Pareidolia

First, there was the Jesus toast and the Virgin Mary grilled cheese.¹




Then there was the Virgin Mary rock.



The Virgin Mary Tree.




The Jesus x-ray.



And now Our Blessed Lady of the Cerebellum (originally reported by Mind Hacks).



Pareidolia is the phenomenon of perceiving a meaningful stimulus (such as a face or a hidden message) in fairly random everyday objects or sounds. We do have quite a propensity to see faces everywhere, and some religious people see the face of god (and other religious iconography) everywhere.

Neuroanthropology covers the serious side of the story, explaining that the brain in the upside down MRI belongs to Pamela Latrimore, who is quite ill with a variety of ailments. She's auctioning off the scan to help pay her medical bills.

The listing on eBay for the Mary MRI can be found here. Reading the listing is heart-breaking, not only because of the woman’s own suffering, but also because of her account of how the manufacture of dioxin and Agent Orange has affected health in her community. She writes that she is putting the image up for auction, not only to raise money for her healthcare, but also to attract greater attention to the problem of environmental poisoning in her area of Florida [NOTE: it's actually Jacksonville, AK, her former home and a Superfund site in the 1980s. For more info, see this EPA document].

Footnote

¹ For an extensive catalog of religious pareidolilia see Yoism featuring Penn and Teller.

ADDENDUM: Here's a great one recommended by jdc325. Somehow, I'm reminded of the Scary Skull Table Illusion.

Get out of jail free (postage not included)

via The Null Device:

A convicted drug dealer escaped from a prison in western Germany by climbing into a cardboard box and mailing himself out. And I thought that such things didn't happen outside of old animated cartoons.

The story continues, stating the obvious:

The chief warden of the jail told the BBC this was an embarrassing incident.

The prison authorities in Willich, near Duesseldorf, said the man, who was tall and broad-shouldered, had hidden in a box that was about 150cm by 120cm.

When the weekly express courier arrived to pick up several boxes of merchandise, the one containing the prisoner was also loaded into the back of the lorry.

Shortly after it had passed through the prison gates, the inmate made his dash for freedom by cutting a big hole in the tarpaulin of the lorry and jumping off.

I Hate Yellow

I hate yellow. I hate any signs of spring. Don't you know I'm only happy when I'm depressed? Don't you know that I'm only happy when I'm wearing black? That I'm only happy at night. Yes, I'm a creature of the night.

--Karen Finley, Shock Treatment [text arrangement adapted from Dawn's]

Feeling Blue? Yellow is the New Black

NEW YORK (AP) _ Enough gloom and doom: There's a prediction from a leading color source that cheerful and sunny yellow will be the influential color of 2009.

Pantone, which provides color standards to design industries, specifically cites "mimosa," a vibrant shade of yellow illustrated by the flowers of some mimosa trees as well as the brunch-favorite cocktail, as its top shade of the new year. In general, Pantone expects the public to embrace many tones of optimistic yellow.

"I think it's just the most wonderful symbolic color of the future," says Leatrice Eiseman, executive director of the Pantone Color Institute. "It's invariably connected to warmth, sunshine and cheer — all the good things we're in dire need of right now."

So it's come to this: Orwellian color therapy to fix the financial crisis and calm the unsettled consumer masses...

Pantone Selects Color of the Year for 2009: PANTONE 14-0848 Mimosa

December 03, 2008 06:15 AM Eastern Time

Mimosa Embodies Hopefulness and Reassurance in a Climate of Change

CARLSTADT, N.J.--Pantone, an X-Rite company, and the global authority on color and provider of professional color standards for the design industries, today announced PANTONE^® 14-0848 Mimosa, a warm, engaging yellow, as the color of the year for 2009. In a time of economic uncertainty and political change, optimism is paramount and no other color expresses hope and reassurance more than yellow.

“The color yellow exemplifies the warmth and nurturing quality of the sun, properties we as humans are naturally drawn to for reassurance,” explains Leatrice Eiseman, executive director of the Pantone Color Institute^®. “Mimosa also speaks to enlightenment, as it is a hue that sparks imagination and innovation.”

Best illustrated by the abundant flowers of the Mimosa tree and the sparkle of the brilliantly hued cocktail, the 2009 color of the year represents the hopeful and radiant characteristics associated with the color yellow. Mimosa is a versatile shade that coordinates with any other color, has appeal for men and women, and translates to both fashion and interiors. Look for women’s accessories, home furnishings, active sportswear and men’s ties and shirts in this vibrant hue.

I see you coming into my neighborhood with your new teeth, and your solid pastel lime green puke green pale pink apricot shirt that goes together with everything, catching sales as you go, with the
as your mascot.






--Karen Finley, Shock Treatment [text arrangement adapted from Dawn's]

Neuroimaging Studies of Stroke Rehabilitation

OR: Why is the RSNA Makin' Stuff Up? (Part 2)

Here's the next erroneous press release from the Radiological Society of North America (RSNA):

Robotic Technology Improves Stroke Rehabilitation

CHICAGO — esearch [sic] scientists using a novel, hand-operated robotic device and functional MRI (fMRI) have found that chronic stroke patients can be rehabilitated, according to a study presented today at the annual meeting of the Radiological Society of North America (RSNA). This is the first study using fMRI to map the brain in order to track stroke rehabilitation.

No, not even close. Many published papers have used fMRI to map the brain in order to track stroke rehabilitation. Three recent review articles are listed in the References.

"We have shown that the brain has the ability to regain function through rehabilitative exercises following a stroke," said A. Aria Tzika, Ph.D., director of the NMR Surgical Laboratory at Massachusetts General Hospital (MGH) and Shriners Burn Institute and assistant professor in the Department of Surgery at Harvard Medical School in Boston. "We have learned that the brain is malleable, even six months or more after a stroke, which is a longer period of time than previously thought."

That's not true, either, because the literature on post-stroke recovery of function includes articles like the one by Liepert et al. (back in 2000) on constraint-induced movement therapy in patients with strokes 5 years earlier:

...CI therapy might produce its therapeutic effect through the induction of a use-dependent cortical reorganization that counteracts adverse brain function changes and enhances recovery-associated plastic changes that occur in the human brain after stroke.

Well, the robotic technology is cool, let's take a look at that.

For the study, the patients squeezed a special MR-compatible robotic device for an hour a day, three days per week for four weeks. fMRI exams were performed before, during, upon completion of training and after a non-training period to assess permanence of rehabilitation.

Figure 4 (Tzika et al., 2008). Diagram illustrating the concept of on-line brain mapping using fMRI and a Magnetic Resonance Compatible Hand-Induced Robotic Device (MR_CHIROD).

The intensive rehabilitation regime produced an increase in the number of voxels activated when the patients were using MR_CHIROD in the scanner.


Figure 16 (Tzika et al., 2008). This fMRI image illustrates the area in the brain that corresponds with hand use of a patient before training (left), after eight weeks of training (middle), and one month after training was completed (right) at a 60percent effort level.

Earlier experiments have reported similar findings (e.g., Dong et al., 2007). In fact, the excellent review paper by Carey and Seitz (2007), which has 244 references, includes a table of 12 neuroimaging studies that specifically looked at rehabilitation of the upper limb in stroke patients.

So to conclude, this is not the first time fMRI has been used to track rehabilitation, and it's not news that the potential for cortical plasticity persists at six or more months post-stroke. Why would a professional society release false PR to promote their annual meeting?


References

1. Reviews

Carey LM, Seitz RJ. (2007). Functional neuroimaging in stroke recovery and neurorehabilitation: conceptual issues and perspectives. Int J Stroke 2:245-64.

Eliassen JC, Boespflug EL, Lamy M, Allendorfer J, Chu WJ, Szaflarski JP. (2008). Brain-mapping techniques for evaluating poststroke recovery and rehabilitation: a review. Top Stroke Rehabil. 15:427-50.

Brain-mapping techniques have proven to be vital in understanding the molecular, cellular, and functional mechanisms of recovery after stroke. This article briefly summarizes the current molecular and functional concepts of stroke recovery and addresses how various neuroimaging techniques can be used to observe these changes. The authors provide an overview of various techniques including DTI, MRS, ligand-based PET, SPECT, rCBF and rCMRglc PET and SPECT, fMRI, NIRS, EEG, MEG, and TMS. Discussion in the context of poststroke recovery research informs about the applications and limitations of the techniques in the area of rehabilitation research. The authors also provide suggestions on using these techniques in tandem to more thoroughly address the outstanding questions in the field.

Ward NS. (2007). Future perspectives in functional neuroimaging in stroke recovery. Eura Medicophys. 43:285-94.

Neurological damage and stroke in particular is the leading cause of long-term disability worldwide. Recovery of function after stroke is a consequence of many factors including resolution of oedema and survival of the ischaemic penumbra. In addition, there is a growing interest in how reorganisation of the surviving tissue might subserve the improvements in function that are commonly seen over weeks, months, and sometimes years after stroke. Noninvasive techniques such as functional magnetic resonance imaging, electroencephalography, magnetoencephalography and transcranial magnetic stimulation allow the study of this reorganisation in humans. Currently, results suggest that functionally relevant reorganisation does occur in cerebral networks in human stroke patients. This reorganisation can only occur in structurally and functionally intact brain regions. Because these vary depending on the location of the infarction, it is likely that different therapeutic strategies will be required to promote reorganisation depending on residual functional anatomy. This review maps out the attempts to describe functionally relevant adaptive changes in the human brain following focal damage. A greater understanding of how these changes are related to the recovery process will facilitate the development of novel therapeutic techniques designed to minimise impairment based on neurobiological principles and how to target these treatments to individual patients.

2. Primary articles

Dong Y, Winstein CJ, Albistegui-DuBois R, Dobkin BH. (2007). Evolution of FMRI activation in the perilesional primary motor cortex and cerebellum with rehabilitation training-related motor gains after stroke: a pilot study. Neurorehabil Neural Repair. 21:412-28.

Liepert J, Bauder H, Wolfgang HR, Miltner WH, Taub E, Weiller C. (2000). Treatment-induced cortical reorganization after stroke in humans. Stroke 31:1210-6.

BACKGROUND AND PURPOSE: Injury-induced cortical reorganization is a widely recognized phenomenon. In contrast, there is almost no information on treatment-induced plastic changes in the human brain. The aim of the present study was to evaluate reorganization in the motor cortex of stroke patients that was induced with an efficacious rehabilitation treatment. METHODS: We used focal transcranial magnetic stimulation to map the cortical motor output area of a hand muscle on both sides in 13 stroke patients in the chronic stage of their illness before and after a 12-day-period of constraint-induced movement therapy. RESULTS: Before treatment, the cortical representation area of the affected hand muscle was significantly smaller than the contralateral side. After treatment, the muscle output area size in the affected hemisphere was significantly enlarged, corresponding to a greatly improved motor performance of the paretic limb. Shifts of the center of the output map in the affected hemisphere suggested the recruitment of adjacent brain areas. In follow-up examinations up to 6 months after treatment, motor performance remained at a high level, whereas the cortical area sizes in the 2 hemispheres became almost identical, representing a return of the balance of excitability between the 2 hemispheres toward a normal condition. CONCLUSIONS: This is the first demonstration in humans of a long-term alteration in brain function associated with a therapy-induced improvement in the rehabilitation of movement after neurological injury.

Deliberate self-harm by insertion of foreign bodies into the forearm

OR: Why is the RSNA Makin' Stuff Up?

First, we had the latest new scourge among teenage girls, as featured in yesterday's post:

Self-Embedding Disorder appears to be a newly-coined term described in a press release issued by the Radiological Society of North America (RSNA):

Radiologists Diagnose and Treat Self-Embedding Disorder in Teens

CHICAGO — Minimally invasive, image-guided treatment is a safe and precise method for removal of self-inflicted foreign objects from the body, according to the first report on "self-embedding disorder," or self-injury and self-inflicted foreign body insertion in adolescents. The findings will be presented today at the annual meeting of the Radiological Society of North America (RSNA).

A quick PubMed search shows that although "self-embedding disorder" resulted in zero hits, "self-harm, foreign" yielded 17 references, with the most relevant being:

Wraight WM, Belcher HJ, Critchley HD. (2008). Deliberate self-harm by insertion of foreign bodies into the forearm. J Plast Reconstr Aesthet Surg. 61:700-3. Epub 2007 Jun 20.

Deliberate self-harm is common. It is usually by drug overdose or ingestion of other noxious substances, but self-harm by cutting or burning often comes to the attention of plastic surgeons. We report three variant cases involving insertion of paperclips, a ballpoint pen cartridge and sewing needles into the forearm. We discuss the management considerations of each case and emphasise the importance of actively addressing the underlying psychiatric problems for all instances of deliberate self-harm.

OK, the case reports were from three adult women (not teen girls), but it's not exactly a new phenomenon. It's a form of self-injury, which has been widely reported in the literature (more broadly), and is well-known to clinicians.


Figure 2 (Wraight et al., 2008). Case A, dorso-palmar and lateral radiographs of left forearm.

Case A:

A 42-year-old woman with a history of depression, personality disorder and deliberate self-harm by drug overdose and cutting was referred for non-healing wounds of her left, non-dominant forearm (Fig. 1). Over the preceding five years the self-harm included subcutaneous insertion of straightened-out paperclips. Consequently, abscesses had formed intermittently and were managed by incision and drainage with removal of the causative paperclip. Nevertheless, numerous paperclips remained embedded in subcutaneous tissue (Fig. 2), engendering ferrous staining of the skin and overgranulating chronic ulcers. There was no functional deficit in the hand or forearm at the time of assessment.

Wraight and his colleagues are from Plastic Surgery and Psychiatry Departments (not Radiology Departments), so the emphasis of their short Case Report was different from that of the conference presentation by Young et al., and did not involve interventional radiology to assist in removal of the self-inflicted soft tissue foreign bodies. Nonetheless, their discussion notes that

Insertion of foreign bodies is an unusual form of deliberate self-harm. Most are inserted through existing orifices, and urologists, ENT surgeons and gastrointestinal endoscopists may be involved in their assessment, monitoring and removal. Breach of an epithelium is less common, but is reported with insertion of long thin objects through the nose into the brain, or through the urethra and bladder into the abdominal cavity. Foreign bodies may also be inserted directly through skin, for example into the orbit, breast and abdomen. The forearm is a common site of deliberate self-harm by cutting, but our report is the first to highlight the forearm as a site for foreign body insertion.

They also emphasize that medical management of these cases must take into account the underlying psychiatric problems, and ensure that the patients' emotional behavior doesn't compromise the standard of surgical care. The patients are often subject to stigmatization by health care providers, and psychiatry teams specializing in deliberate self-harm are recommended to improve the quality of care.

So to conclude: "self-embedding disorder" is not a new phenomenon, just a new term for a variant of self-injurious behavior.

Next on the agenda: Stay tuned for another [more egregiously] false press release from the RSNA...

Reference

W WRAIGHT, H BELCHER, H CRITCHLEY (2008). Deliberate self-harm by insertion of foreign bodies into the forearm. Journal of Plastic, Reconstructive & Aesthetic Surgery, 61 (6), 700-703 DOI: 10.1016/j.bjps.2007.04.004.

We Won't Forget You

The famous amnesic patient H.M. has died. From Dr. Suzanne Corkin (MIT):

Henry G. Molaison, 82, of Windsor Locks, CT died on Tuesday. He is known in the medical and scientific literatures as "the amnesic patient, H.M." He was born in Manchester, CT and graduated from East Hartford High School. In 1953, he underwent an experimental brain operation at the Hartford Hospital to relieve his seizure disorder. Immediately after the operation, Mr. Molaison showed a profound amnesia, which became the topic of intense scientific study for more than five decades. From age 27 on, he was unable to establish new memories for events in his everyday life and to acquire general information about the world in which he lived. His memory impairment was "pure" and not accompanied by intellectual or personality disorders. For this reason, and because the operation has not been repeated, he is the most widely studied and famous case in the neuroscience literature of the 20th and 21st centuries. Mr. Molaison's contributions to knowledge about memory have been groundbreaking, and researchers worldwide are in his debt. Burial will be private.

via Dr. Vivienne Ming.

See Mind Hacks for more info about the significance of H.M.'s contribution to the neuropsychology of memory.


Figure 1 (Corkin, 2002). Multiplanar views of 18 averaged T1-weighted MRI volumes showing preserved structures in H.M.’s MTL. This magnetic resonance imaging (MRI) scan was obtained on 15 December 1998. The images are based on data averaged over 18 runs; images were motion corrected using the first scan (out of the 18 axials) as a reference. The asterisk marks the intersection of the three viewing planes, just caudal to the left medial temporal lobe (MTL) resection, seen best in the transaxial view. Top left, sagittal view; bottom left, coronal view; bottom right, transaxial view; top right, surface rendering showing locations of transaxial and coronal planes. Abbreviations: CS, collateral sulcus; EC, entorhinal cortex; H, hippocampus; L, left; PH, parahippocampal gyrus; R, right.


Coda (from Corkin, 2002):

Prospects

H.M. is now 75 years old. His mobility is markedly reduced because of osteoporosis, another side effect of phenytoin (Dilantin). Although he is in relatively good health, plans are in place for the post-mortem examination of his brain when he dies. He and his court-appointed conservator have both signed his brain donation form, ensuring that the final chapter in his lifelong contribution to science will include a precise description of his brain and documentation of his lesion. His wish to help other people will have been fulfilled. Sadly, however, he will remain unaware of his fame and of the impact that his participation in research has had on scientific and medical communities internationally.

Self-Embedding Disorder and Removal of Soft Tissue Foreign Bodies

Figure 1 (Young et al., 2008). This x-ray image illustrates 3 metal staples embedded in the hand of a teenage girl.

Self-Embedding Disorder appears to be a newly-coined term¹ described in a press release issued by the Radiological Society of North America (RSNA):

Radiologists Diagnose and Treat Self-Embedding Disorder in Teens

CHICAGO — Minimally invasive, image-guided treatment is a safe and precise method for removal of self-inflicted foreign objects from the body, according to the first report on "self-embedding disorder," or self-injury and self-inflicted foreign body insertion in adolescents. The findings will be presented today at the annual meeting of the Radiological Society of North America (RSNA).

"Radiologists are in a unique position to be the first to detect self-embedding disorder, make the appropriate diagnosis and mobilize the healthcare system for early and effective intervention and treatment," said the study's principal investigator, William E. Shiels II, D.O., chief of the Department of Radiology at Nationwide Children’s Hospital in Columbus, Ohio.

It's a form of self-injury, which has been widely reported in the literature (more broadly), and is well-known to clinicians.

As the press release explains:

Self-injury, or self-harm, refers to a variety of behaviors in which a person intentionally inflicts harm to his or her body without suicidal intent. It is a disturbing trend among U.S. adolescents, particularly girls. Prevalence is unknown because many cases go unreported, but recent studies have reported that 13 to 24 percent of high school students in the U.S. and Canada have practiced deliberate self-injury at least once. More common forms of self-injury include cutting of the skin, burning, bruising, hair pulling, breaking bones or swallowing toxic substances. In cases of self-embedding disorder, objects are used to puncture the skin or are embedded into the wound after cutting.

The interventional radiologists enter the scene (and intervene) when they use imaging to assist in the removal of self-inflicted soft tissue foreign bodies (STFBs). The abstract below (from an RNSA presentation on December 4, 2008) says it all...

Self-Mutilation in Adolescents: Radiological Management of Self-inflicted Soft Tissue Foreign Bodies

Adam Young, William Shiels, James Murakami, Brian Coley and Mark Hogan

PURPOSE

To evaluate the efficacy and clinical impact of image-guided foreign body removal (IGFBR) for treatment of self-inflicted soft tissue foreign bodies (STFBs).

METHOD AND MATERIALS

Four hundred patients underwent IGFBR with sonographic and/or fluoroscopic guidance. Self-mutilation was seen in 5 adolescent female patients (1.2%), representing 7 patient care encounters; 2 patients presented with self-inflicted STFBs on 2 separate occasions. Mean age 16.8 yr; (range 15-17 yr). Foreign body number, location, type and size as well as incision size, intraoperative imaging modality, type of surrounding reaction, and success or failure of removal were documented prospectively.

RESULTS

Twenty-five foreign bodies were inserted into the forearm or upper arm of the five patients. Referring services included Pediatric Surgery, Emergency Department, and Psychiatry. Number of STFBs per case ranged from 1-9; median=2. Foreign body types included metal (13), wood (5), graphite (3), plastic (2), crayon (1), and stone (1). STFB measurement (greatest dimension) ranged from 4.5-160 mm; mean=22.06 mm. During sonographic removal, hypoechoic halos representing purulent material surrounding the STFBs were defined in 2 cases. Mean incision = 4.67 mm; STFBs were removed with sonographic guidance in 3 cases, fluoroscopic guidance in 3 cases, and a combination of the two modalities in 1 case. IGFBR was successful in all 7 cases without fragmentation or complications.

CONCLUSION

Percutaneous radiological treatment of self-inflicted STFBs is safe, precise, and effective for radiopaque and non-radiopaque foreign bodies, including foreign bodies at risk for fragmentation during traditional operative removal techniques.

CLINICAL RELEVANCE/APPLICATION

Percutaneous IGFBR with sonography and/or fluoroscopy offers surgeons and emergency physicians a safe and effective alternative to operative foreign body removal in this unique high-risk population.

Figure 2 (Young et al., 2008). This x-ray image illustrates 8 metal pieces embedded in the left arm of a teenage girl.

Footnote

¹ The term was not found in PubMed.

ADDENDUM: Psychologist Dr Lisa Boesky wants parents to understand that this is a very extreme disorder. "This is not new," she says. "I have been dealing with people who do this since 1995 in juvenile jails and prison. It's very rare in the public arena. Teens who embed typically have major mental health disorders and frequently have histories of severe sexual abuse or trauma."

-via Momlogic.

ADDENDUM #2: The spelling error in the title [formerly ...Soft Tissue Foreign Bodes] has been corrected, thanks to psychiatrist Dr. Eliot Gelwan, who also notes, "...there is no need for a new diagnosis. Indeed, self-injuriousness in general is not an illness, or a diagnosis, unto itself, but rather a symptom of a variety of diagnoses. A fortiori for a particular kind of self-injuriousness. This illustrates one of the epistemological confusions plaguing the system for diagnosing behavioral problems, and is a perfect example of the needless proliferation of diagnostic categories."