and were compared to a control group of 15 sub-acute neglect patients without supplementary therapy. Feasibility was assessed using verbal-feedback protocols. Efficacy was determined using various standardised functional-outcome measures and neuropsychological tests.Results. According to therapy protocols, compliance and subjective-gain ratings were high. The results suggest that imagined activation of the contralesional upper limb significantly reduces the severity of neglect in drawing/copying tasks as well as enhancing sensation in the affected arm.Conclusions. We conclude that (i) kinaesthetic visuomotor imagery is a feasible technique for sub-acute neglect patients and that (ii) imagery practice leads to improvements in the perception of body and space. Future research is required to specify criteria for indication and contraindication.

Mentales Training findet vermehrt in der neurologischen Rehabilitation Einsatz. Neglekpatienten mit repräsentationalen Störungen, u. a. des eigenen Körpers, könnten von einer visuomotorischen Imaginationstherapie profitieren. Das therapeutische Vorgehen für die praktische Anwendung in der Neglektrehabilitation wird vorgestellt bezüglich (1) Patientenauswahl, (2) Testdiagnostik, (3) Messung der Imaginationsfähigkeit, (4) Psychoedukation, (5) Setting, (6) Therapiemanual, (7) Frequenz und Komplexitätsgrade, (8) Therapieprotokoll, (9) Elektromyographie sowie (10) Eigentraining. Zwei Fallbeispiele verdeutlichen wie eine visuomotorische Imaginationstherapie selbst im chronischen Krankheitsstadium zu Funktionsverbesserungen führen und bei subakutem personalem Neglekt die Körperwahrnehmung beeinflusst werden kann.

The case of a patient suffering from rupture of an aneurysm of the anterior communicating artery is reported. The hematoma was located in the basal forebrain, one of the anatomical regions associated with mnestic functions. Memory and other cognitive functions were studied. The patient performed well on all non-mnestic tests, but showed significant memory impairment. Anterograde memory was deficient not only in recall, but also in recognition. Performance on remote memory tests showed some differentiation. The patient remembered autobiographical material and famous faces correctly, but presented deficits on a Famous Events Test. This dissociation represents a difference in emotional content or familiarity of the material; the performance in tests using material with a higher emotional content was unremarkable. Lesions within the basal forebrain seem to deteriorate anterograde and remote memory, but performance may be inconspicuous if test material of high emotional content or familiarity is used.

Everyday experience suggests that highly emotional events are often the most memorable, an observation supported by psychological and pharmacological studies in humans. Although studies in animals have shown that nondeclarative emotional memory (behaviors associated with emotional situations) may be impaired by lesions of the amygdala, Little is known about the neural underpinnings of emotional memory in humans, especially in regard to declarative memory (memory for facts that can be assessed. verbally). We investigated the declarative memory of two rare patients with selective bilateral amygdala damage. both subjects showed impairments in long-term declarative memory for emotionally arousing material. The data support the hypothesis that the human amygdala normally enhances acquisition of declarative knowledge regarding emotionally arousing stimuli.

Dysfunctions in spatial attention and neglect are frequently observed after right parietal lobe damage. We present the case of a 32-year-old male patient with a left parietal stroke involving the supramarginal and angular gyri. He showed no signs of perceptual, language, memory or intellectual deterioration, but disturbances in spatial attention and somatosensory awareness for his contralateral side. A small zone of the left parietal cortex seems to be essential for attentional processes and deficits are not compensated by the right hemisphere.

See also: Zufallsbefund einer ausgedehnten linkshirnigen asymptomatischen ArachnoidalzysteAktuelle Neurologie 1994; 21(01): 14-16DOI: 10.1055/s-2007-1017944

Bei der sogenannten Urbach-Wiethe-Erkrankung handelt es sich um eine lipoide Proteinose, die erstmals im Jahre 1908 von Siebermann als generalisierte Hyper-keratose der Haut unter Einbeziehung der Mucosa beschrieben wurde. Die erste umfassende Darstellung dieses Krankheitsbildes stammt von Urbach und Wiethe aus dem Jahre 1929. Anfänglich galt die Erkrankung als umschriebene Dermatose mit zusätzlicher Beteiligung der oralen Mucosa und des Larynx. Im Laufe der Jahre wurde jedoch deutlich, daß es sich bei diesem Syndrom um eine Multi-System-Er-krankung handelt, die zu Veränderungen an Augen, Magen, Rektum, Vagina, Leber, Pankreas und Gehirn führen kann. Es handelt sich um ein sehr seltenes und gutartiges, autosomal-rezessiv vererbtes Krankheitsbild.

Thirty‐five multiple sclerosis (MS) patients diagnosed according to the Poser criteria were examined in a variety of cognition and memory tasks. Their performance was compared to age‐ and gender‐matched healthy individuals. While there was no difference in overall intellectual performance and short‐term memory between the MS group and control subjects, the patient group showed significant deficits in several everyday memory tasks including story recall, object and face recognition, procedural, topographical and prospective memory tasks. An intra‐group comparison in the MS cohort revealed that those patients with a chronic‐progressive MS course exhibited the most substantial everyday memory impairments and highest EDSS scores. These findings coincide with the neuroradiological, semiquantitative lesion analysis which was also performed. In this analysis, the latter MS subgroup also had the highest lesion score, as a sign of an overall brain involvement

The consequences of primary amygdaloid damage on memory performance are described in terms of neuropsychological, CT, MRI and PET results of two patients, a brother and a sister. Both had circumscribed, bilaterally symmetrical damage confined to the amygdaloid region, while the hippocampal formation and other brain structures were intact. PET-imaging furthermore revealed an overall decrease in glucose metabolism which was particularly apparent at the cingular and thalamic levels. Although neither patient was amnesic, both showed memory impairments in selective tests. In one patient these impairments were more pronounced and they were accompanied by marked affective-emotional fluctuations. Our results suggest that the amygdaloid region is a bottle-neck structure that confers an affective flavour to memories, thereby enhancing the probability of their long term storage.

35 multiple sclerosis patients and 30 matched healthy controls were investigated for mnestic problems using a German everyday memory test. The objects were both the description of structural characteristics of disturbances and "ecological validity" to meet rehabilitative issues prospectively. In the MS group, impairments were found mainly in the memory domain under delayed recall conditions of complex material. The processing of these tasks may be especially sensitive against fiber tract lesions. While discrete lesions, mostly found in patients with relapsing-remitting courses, inconsistently lead to partial memory disturbances, global mnestic deficits are to be expected in confluent lesion patterns exceeding a critical "threshold of cerebral tolerance." The latter characterises mostly patients with chronic progressive disease courses.

THE consequences of primary amygdaloid damage on memory performance are described in terms of neuropsychological, CT, MRI and PET results of two patients, a brother and a sister. Both had circumscribed, bilaterally symmetrical damage confined to the amygdaloid region, while the hippocampal formation and other brain structures were intact. PET-imaging furthermore revealed an overall decrease in glucose metabolism which was particularly apparent at the cingular and thalamic levels. Although neither patient was amnesic, both showed memory impairments in selective tests. In one patient these impairments were more pronounced and they were accompanied by marked affective-emotional fluctuations. Our results suggest that the amygdaloid region is a bottleneck structure that confers an affective flavour to memories, thereby enhancing the probability of their long term storage.

The processing of episodic memories is believed to depend on the proper functioning of so-called bottleneck structures through which information apparently must pass in order to be stored long term. These regions are seen in the basal forebrain, the medial diencephalon, and the medial temporal lobe. We here report a case with circumscribed bilateral temporal lobe damage, principally involving the amygdaloid area. Neuropsychological investigation demonstrated preserved intelligence, intact general memory and several other undisturbed cognitive functions, but a specific, affect-related, memory disorder. We conclude from these findings that the role of the amygdala is to process mnemonic events in a way that a specific emotional significance can be found and reactivated. Therefore it is suggested that the amygdala is likely to be a bottleneck structure for affect-related long-term memory functions.

We are very grateful to R a n Kosaraju, whose mastery of the theoretical results in structured p r o g r a m m i n g is impeccable, a n d to Robert Taylor, for his helpful readings of the conclusions.