We investigated the relationship between preoperative MRI hippocampal volumes and clinical neuropsychological memory test data obtained before and after temporal lobectomy and amygdalohippocampectomy for intractable epilepsy in 44 left (LTL) and 36 right (RTL) temporal lobectomy patients. In LTL patients, the difference (right minus left hippocampal volume) between hippocampal volumes (DHF) was significantly (p < 0.001) correlated (r = 0.61) with postoperative verbal memory change as measured by a delayed memory percent retention score from the Wechsler Memory Scale-Revised, Logical Memory subtest. DHF was also positively associated with postoperative memory for abstract geometric designs in LTL patients (r = 0.49, p < 0.005). Resection of a relatively nonatrophic left hippocampus was associated with poorer verbal and visual memory outcome. In RTL patients, larger right adjusted (for total intracranial volume) hippocampal volume was associated with decline in visual-spatial learning, but not memory, following surgery. MRI hippocampal volume data appear to provide meaningful information in evaluating the risk for memory impairment following temporal lobectomy.

Identification of clinical and serologic clues to an autoimmune dementia allows early initiation of immunotherapy, and maintenance if needed, thus favoring an optimal outcome.

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Results of this study modified our approach in patients with TLE. Interictal epileptiform discharges localized to one temporal lobe on serial routine EEGs or during LTM may be adequate to identify the epileptogenic zone in patients with MRI-identified unilateral medial temporal lobe atrophy.

Abstract-Background: Neurologic symptoms have been attributed to manganese fumes generated during welding. Increased T1 MRI signal in the basal ganglia is a biologic marker of manganese accumulation. Recent studies have associated welding and parkinsonism, but generally without MRI corroboration. Objective: To characterize the clinical and neuropsychological features of patients with MRI basal ganglia T1 hyperintensity, who were ultimately diagnosed with neurotoxicity from welding fumes. Methods: The medical records of welders referred to the Department of Neurology with neurologic problems and basal ganglia T1 hyperintensity were reviewed. Results: All eight patients were male career welders with increased T1 basal ganglia signal on MRI of the brain. Several different clinical syndromes were recognized: a parkinsonian syndrome (three patients), a syndrome of multifocal myoclonus and limited cognitive impairment (two patients), a mixed syndrome with vestibular-auditory dysfunction (two patients), and minor subjective cognitive impairment, anxiety, and sleep apnea (one patient). Neuropsychometric testing suggested subcortical or frontal involvement. Inadequate ventilation or lack of personal respiratory protection during welding was a common theme. Conclusions: Welding without proper protection was associated with syndromes of parkinsonism, multifocal myoclonus, mild cognitive impairment, and vestibular-auditory dysfunction. The MRI T1 hyperintensity in the basal ganglia suggests that these may have been caused by manganese neurotoxicity. NEUROLOGY 2005;64:2033-2039 Welding utilizes an electric arc to melt and bond metals. Fumes with high concentrations of aerosolized metals generated by welding may cause systemic as well as neurologic problems.1-4 Although many elemental metals are released in welding plumes, the neurotoxicity is presumed to be primarily mediated by manganese. [5][6][7][8][9] Manganese neurotoxicity presents commonly as a parkinsonian syndrome 7,8,10,11 and has been reported to be associated with welding. 5,12 A biologic marker of manganese accumulation within the CNS is bilaterally increased T1 MRI signal within the basal ganglia, especially the globus pallidus, but also the striatum.1,13-18 Although T1 signal changes in these nuclei may be seen in several other conditions (e.g., nonketotic hyperglycemic episodes, hypoxia, neurofibromatosis, and other paramagnetic ions), it is an uncommon pattern. When the T1 hyperintensity is confined to the lentiform nuclei, and in the appropriate clinical setting, it has relative specificity for brain manganese. This MRI appearance suggests that the ambient fume intensity has been sufficient to affect the brain. Although an association between welding and parkinsonism has been postulated in two recent clinical series, the MRI scans in these patients were either normal or not reported. 5,12We report eight patients referred for neurologic evaluation and diagnosed with neurotoxicity from welding fumes. All had chronic and intense exposure to ambient welding fum...