A Lesion-Proof Brain? Multidimensional Sensorimotor, Cognitive, and Socio-Affective Preservation Despite Extensive Damage in a Stroke Patient

Abstract

In this study, we report an unusual case of mutidimensional sensorimotor, cognitive, and socio-affective preservation in an adult with extensive, acquired bilateral brain damage. At age 43, patient CG sustained a cerebral hemorrhage and a few months later, she suffered a second (ischemic) stroke. As a result, she exhibited extensive damage of the right hemisphere (including frontal, temporal, parietal, and occipital regions), left Sylvian and striatal areas, bilateral portions of the insula and the amygdala, and the splenium. However, against all probability, she was unimpaired across a host of cognitive domains, including executive functions, attention, memory, language, sensory perception (e.g., taste recognition and intensity discrimination), emotional processing (e.g., experiencing of positive and negative emotions), and social cognition skills (prosody recognition, theory of mind, facial emotion recognition, and emotional evaluation). Her functional integrity was further confirmed through neurological examination and contextualized observation of her performance in real-life tasks. In sum, CG's case resists straightforward classifications, as the extent and distribution of her lesions would typically produce pervasive, multidimensional deficits. We discuss the rarity of this patient against the backdrop of other reports of atypical cognitive preservation, expound the limitations of several potential accounts, and highlight the challenges that the case poses for current theories of brain organization and resilience.

Action Semantics at the Bottom of the Brain: Insights From Dysplastic Cerebellar Gangliocytoma

“…First, the control sample had a modest size. However, our tests are considered robust with small control groups (∼5 subjects) ( Crawford and Howell, 1998 ), as attested by previous single-case studies yielding robust findings with similar or even smaller control-sample sizes ( Bak et al, 2006 ; García et al, 2016a , 2017c ; Birba et al, 2017b ), or even in the absence of control groups ( Caramazza and Hillis, 1991 ; Silveri et al, 1998 ; Berndt and Haendiges, 2000 ). Second, our assessment was restricted to a single cognitive task, whereas the explored domains manifest in multiple ways.…”

Action‐semantic and syntactic deficits in subjects at risk for Huntington's disease

“…Second, individual subjects confirmed to be gene carriers and non-carriers should perform those tasks and their performance should be compared to that of healthy control samples, on the assumption that only the former should evince the deficits documented herein. The necessary analysis could be performed, for example, through Crawford's modified two-tailed t-test (Crawford & Garthwaite, 2002, 2012Crawford, Garthwaite, & Howell, 2009;Crawford, Garthwaite, & Ryan, 2011;Crawford & Howell, 1998), which proves robust for non-normal distributions, presents low rates of type-I error, and has been successfully used in previous single-case studies (Couto et al, 2013(Couto et al, , 2014Garc ıa, Sedeño, Herrera Murcia, Couto, & Ib añez, 2017;Garc ıa, Abrevaya, et al, 2017;Straube et al, 2010). The evidence thus obtained would be critical to test the usefulness of the proposed domains to detect pre-clinical deficits at the singlesubject level.…”

Early bilateral and massive compromise of the frontal lobes

“…Alongside other lesion-based approaches, frontal compromise offers an informative model of development, resilience, and plasticity ( Payne and Lomber, 2001 ). Comparably unexpected evidence has been offered in previous reports, including those of a man who led a completely normal life although he lacked 75% of his brain ( Feuillet et al, 2007 ), a woman with highly preserved motor function despite primary cerebellar agenesis ( Yu et al, 2015 ), another woman with multiple preserved functions even after two subsequent stroke affecting massive regions of her brain ( García et al, 2016 ), patients who were able to restore their language skills after left hemispherotomy (e.g., Hertz-Pannier et al, 2002 ), or hydranencephaly patients with almost not cortices and preserved functions of consciousness, emotion, and basic sensorimotor abilities ( Merker, 2007 ). In fact, these previous cases of preserved functions despite damage to critical regions have provided important insights into cognitive function and challenge current neurocognitive models and conceptions of brain organization and plasticity.…”