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Bilateral cingulectomies performed in psychotic and neurotic patients result in an overall diminution of emotional reactions (Ballantine et al; Brown) women's health grampians buy aygestin 5 mg with visa. Some investigators believe that the cingulate gyri are also involved in memory processing (functioning presumably in connection with the mediodorsal thalamic nuclei and mediotemporal lobes) and in exploratory behavior and visually focused attention. In humans, this system appears to be more efficient in the nondominant hemisphere, according to Bear. Baleydier and Mauguiere emphasize this dual function- in cognition and in emotional reactions- of the cingulate gyrus. Another aspect of limbic function has come to light as information is being acquired about neurotransmitters. The concentration of norepinephrine is highest in the hypothalamus and next highest in the medial parts of the limbic system; at least 70 percent of this monoamine is concentrated in terminals of axons that arise in the medulla and in the locus ceruleus of the rostral pons. Axons of other ascending fibers- especially those originating in the reticular formation of the midbrain and terminating in the amygdala and septal nuclei as well as in lateral parts of the limbic lobe- are rich in serotonin. The axons of neurons in the ventral tegmental parts of the midbrain, which ascend in the medial forebrain bundle and the nigrostriatal pathway, contain a high content of dopamine. Emotional Disturbances in Hallucinating and Deluded Patients these are best portrayed by the patient with a florid delirium. Threatened by imaginary figures and voices that seem real and Table 25-1 Neurology of emotional disturbances I. We have seen a patient slash his wrists and another try to drown himself in response to hallucinatory voices that admonished them for their worthlessness and the shame they had brought on their families. But the abnormality in these circumstances is one of disordered perception and thinking, and we have no reason to believe that there is a derangement of the mechanisms for emotional expression. There also occurs a state- difficult to classify- of overwhelming emotionality in patients who are in severe acute pain. We have encountered this with spinal subdural hemorrhage, subarachnoid hemorrhage, explosive migraine, trauma with multiple fractures, and intense pelvic, renal, or abdominal pain, all understandable as responses to extralimbic stimuli. Table 25-2 Causes of pseudobulbar affective display Bilateral strokes (lacunes in the cerebral hemispheres or pons most often, and after several strokes in succession) Binswanger diffuse leukoencephalopathy (Chap. The degree to which this pertains varies with gender and ethnicity and has more to do with social norms than with biology. In the realm of neurologic disease, a patient whose cerebrum has been damaged- for example, by a series of vascular lesions- may suffer the humiliation of crying in public upon meeting an old friend or hearing the national anthem, or of displaying uncontrollable laughter in response to a mildly amusing remark or an attempt to tell a funny story.
Mojok, 26 years: In many cases the disease is less severe and the patient suffers a transient encephalitic illness with headaches, confusion, and slight signs of meningeal irritation.
Barrack, 58 years: Other palsies of gaze (due to interruption of supranuclear connections) or palsies of individual ocular muscles (due to involvement of the ocular motor nerves in their intramedullary course) also occur, but less frequently.
Taklar, 47 years: By contrast, in cytotoxic edema, all the cellular elements (neurons, glia, and endothelial cells) imbibe fluid and swell, with a corresponding reduction in the extracellular fluid space.
