Neurological Disorders Arising from Cortical Lesions

A brain lesion is an abnormality in part of the brain tissue, often resulting from a stroke, from a traumatic brain injury, or from a tumor or other disease process. Cortical lesions are lesions occurring in the brain’s cortex--- the part of the human brain responsible for higher functions like cognition, as well as for sensory and motor functions. Depending on the location of the lesion, neurological disorders can arise after a stroke or injury in Boston, with the type of problems dependent on the location of the lesion. Different types of neurological disorders arise from lesions in different areas of the brain, with injuries to the frontal lobes, parietal lobes, temporal lobes, or occipital lobes producing different effects that correspond to the functions of the damaged area.

Neurological Disorders from Frontal Lobe Lesions

The brain’s frontal lobes are most strongly associated with what is called “executive function”. This refers to the ability to plan future actions, to contemplate the consequences of possible alternate courses of action, to modulate one’s responses based on what is socially acceptable, and to recognize patterns in systems or events. When a lesion in Boston occurs in the frontal lobes, executive function can become compromised as a result. Various behavioral changes can arise as a result. Sometimes a frontal lobe lesion will decrease a person’s volition and motivation, functions which are largely handled in the frontal lobes. The person can also become less socially inhibited and display inappropriate behaviors, or otherwise become more impulsive than they were before the injury occurred.

Neurological Disorders from Parietal Lobe Lesions

The parietal lobes play an important role in integrating sensory information, as well as in mathematical and spatial reasoning processes. The neurological disorders that result from parietal lobe lesions in Boston often correspond to which hemisphere is affected. Right parietal lesions often compromise mental imagery and the ability to visualize spatial relationships. Sometimes a right parietal lesion can also lead to a neurological condition called “left hemispheric neglect”, in which the person is no longer aware of, or in control of, the left side of their body. Left parietal lobe lesions often cause neurological disorders involving a loss of mathematical, reading, and symbolic reasoning abilities. Other neurological disorders associated with parietal lobe lesions in Boston involve ataxia, a loss of motor coordination ability; amorphosynthesis, a loss of perception of one side of the body, generally the side opposite the side on which the lesion occurred; and Gerstmann syndrome. Gerstmann syndrome is a neurological disorder characterized by loss of the ability to write, loss of the ability to perform mathematical calculations, left-right disorientation, and finger agnosia.

Neurological Disorders from Temporal Lobe Lesions

Among the primary functions of the temporal lobes, which contain a brain structure called the “hippocampus”, is the formation of long-term memories. The temporal lobes are also involved in processing auditory sensory information; establishing object recognition and interpreting the meaning and importance of visual input; and recognizing and processing language. These functions can become impaired in Boston when lesions result from injury or stroke. One common result of temporal lobe lesions is the loss of the ability to remember visual stimuli, called visual agnosia. Another of the neurological disorders associated with temporal lobe lesions in Boston is prosopagnosia, a disorder in which a person loses the ability to recognize faces.

Neurological Disorders from Occipital Lobe Lesions

The occipital lobes, located at the back of the brain, are best known for containing the areas that process various aspects of visual information. Occipital lobe lesions in Boston most often lead to some form of vision loss. Often this take the form of homonymous hemianopsia, in which one side of the visual field is “cut off” in both eyes. Damage to the primary visual cortex in the occipital lobes can cause total cortical blindness. When areas of the occipital lobes adjacent to the temporal or parietal lobes are damaged, phenomena like color agnosia--- a loss of the ability to recognize color--- and movement agnosia--- a loss of the ability to recognize motion--- can occur.

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Concussion Treatment in Boston

How Doctors Handle A Blow to the Head 

A concussion is defined as a brief and transient loss of consciousness, often with a brief period of amnesia, resulting from a blunt impact to the head. The most common causes of concussions are falls, car or bicycle accidents, and sports injuries. Concussions can vary in severity. Although there is not one classification system for concussion severity that is universally agreed upon, the American Academy of Neurology guidelines divide concussions into grades:

·         Grade I: There is no loss of consciousness, and symptoms of confusion and disorientation last for less than 15 minutes.

·         Grade II: There is no loss of consciousness, but symptoms of confusion and disorientation last for longer than 15 minutes.

·         Grade IIIa: There is a loss of consciousness lasting for less than a minute.

·         Grade IIIb: There is a loss of consciousness lasting for minutes.

In movies and television shows, it is not uncommon for a character to be struck on the head and lose consciousness, and then “come to” hours later. This is highly unrealistic; the longer someone is unconscious as a result of a concussion, the more severe the concussion and the higher the risk of permanent brain damage. In real life someone will not lose consciousness from a head impact for hours on end and then wake up perfectly fine!

Concussion treatment is usually the domain of a neurologist, a doctor who specializes in the diagnosis and treatment of nervous system injuries and disorders. When a concussion results in loss of consciousness, the person often experiences some degree of amnesia as well. This may take the form of anterograde amnesia, the inability to retain new information, or retrograde amnesia, the inability to remember what happened before the injury. In most cases, the amnesia improves in a matter of hours, and does not result in a loss of autobiographical information such as the person’s name and birthday. 

How do Doctors in Boston Respond to a Concussion? 

When a concussion occurs, even a Grade I concussion, medical attention should be sought right away. Proper concussion treatment is important to evaluate the severity of the injury, the extent of damage, and to plan for appropriate treatment. The first step after a concussion is often to check the patient for any sign of neck injury. If the patient has neck pain, this could indicate a neck injury, and cervical immobilization is usually required. The next matter of concern is whether the impact has caused a brain hematoma. A hematoma is a collection of blood outside the blood vessels. This is very serious, but fortunately, less than 10% of concussions result in hematoma, and less than 2% require neurosurgical intervention. A hematoma can be detected with a CT (cranial computed tomography) scan. A neurological evaluation is given, with signs like poor arousal or hemiparesis indicating the need for a CT scan. The patient will also be evaluated to ensure that the skull has not been fractured.

After the concussion, the patient will need to be monitored for a period of time. Usually, a person with a normal neurologic examination after a minor concussion will be observed for two hours. If the patient’s CT scan has revealed small surface contusions on the brain or limited hemorrhage, which may not produce symptoms beyond a headache, a longer period of observation or overnight hospital stay may be required.  

After the Concussion: Watching for Signs of Post-Concussion Syndrome 

Post-concussion syndrome (PCS) is a constellation of symptoms that may persist for days, weeks, or even longer after a concussion occurs. It is estimated that a post-concussion syndrome occurs in around 15% of patients who have had a concussion, and it generally subsides after a period of time. 

Symptoms that indicate a post-concussion syndrome include:

·         Headache

·         Dizziness

·         Blurred vision or double vision

·         Ringing in the ears

·         Increased sensitivity to light or noise

·         Insomnia, fatigue, or other sleep problems

·         Irritability

·         Anxiety

·         Depression

·         Mood swings

·         Changes in personality

·         Problems with attention and memory, especially short-term memory

·         Cognitive deficits

Concussion treatment for post-concussion syndrome in Boston generally involves treating individual symptoms. Pain relievers may be used for headaches, antidepressants for mood changes, and sleep aids for insomnia. About 50% of people with post-concussion syndrome are referred for psychotherapy as part of their concussion treatment. Evidence has shown psychotherapy to be effective in reducing cognitive and affective symptoms associated with PCS. Neurofeedback therapy has also shown promise as a treatment for PCS.

With proper concussion treatment and management of a post-concussion syndrome, if it occurs, most patients have an excellent prognosis. Symptoms usually resolve completely over time, and approximately 67% of concussion patients are symptom-free three months after the injury. Excellent concussion treatment is available in Boston, both to evaluate damage and severity after the injury, and also to manage a post-concussion syndrome, if it occurs. Recently, neurofeedback therapy has become available in the Boston area, providing an exciting and highly effective new approach to managing post-concussion syndromes. Thanks to advancements in modern medicine, most people who suffer a concussion have a favorable outcome.

BOSTON - NEUROFEEDBACK THERAPY FOR BRAIN INJURY