The figurative use of the word “airhead” originated in the late 1970’s and signified a simple-minded or stupid person. But what are the characteristics of the literal “airhead” (or in medical jargon, pneumocephalus)? Does this person also exhibit similar deficits in cognitive function?

The New England Journal of Medicine recently featured the case of an Argentinian patient who spontaneously developed the so-called pneumocephalus. She is a 54 year-old woman who experienced progressive visual, auditory, and speaking abnormalities. A head radiograph demonstrated an air pocket along her left temporal region (enlarged image). A computed tomography (CT) scan revealed similar findings, with the pocket measuring 4 cm x 3 cm x 5 cm. There was no evidence of fracture or trauma.

The cause of the woman’s sensory and speech deficits can be explained by the air compressing against her brain, with indirect compromise of her brainstem. Her symptoms resolved soon after undergoing neurologic surgery to decompress the air and to repair a defect in an adjacent bone (mastoid). No tumor or infection was noted. Although most cases of pneumocephalus occur secondary to head trauma, it is possible the mastoid bone defect discovered during surgery may have been the source for air to enter the skull.

On a lighter note, the next time someone accuses you of being an airhead, you could refute him figuratively and literally with the following response: “I do not manifest the typical characteristics of pneumocephalus”.

• Sources
• Villa RA, Capdevila A. Spontaneous otogenic pneumocephalus. NEJM 2008;358:e13.
• Image Copyright: New England Journal of Medicine

A group at the University of Wurzburg, Germany, and their European colleagues have recently demonstrated moderate reversal of some brain changes due to chronic alcohol abuse. The test subjects included 15 detoxified alcoholics who had been sober for at least 6 weeks. The researchers measured changes in brain volume, neurotransmitter metabolism, and performance on neuropsychological tests. The subjects showed improvement in all three parameters between the time of enrollment in the study and at follow-up. Improvement has been noted to predominantly affect certain regions of the brain. A control group of 10 healthy volunteers did not demonstrate a similar change.

It is worthwhile to note that the test subjects were chosen from an original cohort of 24 alcohol-dependent patients. Some exclusion criteria included concomitant nicotine abuse, alcohol withdrawal, Wernicke-Korsakoff encephalopathy, hepatic disease, or other related disorders. While the data are reassuring for short-term neurologic recovery from alcoholism, we cannot disregard the irreversible effects of chronic alcohol abuse. We do not know whether abuse of additional substances may synergistically cause irreparable damage to the brain. The potential permanency of alcohol-induced Korsakoff’s syndrome has yet to be disproven. Moreover, non-neurologic organ damage (e.g., the liver) may show little to no improvement with abstinence after enough damage has occurred. In any case, the study reaffirms the regenerative capabilities of the brain. These findings prompt further research into brain recovery with hopes for future therapies benefiting patients with brain tumors, head trauma, and chemical toxicity.

• Source
• Bartsch AJ, Homola G, Biller A, Smith SM, Weijers HG, Wiesbeck GA, Jenkinson M, De Stefano N, Solymosi L, Bendszus M. Manifestations of early brain recovery associated with abstinence from alcoholism. Brain 2007;130:36-47.

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Alzheimer disease is a chronic condition that afflicts more than 14% of the geriatric population. It is the most common cause of dementia, characterized by a progressive decline in cognitive function. Although there are pharmaceutical drugs (i.e., donepezil) that attempt to stave this decline, there is yet no cure.

A recent study published in the American Journal of Clinical Nutrition has correlated green tea consumption with a lower prevalence of cognitive impairment. Although previous animal studies have suggested a protective effect of green tea against neurodegenerative diseases, this is the first study that addresses the topic in humans.

Researchers at the Tohoku University School of Medicine (Sendai, Japan) surveyed 1003 geriatric citizens at ages 70 years or older from the Tsurugaya district of Sendai City. The study examined several variables, including the consumption of certain beverages, the health status, and the social habits of the participants. Their cognitive function was assessed using the Mini-Mental Status Examination (MMSE), a tool commonly used by neurologists and geriatricians.

The study found that participants who routinely consumed greater quantities of green tea generally scored higher on the MMSE. Consumption of black or oolong tea, or coffee did not produce similar trends. The researchers also adjusted the data for several possible confounders, such as presence of different diseases, level of physical activity, educational background, dietary habits, and substance use. The results still demonstrated a positive effect of green tea in cognitive function.

Does green tea hold promise for dementia patients? Can it reverse the cognitive decline in Alzheimer disease? What about using it as prophylaxis by healthy individuals? The findings are exciting, but there is yet much research needed to validate and extend the results of the Tsurugaya Project.

• Source
• Kuriyama S, Hozawa A, Ohmori K, Shimazu T, Matsui T, Ebihara S, Awata S, Nagatomi R, Arai H, Tsuji I. Green tea consumption and cognitive function: a cross-sectional study from the Tsurugaya Project. Am J Clin Nutr 2006;83:355-61.

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Time Online recently published an article on “How to Get Smarter, One Breath at a Time”. It focuses on the benefits of meditation on cognitive abilities, particularly through alteration of the brain’s structure and function. It cites the work of Dr. Sara Lazar (Instructor of Psychology at MGH), which I assume is her publication in Neuroreport (2005 Nov 28;16:1893-7). Partly based on her findings of greater cortical thickness in the meditation group versus the controls, the Time article extrapolates that meditation can promote cognitive function.

Although I do not dispute the benefits of meditation or the results of the study, there are several thoughts to consider. As a caveat, twenty study participants may be adequate for a preliminary report, but the population pool would have to be larger to be more relevant and to increase the power of the study. Many confounding factors are possible, including educational backgrounds and “academic” inclinations of the individuals. I am not talking about achieved educational levels (i.e., high school drop-out or college graduate). The diversity of learning aptitude or motivation varies immensely at all levels of education. Even in medicine, some M.D.s “are more equal than others”.

I realize that the concepts of neuronal plasticity and possibly neuronal growth/regeneration are gaining acceptance in the neuroscience community. I nevertheless wonder whether the increased cortical thickness of the meditation participants may be less a function of cortical growth (which Dr. Lazar does not necessarily imply), but more due to reduction in the rate of natural–or stress-induced–atrophy. Stress has been demonstrated to affect neuronal signaling in the hippocampus (memory) and prefrontal cortex (executive functions). Moreover, I vaguely recall a study I read several years ago that compared exam performances between a group that listened to classical music beforehand to another group that didn’t. Guess who scored higher?

So, the question remains … must I meditate or can I just relieve my stress through basketball?