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J Brinkley

Publications and source records attributed to J Brinkley.

10 recordsLinked to original sources
PubMed1999

Functional roles of Broca's area and SMG: evidence from cortical stimulation mapping in a deaf signer.

The importance of the left hemisphere in language function has been firmly established and current work strives to understand regional specializations within the perisylvian language areas. This paper reports a case study of a deaf user of American Sign Language undergoing an awake cortical stimulation mapping procedure. Patterns of sign errors accompanying electrical stimulation of Broca's area and the supramarginal gyrus (SMG) are reported. Our findings show Broca's area to be involved in the motor execution of sign language. These data demonstrate that the linguistic specificity of Broca's area is not limited to speech behavior. In addition, unusual semantic-phonological errors were observed with stimulation to the SMG; these data may implicate the SMG in the binding of linguistic features in the service of language production. Taken together, these findings provide important insight into the linguistic specificity of Broca's area and the functional role of the supramarginal gyrus in language processing.

Anomia↗
PubMed1997

Visualization-based mapping of language function in the brain.

Cortical language maps, obtained through intraoperative electrical stimulation studies, provide a rich source of information for research on language organization. Previous studies have shown interesting correlations between the distribution of essential language sites and such behavioral indicators as verbal IQ and have provided suggestive evidence for regarding human language cortex as an organization of multiple distributed systems. Noninvasive studies using ECoG, PET, and functional MR lend support to this model; however, there as yet are no studies that integrate these two forms of information. In this paper we describe a method for mapping the stimulation data onto a 3-D MRI-based neuroanatomic model of the individual patient. The mapping is done by comparing an intraoperative photograph of the exposed cortical surface with a computer-based MR visualization of the surface, interactively indicating corresponding stimulation sites, and recording 3-D MR machine coordinates of the indicated sites. Repeatability studies were performed to validate the accuracy of the mapping technique. Six observers-a neurosurgeon, a radiologist, and four computer scientists, independently mapped 218 stimulation sites from 12 patients. The mean distance of a mapping from the mean location of each site was 2.07 mm, with a standard deviation of 1.5 mm, or within 5.07 mm with 95% confidence. Since the surgical sites are accurate within approximately 1 cm, these results show that the visualization-based approach is accurate within the limits of the stimulation maps. When incorporated within the kind of information system envisioned by the Human Brain Project, this anatomically based method will not only provide a key link between noninvasive and invasive approaches to understanding language organization, but will also provide the basis for studying the relationship between language function and anatomical variability.

Brain Mapping↗
PubMed1997

Evaluation of a visualization-based approach to functional brain mapping.

We describe a method for mapping stimulation data, obtained at the time of neurosurgery for intractable epilepsy, onto a 3D MRI-based neuroanatomic model of the individual patient. The mapping is done by comparing an intraoperative photograph of the exposed cortical surface with a computer-based MR visualization of the surface, interactively indicating corresponding stimulation sites, and recording 3-D MR machine coordinates of the indicated sites. Repeatability studies were performed to validate the accuracy of the mapping technique. Six observers--a neurosurgeon, a radiologist, and four computer scientists, independently mapped 218 stimulation sites from 12 patients. The mean distance of the six locations from the mean location of each site was 2.07 mm, with a standard deviation of 1.5 mm, or within 5.07 mm with 95% confidence. Since the surgical sites are accurate within approximately 1 cm, these results show that the visualization-based approach is accurate within the limits of the stimulation maps. When incorporated within the kind of information system envisioned by the Human Brain Project, this anatomically-based method will not only provide a key link between non-invasive and invasive approaches to understanding language organization, but will also provide the basis for studying the relationship between language function and anatomical variability.

Brain Mapping↗
PubMed1995

A psychiatrist-rated battery of measures for assessing the clinical status of psychiatric inpatients.

Despite the increasing demand for outcome assessment measures, no published reports have provided a standardized way to assess psychiatric inpatients that includes diagnosis and observer ratings of psychopathology. This paper reviews general principles for selecting outcome assessment measures, proposes a battery of instruments based on already available measures to assess clinical status in psychiatric inpatients, reviews methods of implementing the battery in an academic inpatient psychiatric setting, and presents preliminary data on its interrater reliability, construct validity, and range of response to acute hospitalization. Preliminary results suggest that the battery may be useful for resident and medical student education and for enhancing quality assurance and continuous quality improvement.

Comorbidity↗
PubMedDate not supplied

Adult attention-deficit hyperactivity disorder: assessment guidelines based on clinical presentation to a specialty clinic.

Of 143 adults presenting for attention-deficit hyperactivity disorder (ADHD) evaluation, 46 (32%) clearly met diagnostic criteria, 46 (32%) clearly did not meet diagnostic criteria, and another 51 (36%) with current ADHD-like features did not meet criteria due to either a lack of childhood history and/or complicating severe psychiatric or substance abuse comorbidity. The three groups were similar in demographics, psychiatric diagnosis, psychiatric symptom severity, and functional impairment. Compared with the group not meeting ADHD criteria, patients with ADHD had more frequent histories of learning disability in childhood, poorer reading scores on the Wide-Range Achievement Test (WRAT), poorer scores on the Continuous Performance Test (CPT), and higher scores on the Wender-Utah Rating Scale (WURS) for ADHD. Patients in the ambiguous ADHD category had higher rates of current substance abuse than the other two groups. While this group resembled the non-ADHD group in having a low incidence of learning disability and normal reading scores, their poor performance on the CPT and high scores on the WURS more closely resembled those of ADHD patients. These findings suggest that there are a few rating scales, testing instruments, and lifetime history characteristics that help to clarify the difficult diagnostic distinction between adult patients who do and do not have ADHD.

Achievement↗
PubMedDate not supplied

Percutaneous cardiopulmonary bypass to support angioplasty and valvuloplasty. Technical considerations.

To eliminate problems during percutaneous transluminal coronary angioplasties (PTCAs) or valvuloplasties (PV), percutaneous cardiopulmonary bypass (PCPB) was used in 19 high-risk patients (pts) to perform supported PTCA (12 pts, age 40-68) for low EF and/or a large area of risk (L main), and supported PV (7 pts, age 68-92) for "nonoperative" candidates with severe AS. Our experience promoted a review of the technical aspects of PCPB was needed for a successful outcome in these high-risk patients. All patients were treated with IV amnestics while awake in the catheter laboratory. Early in the experience, 20F arterial and venous cannulas were inserted via a 2 cm cutdown in the right groin; now 17F arterial and 20F venous cannulas are placed via a Seldinger technique using fluoroscopy. Traversement of the iliac vein is enhanced by a roll under the buttocks. If the artery is calcified, a cutdown, vessel loops, and direct repair are employed to assure post-PCPB patency. Total flows of 6L/min are easily achieved with nonreservoir centrifugal pump bypass. If flow or pressures fall, 200 cc of blood or crystalloid rapidly improves venous drainage and flows and unlike during reservoir bypass, alpha agonists are only rarely necessary; CaCl often produces nausea in these patients. PCWP's are brought to 0-5 mm Hg. Due to the 1,500 cc priming volume, on-pump transfusion is often required. Two patients were successfully transported to the OR on PCPB for treatment of catheter failures. With attention to technical details, percutaneous bypass supported PTCA or PV is an important new therapy for high risk patients.

Adult↗
PubMedDate not supplied

Congenital toxoplasmosis presenting as isolated acute chorioretinitis in the neonate.

We describe a neonate with congenital ocular toxoplasmosis that presented as isolated, acute bilateral retinochoroiditis. Although toxoplasmic retinochoroiditis is not rare, it is quite unusual to diagnose congenital toxoplasmosis based on isolated bilateral retinochoroiditis in an otherwise healthy neonate. Bilateral retinochoroiditis can be caused by syphilis, herpes virus, cytomegalovirus, and toxoplasmosis. Because specific treatments now exist for these conditions, it is important to establish proper diagnosis so that treatment can be initiated promptly. The differential diagnosis, work-up, and management of retinochoroiditis in the newborn is presented and discussed.

Chorioretinitis↗