Lesion

A lesion is any abnormality in the tissue of an organism (in layman's terms, "damage"), usually caused by disease or trauma. Lesion is derived from the Latin word laesio meaning injury.

History

DuVerney was the first to use experimental ablation method on animals in 1679. Flourens first published the method in 1824, describing the method and behavioral effect of brain damage.

Lesions done by knife cuts and suction techniques, called mechanical lesions, were tried by Veyssiere and Nothnagel in 1874. This process was done by inserting a fine wire blade through the head, rotating the curved or angled wire, and cutting neural projection. Baginski and Lehmann used this method with thin glass tube lowered through a small hole in the skull in 1886.

In 1895, Golsinger was the first to make electrolytic lesions in animals. In 1898, Sellier and Verger destroyed discrete areas in the caudate and anterior segment of internal capsule by passing current through double-needle insulated electrodes. This process kills neurons surrounding the electrodes.

In 1908, Horsley and Clark developed the stereotaxic method and combined it with electrolytic lesions to improve localization, precision, and reliability of brain damage in subcortical structures.

In the 1940s to 1950s, Lobotomy was a popular procedure for curing various psychological conditions which relied on lesioning the frontal lobes.

Types

Because the definition of a lesion is so broad, the varieties of lesions are virtually endless. Lesions can occur anywhere in the body that consists of soft tissue or osseous matter, though most frequently found in the mouth, skin, and the brain, or anywhere where a tumour may occur.^{[citation needed]} They are subsequently classified by their features. If a lesion is caused by a tumor it will be classified as malignant or benign. Lesions may be classified by the shape they form, as is the case with many ulcers, which can have a bullseye or 'target' appearance. Their size may be specified as gross or histologic depending on whether they are visible to the unaided eye or require a microscope to see.

An additional classification that is sometimes used is based on whether or not a lesion occupies space. A space-occupying lesion, as the name suggests, has a recognizable volume and may impinge on nearby structures, whereas a non space-occupying lesion is simply a hole in the tissue, e.g. a small area of the brain that has turned to fluid following a stroke.

Some lesions have specialized names, such as Ghon lesions in the lungs of tuberculosis victims. The characteristic skin lesions of a varicella zoster virus (VZV) infection are called chickenpox. Lesions of the teeth are usually called dental caries.

Another type of lesion is excitotoxic lesions that can be caused by excitatory amino acid like kainic acid that kills neuron by stimulating to death.

Sham lesions are the process of putting stereotaxic apparatus and insert it inside the skull to produce a lesion to see if behavior correlates with the brain lesion.

Finally, lesions are often classified by their location. For example, a 'skin lesion' or a 'brain lesion'.

Causes

Lesions are caused by any process that damages tissues. Lesions can also be caused by metabolic processes, like an ulcer or autoimmune activity, as in the case with many forms of arthritis.

Lesions are sometimes intentionally inflicted during neurosurgery, such as the carefully placed brain lesion used to treat epilepsy and other brain disorders. (See Ablative brain surgery.)

Note that lesions are not limited to animals or humans; damaged plants are said to have lesions.

Causes of Brain Lesions

Lesions to the brain can result from many factors, including vascular disorders, traumatic brain injuries, and tumors.

Vascular Disorders

Vascular disorders of the brain, often called strokes, disrupt the flow of blood to the brain, resulting in a lesion called an infarct. Vascular disorders of the brain include thrombosis, embolisms, angiomas, aneurysms, and cerebral arteriosclerosis.

Traumatic Brain Injuries

Traumatic brain injuries (TBI) damage the brain by causing swelling and bleeding inside the brain, leading to inter-cranial pressure. TBIs are divided into open-head injuries, in which the brain is penetrated, and closed head injuries, typically caused by blunt force to the head. Closed head injuries typically cause damage both at the site of the blow (referred to as the coup) and at the opposite side of the skull (referred to as the contrecoup).

Tumors

Brain tumors increased inter-cranial pressure, causing brain damage.

Surgery

Lesions are used as a treatment for epilepsy and in neuropsychological research using animals. These lesions can be induced with electric shocks (electrolytic lesions) to the exposed brain or commonly by infusion of exictotoxins to specific areas.

Effects of Brain Lesions

Studies show there is a correlation between brain lesion and language, speech, and category-specific disorders. However, lesions in Broca's and Wernicke's areas are not found to alter language comprehension.

Lesions to the fusiform gyrus often result in prosopagnosia, the inability to distinguish faces and other complex objects from each other.

Lesions to the visual cortex have different effects depending on the sub-area effected. Lesions to V1, for example, can cause blindness in different areas of the brain depending on the size of the lesion and location relative to the calcarine fissure. Lesions to V4 can cause color-blindness, and bilateral lesions to V5 can cause the loss of the ability to perceive motion.

Lesion in amygdala would eliminate the enhanced activation seen in occipital and fusiform visual areas in response to fear with the area intact. Amygdala lesions change the functional pattern of activation to emotional stimuli in regions that are distant from the amygdala.

Lesion size is correlated with severity, recovery, and comprehension.

In the Wisconsin Card Sorting Test with unilateral frontal or nonfrontal lesions, patients with left frontal lesions did more poorly but had high perseverative error scores. In right frontal and nonfrontal lesions are impaired but due to differences in patients. As a result, medial frontal lesions are associated with poor performance.

An impairment following damage to a region of the brain does not necessarily imply that the damaged area is wholly responsible for the cognitive process which is impaired, however. For example, in pure alexia, the ability to read is destroyed by a lesion damaging both the left visual field and the connection between the right visual field and the language areas (Broca’s Area and Wernicke’s area). However, this does not mean one suffering from pure alexia is incapable of comprehending speech -- merely that there is no connection between their working visual cortex and language areas -- as is demonstrated by the fact that pure alexics can still write, speak, and even transcribe letters without understanding their meeting.

Research using Lesions

Lesions are useful to researchers in understanding how the components of the brain produce cognition. Research involving lesions is predicated on the formal logic that if impaired performance implies a model of damaged cognition and that the model of the damaged cognition is equal to the normal system plus the effect of the lesion, then the impaired performance implies the normal cognitive system plus the effect of the lesion.

Research with Humans

Humans with brain lesions are often the subjects of research with the goal of establishing the function of the area where their lesion occurred.

A drawback to the use of human subjects is the difficulty in finding subjects who have a lesion to the area which the researcher wishes to study.

Research with Animals

Using animal subjects gives researchers the ability to lesion specific areas in the subjects, allowing them to quickly acquire a large group of subjects. An example of such a study is the lesioning of rat hippocampi to establish the role of the hippocampus in object recognition and object recency.

The major disadvantage of animal subjects is the limited extendability of the results to humans, whose brains differ to varying degrees from the animals.

See also

• Skin lesion
• Ablation
• Cognitive Neuropsychology
• Neuroplasticity

References

2. Alexander, M.P., Naeser, M.A., & Palumbo, C.L. (1987). Correlations Of Subcortical CT Lesion Sites And Aphasia Profiles. Brain, 110, 961-991.

3. Cancelliere, A.E.B, Kertesz, A. (1990). Lesion Localization In Acquired Deficits Of Emotional Expression And Comprehension. Brain and Cognition, 13(2), 133-147.

4. Carlson, N.R. (1977). Physiology of behavior. Boston: Allyn and Bacon.

5. Drewe, E.A. (1974). The Effect Of Type And Area Of Brain Lesion On Wisconsin Card Sorting Test Performance. A Journal Devoted to the Study of the Nervous System and Behavior, 10(2), 159-170.

6. Dronkers, N.F., Wilkins, D.P., Van Valin Jr., R.D., Redfern, B.B, Jaeger, J.J. (2004). Lesion Analysis Of The Brain Areas Involved In Language Comprehension. Cognition, 92(1-2), 145-177.

7. Gainotti, G. (2000). What the Locus of Brain Lesion Tells us About the Nature of the Cognitive Defect Underlying Category-Specific Disorders: A Review. Cortex, 36(4), 539-559.

8. Kent, R.D. (1982). Prosodic Disturbance And Neurologic Lesion. Brain and Language, 15(2), 259-291.

9. Kertesz, A., Harlock, W., & Coates, R. (2004). Computer Tomographic Localization, Lesion Size, And Prognosis In Aphasia And Nonverbal Impairment. Brain and Language, 8(1), 34-50.

10. Schallert, T., & Wilcox, R.E. (1986). Neurotransimitter-Selective Brain Lesions. Biomedical and Life Sciences, 1, 343-387.

11. Vuilleumier, P., Richardson, M.P., Armony, J.L., Driver, J. & Dolan, R.J. (2004). Distant Influences Of Amygdala Lesion On Visual Cortical Activation During Emotional Face Processing. Nature Neuroscience, 7, 1271-1278.

12. Kolb, Bryan, Whishaw, Ian Q. (2009). Fundamentals of Human Neuropsychology 6th Edition, 749 - 756.

External links

• Brain Lesion Locator Differential Diagnosis of Brain Lesions
• Al Jazeera Fish born with Lesions as a result of BP oil spill