Brain, Vol. 124, No. 4, 838,
April 2001
© 2001 Oxford University Press
Book reviews |
LOCALIZATION OF BRAIN LESIONS AND DEVELOPMENTAL FUNCTIONS.
By D. Riva and A. Benton. 2000. Eastleigh: John Libbey. Price £39. Pp. 168. ISBN 0-86196-599-X.
Department of Pediatrics, University Childrens' Hospital, Uppsala, Sweden
The book starts with a chapter on historical aspects concerning cerebral localization. The application of modern neuroimaging and cognate techniques has re-evaluated the meaning of `localization'. The complicated concept of interhemispheric interaction and integration is emphasized. Two chapters deal with corpus callosum agenesis and its influence on hemispheric specialization and interhemispheric communication. The congenital absence of corpus callosum in children is not related to the severe disconnection syndrome seen in commissurotomized adults, which points to the great potential for cerebral plasticity and re-organization of the young brain. The compensation, however, is not complete. This is also valid for acquired lesions of the corpus callosum in children and adolescents.
One chapter deals with language and neuropsychological dysfunction in basal ganglia lesions. Interesting information is provided concerning the cortico-striato-pallido-thalamo-cortical loops subserving multiple functions. Some of them have an activating or modulatory role on the overlying cortex. They also have an indirect effect upon cognitive functions, as they may produce a depression of the metabolic activity of the overlying cortex, which has been shown with PET scanning. Subcortical damage has a better outcome for immediate recovery in children compared with adults.
A chapter on acquired aphasic syndromes points to fundamental similarities with adulthood aphasia. Lesions in different areas of the left hemisphere in right-handed individuals can be associated with different aphasic syndromes. Informative tables concerning the aphasic syndromes and clinico-radiological correlations are provided. The role of the left hemisphere, not only for language processing, but also for the processing of spatial information is described in a separate chapter.
One chapter deals with closed head injuries in children and their effect on cognitive function. The prefrontal region is usually involved, which contributes to persistent impairment. The findings indicate that measures of executive function in children are sensitive to the severity of the injury and to the volume of prefrontal lesions. Preliminary results indicate no support for initial sparing of function or delayed onset of deficit as children with prefrontal lesions sustained at a young age approach adolescence.
Neuropsychological deficits relating to object recognition are highlighted. Apperceptive and associative agnosia (recognition of objects) and prosopagnosia (recognition of faces) are discussed, together with developmental aspects. There is a special chapter on language development in children with early focal brain damage as a means to understanding the development of the brain basis for language and the flexibility of the developing brain. Childrens' brains, unlike those of adults, are flexible and reflect a wider potential for assuming diverse behavioural functions. The matter of non-verbal learning disabilities is specially addressed with respect to white matter disorders and dysfunction of the right cerebral hemisphere.
The final two chapters concern the cerebellum. A short review of developmental disorders of the cerebellum is presented, emphasizing that the integrity of the cerebellum is necessary for normal cognitive development and that cerebro-cerebellar pathways are involved in this process. An interesting phenomenon is the so-called crossed cerebellar diaschisis, i.e. the metabolic depression shown by PET studies in the cerebellar hemisphere contralateral to a cerebral lesion. A reversed phenomenon, a cerebello-cerebral diaschisis, has also been described. That the cerebellum contributes to higher cognitive and social behaviour in childhood as well as to the regulation of complex movements is illustrated by 25 children who underwent surgery for different posterior fossa tumours and one for stroke. The clinical difference in lesions involving the vermis and the hemispheres, respectively, are pointed out, as well as the persistence of deficits. This persistence demonstrates that, in this context, plasticity is not so powerful as to fully compensate for even very early lesions. Developmentally the connections from the cerebellum to the associative cortical areas, particularly the frontal ones, and vice-versa, are established very early in life.
As the area between paediatric neurology and neuropsychiatry has developed during recent years, thus resulting in intensified collaboration, this book is of great interest for paediatric neurologists and neuropsychiatrists, especially for those interested in developmental disorders and lesions of the cerebellum and brain stem and the disorders influencing the interhemispheric connections. The book is also of the utmost interest for neuropsychologists engaged in developmental studies and research concerning cerebral and cerebellar tumours and epilepsy.
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