A case of bilateral frontal tumors without “frontal syndrome”

Abstract

We report the longitudinal case study of a right-handed patient harboring two frontal tumors that benefited from bilateral simultaneous surgery. The tumors were WHO Grade II gliomas located in the left inferior frontal area (including the cingulate gyrus) and the right anterior superior frontal gyrus. The double tumor resection was guided by direct electrical stimulation of brain areas while the patient was awake. Neuropsychological assessments were administered before and after the surgery to analyse how the brain functions in the presence of two frontal gliomas that affect both hemispheres and reacts to a bilateral resection, which can brutally compromise the neuronal connectivity, progressively established during the infiltrating process. We showed that both the tumor infiltration and their bilateral resection did not lead to a "frontal syndrome" or a "dysexecutive syndrome" predicted by the localization models. However, a subtle fragility was observed in fine-grain language, memory and emotional skills. This case study reveals the significance of brain plasticity in the reorganization of cognitive networks, even in cases of bilateral tumors. It also confirms the clinical relevance of hodotopical brain models, which considers the brain to be organized in parallel-distributed networks around cortical centers and epicenters.

Gender and Hemispheric Asymmetries in Acquired Sociopathy

“…In most cases, the behavioral changes were enmeshed in a fabric of more elementary symptoms, such as somnolence and hyperphagia, which usually reflect damage to functionally heterogeneous neural systems (Alpers, 1937). Conversely, sociopathy was surprisingly absent in patients with even extensive bilateral prefrontal (PF) damage (Penfield and Evans, 1935; Rylander, 1939; Hebb and Penfield, 1940; Nichols and Hunt, 1940; Ghosh et al, 2014; Plaza et al, 2014); still in others the brain damage had little if any impact on socio-occupational status (Tranel et al, 2005), exerting even a paradoxically beneficial effect in some (e.g., Labbate et al, 1997; cases of and eb , Storey, 1970; King et al, 2017). These discrepancies raise the possibility that in at least some cases the laterality of the hemispheric lesion may be decisive for the development of sociopathy; in other words, damage to one cerebral hemisphere might be sufficient to produce sociopathy in at least a few previously normal individuals.…”

Monitoring cognition during awake brain surgery in adults: A systematic review

“…Especially executive functioning is frequently impaired (Van Kessel, Baumfalk, Van Zandvoort, Robe, & Snijders, 2017). While many patients have executive impairments prior to surgery, it is paradoxical that the monitoring of executive functions is only reported in such a small number of studies included in this review (Plaza, Du Boullay, Perrault, Chaby, & Capelle, 2014;Wager et al, 2013). Possibly, the fact that executive functions are less concrete than, for example, language and motor functions makes it more difficult to imagine the consequenses of deficits in this cognitive domain.…”

Atypical crossmodal emotional integration in patients with gliomas

“…The patients often present a 'quasi normal' neuropsychological profile when assessed with classical tests, which were created to assess the impairments that can follow sudden strokes or neurodegenerative diseases (De Angelis, 2001;Desmurget, Bonnetblanc, & Duffau, 2007;Duffau, 2005;Duffau et al, 2008;Meyers & Brown, 2006;Plaza, du Boullay, Perrault, Chaby, & Capelle, 2013). By contrast, fine-grained neuropsychological assessments have shown discrete cognitive impairments, particularly in language, working memory, verbal memory, attention and executive function (Archibald et al, 1994;Le Rhun, Delbeuck, Devosc, Pasquier, & Dubois, 2009;Plaza, Capelle, Maigret, & Chaby, 2012;Plaza et al, 2013;Reijneveld, Sitskoorn, Klein, Nuyen, & Taphoorn, 2001;Satoer et al, 2014;Teixidor et al, 2007;Wu et al, 2011). Subtle impairments in emotion recognition have also been described in a group of eleven patients with left frontal glioma (Mu et al, 2012) concerning a group of seven patients with LGG (Du Boullay, .…”