Category: brain damage

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Modems and White Matter

Yesterday my connection to the Internet decided to stop working. I tried restarting the cable modem, the wireless router, and other attached devices. That didn’t fix the problem. That’s usually a good first step though. I saw that the internet connectivity light was lit on the modem but the PC/Activity light was not lit. That told me that maybe the router was bad. I tried plugging my computer directly into the modem via ethernet and my computer did not recognize that a cable was plugged in. I had discovered what was wrong. While it hadn’t taken me long to figure out the problem, I did what many people do and look for solutions in the hardware first rather than in the connections. That’s not necessarily wrong, cables are more hardy than electronic components, but it did reveal my biases. So what was the problem?

The components were all okay – modem, router – but the connections were not. Wiring was the problem. Being interested in the brain, I immediately knew this would make  great brain analogy.

When someone’s cognitive functioning changes, one of the first things clinicians usually jump to is which part of the cortical or subcortical gray matter went bad, so to speak. While those components can and do go bad, we often overlook, just as I did at first, the connections. In my case, the ethernet cable had gone bad. There are many times when what’s affected in the brain are not the components but rather, the wiring – the axons. White matter might be just as important or even more important than the gray matter for cognition, even if its contribution might be more subtle. Much of my current research revolves around this idea.

So the moral of the story is that when things are not working correctly, the wiring might be the culprit.

How did my ethernet cable get damaged? Maybe it just stopped working spontaneously but it also had experienced a bit of acute stress earlier in the day (the modem fell off its stand). Something might have happened to the cable during this time. The white matter of our brain can similarly be affected by traumatic injury, nontraumatic injury (anoxia, hypoxia, etc.), stroke, or a long history of cerebrovascular problems. Just as we can take care of our electronic equipment (by not dropping it or knocking it off its home or stepping on it or whatever else we can do to our technology), we can take care of our white matter by avoiding similar injuries.

Exercise, weight control, managing diabetes, managing blood pressure, and managing cholesterol, can all help protect white matter from going bad and disconnecting different brain areas. We can’t connect to the Internet if our wiring is bad.

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Donate to Brain Research

The American Academy of Neurology (AAN) has a site where you can donate to help fund brain research. All overhead for the donations are covered by AAN so all of your donated money will go directly to fund research into neurologic disorders. If you or a loved one suffer from a brain disorder or disease, this is a great way to potentially help others with neurologic disorders.

The minimum donation is $5.

Note: I am not affiliated with AAN or the donation site; I just think it is a great cause.

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Aphasia Syndromes

Aphasia is an acquired disorder of language. It can manifest in various ways, including difficulty speaking or difficulty understanding speech or language. Stroke is the most common cause of aphasia with up to 40% of stroke patients experiencing some sort of aphasia. Depending on the nature of the injury (e.g., stroke, tumor, trauma), aphaisa can be temporary or permanent. Even in cases of severe stroke, some types and aspects of aphasia are treatable, with language improving over time. While language does not usually return to pre-morbid functional levels, many people with aphasia benefit greatly from speech therapy.

The following videos demonstrate two different types of aphasia – Broca’s aphasia (or non-fluent) and Wernicke’s aphasia (or fluent). Notice the differences between the aphasias.

Here is a patient with Broca’s aphasia.

Here is a patient with Wernicke’s aphasia.

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PBS Frontline Explores Parkinson’s Disease

Here is the video PBS recently made about Parkinson’s disease called My Father, My Brother, and Me. From what I’ve watched so far, it’s done a good job putting a face to Parkinson’s disease while also focusing on the research and clinical aspects of it.

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Revisiting Clive

Yesterday I posted a video clip about Clive Wearing. Here is the first part of a different documentary about Clive. This video goes more in-depth about his condition. Clive is sometimes referred to as the man with the shortest memory. Not only were his two hippocampi destroyed, but also surrounding areas of the his temporal lobes as well as portions of his left frontal lobe. He also remembers very little from before his illness, which is quite rare; this condition is called retrograde amnesia. Clive lives in an ever-present now, without connection to past or future. Other parts to this video can be found on YouTube.

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The Unusual Case of Clive Wearing

Clive Wearing is a 70 year old British man who contracted herpes simplex encephalitis in 1985. The virus destroyed his hippocampi bilaterally (as well as surrounding areas). He has complete anterograde amnesia and can only remember up to about 20 seconds. He retained the ability to play the piano and conduct a choir (which he did previously to his illness); this is because this procedural memory involves different areas of the brain, including the basal ganglia and the cerebellum. I’ll revisit this case over the coming days. Meanwhile, here is a clip from a BBC production that presents part of Clive’s story.

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Alien Limb Syndrome

I have a new post up on BrainBlogger about Alien Limb Syndrome. Here’s the link.

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Sen. Kennedy’s Brain Tumor

Sen. Ted Kennedy, one of the last of the siblings of JFK and Bobby who is alive recently was diagnosed with a malignant brain tumor in his left parietal lobe. His first symptom was a seizure. As soon as I heard that he had had a seizure I started wondering about a tumor. There aren’t too many reasons someone would have a seizure out of the blue at the age Sen. Kennedy is. Too much stress possibly could cause a seizure as could an adverse reaction to certain medications but those are not likely. Children often can have a seizure at random with no other symptoms or no specific underlying problems but it’s very rare for older adults to experience seizures without very specific reasons, such as a brain tumor (it’s very common to have seizures if you have a brain tumor).

Sen. Kennedy’s tumor, as stated earlier, is in his left parietal lobe. Depending on its specific location and size, the tumor could disrupt his ability to comprehend language (if it disrupts Wernicke’s Area). It could also affect his ability to integrate visual and motor information as well as affect his motor or sensory functioning on his right half of his body. All of those symptoms are speculative without neurological testing, of course, but the parietal lobes are involved in a number of functions, including sensory and cognitive integrative functions.

The good news is that this form of cancer – a glioma – does not spread to other parts of the body (although it could continue to grow in the brain). It is also treatable by resection and chemotherapy. Chemotherapy is far from an enjoyable process (it’s a treatment that practically kills people) but it can be very successful. While Sen. Kennedy’s prognosis is uncertain he could survive the cancer with relatively few lasting effects. I don’t think anyone can survive brain surgery and chemotherapy without at least some lasting cognitive deficits (although the deficits might be very hard to detect) but the outcome of gliomas is not always grim.

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Leukoaraiosis and Lacunes – A Very Brief Overview

As people age, it is common for their brain white matter to change. These changes often appear as bright white spots on T2-weighted MR scans. These areas or spots of hyperintensity (i.e., white matter hyperintensities {WMH}) are also called leukoaraiosis (LA). Researchers are still investigating the exact nature and pathology of these abnormalities but our understanding of them is increasing. They most often seem to start around the lateral ventricles and spread from there, although it is possible to have punctate WMH throughout the brain white matter (i.e., WMH that are not connected to other regions). WMH on brain MRIs represent rarefaction of the white matter, including swelling, demyelination, and damage, although the exact nature and combination of the white matter changes is not known. These WMH can interfere with normal cognitive functioning, including processing speed, attention, inhibition, as well as global executive functioning (although these claims are still being investigated).

Other damage to white matter includes lacunes, which are little holes in the brain, much like the holes in Swiss cheese. They are caused by mini infarcts, or strokes, or other processes. Most of the time they are due to “silent strokes”, or strokes that are small enough that the person does not have any noticeable stroke symptoms. These lacunes can have similar impact on cognition as WMH. Both WMH and lacunes are related to vascular risk factors, such as hyper- or hypo-tension, diabetes, etc.

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Dealing with TBIs from the Iraq War

I read a good article on CNN that details some of the problems that veterans and health professionals face when dealing with TBIs acquired during military action. The article provides a good perspective of the “human side” of TBI.

Link to the story

I’ve posted about this topic before but felt that we should revisit it because so many veterans are affected by TBIs (as well as mental health issues). I don’t know the exact number of veterans affected by TBIs but studies have shown that >30% of soldiers and Marines have some sort of psychological issue related to their service in Iraq and/or Afghanistan. The military and the government are realizing how salient this problem is and will be.

“Congress included $900 million in the DoD’s supplemental budget fir fuscal years 2007 and 2008 to fund more mental health services, as well as more research on the effects of traumatic brain injuries (TBI) and treatments for TBI and post-traumatic stress disorder (PTSD)” (Monitor on Psychology, Sep. 2007, pp. 38-39).

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