Article Figures & Data
Figures
- Fig 1.
An example of a non-real object: In this case, a pot with the outline of a trumpet is where the handle is expected.
- Fig 2.
DSA images in a 27-year-old woman with a left supratentorial AVM.
A, Initial diagnostic angiogram of the left common carotid artery, lateral view, shows a large AVM nidus in the left perirolandic region. Multiple arterial feeders arise from the superior and inferior division of the left MCA. Note the early opacification of the three dilated veins draining into the superior sagittal sinus.
B, During the third embolization session, the tip of the flow-directed microcatheter is advanced into a feeder that topographically corresponds to the anterior parietal branch of the left MCA. Superselective angiogram obtained prior to possible embolization shows opacification of a discrete portion of the nidus and an enlarged parietal vein, but it shows no evidence of normal arterial structures or parenchymal blushing. The amobarbital test is performed with the microcatheter tip in this position.
C, After the documentation of cognitive deficits that correlate with the left parietal cortex during the amobarbital test, the microcatheter is repositioned to a slightly more distal location, and a another superselective angiographic study is performed. This second angiogram clearly reveals the presence of two previously undetected arterial branches with a normal appearance that arise from the large feeder; these are responsible for parenchymal blushing.
Tables
Representative cognitive and neurologic functions assessed during provocative amobarbital testing*
Neuropsychologic or Neurologic Function Lobe Test and/or Stimuli Verbal fluency Frontal, temporal Naming of as many items in a given category (eg, fruits, animals) as possible in 15 seconds Naming Frontal, parietal, temporal, occipital Object naming, picture naming Reading Frontal, parietal, temporal, occipital Single word reading Semantic judgment Temporal Deciding whether two words are related (eg, “Are grass and green related?”) or of a given category (eg, “Is a dog an animal?”) (10) Mental arithmetic Parietal Performing non-rote calculations Right-left orientation Parietal Using a specific hand to point to lateralized body part on the examiner (eg, “Point to my right ear with your right hand.”) Visual-spatial processing Parietal, occipital Reading of analog clock faces, identifying common objects presented in disarranged visual fragments (11), performing and real vs non-real object decision tasks (12) (Fig 1) Color perception and naming Occipital Naming of color patches Recognition memory Frontal, temporal Testing after the amobarbital effect has worn off by asking the patient to choose between pairs of pictures or words, of which one of was shown in the language-testing phase Strength Frontal, parietal Testing of limb strength contralateral to the AVM, assessed with the Medical Research Council scale Sensation Frontal, parietal Assessing light touch and/or temperature in the contralateral limbs Visual fields Parietal, temporal, occipital Confrontation testing with the detection of finger movement or finger counting Limb coordination Cerebellar Testing with finger-to-nose and rapid finger-tapping sequences Eye movements Cerebellar Testing with smooth pursuits and saccades * Tests were based on the lobe in which the AVM was located.
