She was missing a chunk of her brain – it didn’t matter | Hacker News Reader

She was missing a chunk of her brain – it didn’t matter

wired.co.uk

108 pointsJaruzel91 comments

I would be very cautious here. There are many stories about how miraculously people function after brain damage or with half a brain but when examined more closely it turns out there are deficits, just not a super obvious one like inability to speak. Some of Oliver Saks' cases in The Man Who Mistook His Wife for a Hat demonstrate how functionally people can adapt to the point that others may not notice.

In many of these cases there are various skills and modes of perception impacted. Artistic talent, abstract visualization, etc. Proprioception, visual perception (not just acuity but things like recognizing abstract shapes vs "gnosis" of objects). Impulse control. Emotional regulation. Many different kinds of memory.

Even the oft-told story about Phineas Gage is mostly false. He had serious metal problems for the remainder of his life, including very poor impulse control. Was it a miracle he survived? Yes. Did he made a full and complete recovery? Absolutely not.

I would also be careful about correlating brain volume with complexity. We know volume doesn't correlate with intelligence between species. Whales are not more intelligent than humans despite having larger brains... their brains are just less densely packed. So being born with a brain that is "too small" can be less of a deficit than you might expect in some cases if the brain matter that is present is of higher complexity - though keep in mind most babies born with smaller than expected brains have profound and permanent disabilities so any contrary cases are very rare exceptions.

Yeah, fully agree on being cautious here.

On Phineas Gage — indeed, he made headlines for his seemingly "normal functioning", but the devastating impact on his emotional capacities was skipped over in the popular press! So let's hear what happened after he "fully recovered", quoting from the 1994 study on this topic by the maverick neuroscientist, Antonio Damasio[1]:

[quote]

Gage was fully recovered. He remained as able-bodied and appeared to be as intelligent as before the accident; he had no impairment of movement or speech; new learning was intact, and neither memory nor intelligence in the conventional sense had been affected.

On the other hand, he had become irreverent and capricious. His respect for the social conventions by which he once abided had vanished. His abundant profanity offended those around him. Perhaps most troubling, he had taken leave of his sense of responsibility. He could not be trusted to honor his commitments. His employers had deemed him "the most efficient and capable" man in their "employ" but now had to dismiss him. In the words of his physician, "the equilibrium or balance, so to speak, between his intellectual faculty and animal propensities" had been destroyed.

In the words of his friends and acquaintances, "Gage was no longer Gage". Gage began a new life of wandering that ended a dozen years later, in San Francisco, under the custody of his family. Gage never returned to a fully independent existence, never again held a job comparable to the one he once had. His accident had made headlines but his death went unnoticed.

[/quote]

[1] http://jneunuebel.psych.udel.edu/Webpage/Courses/assets/Pape...

Perhaps you're the one who should be a bit more cautious?

https://en.wikipedia.org/wiki/Phineas_Gage#Exaggeration_and_...

Harlow's statement that Gage "continued to work in various places; could not do much, changing often, and always finding something that did not suit him in every place he tried" refers only to Gage's final months, after convulsions had set in. But it has been misinterpreted as meaning that Gage never held a regular job after his accident [and] "never returned to a fully independent existence"... In fact, after his initial post-recovery months spent traveling and exhibiting, Gage supported himself — at a total of just two different jobs — from early 1851 until just before his death in 1860.

His symptoms and treatment were over-interpreted and perhaps exaggerated for ideological reasons even by his contemporaries:

Bigelow's and Harlow's contradictory evaluations (less than a year apart) by differences in their educational backgrounds, in particular their attitudes toward cerebral localization (the idea that different regions of the brain are specialized for different functions) and phrenology (the nineteenth-century pseudoscience that held that talents and personality can be inferred from the shape of a person's skull)...

He seems also to have lucked into an ideal treatment program shortly after the accident:

Gage's stagecoach work — "a highly structured environment in which clear sequences of tasks were required [but within which] contingencies requiring foresight and planning arose daily" — resembles rehabilitation regimens first developed by Soviet neuropsychologist Alexander Luria for the reestablishment of self-regulation in World War II soldiers suffering frontal lobe injuries

(One easy mistake to make is taking a neuroscientist as an historiographer just because the historical topic happens to involve a brain.)

Thanks for the extra details. I do agree with your last point.

That said, perhaps you could be a bit more charitable? I was not trying to provide extensive treatise on Gage's injury. I was highlighting one specific point of emotional impairment due to damage to PFC.

I used the exact same framing you did, less the twee-lecturer "So let's hear..." crap.

Okay, it's clear you overparsed it, as you seem to be needlessly upset. Please take it easy, and try not to read minds on the Internet.

"I've read your mind and determined you shouldn't try to read minds" ok buddy? This thread got real weird real fast.

As someone who has had a severe TBI (traumatic brain injury) as a child, I, at times in my life, have spent time thinking about this. And I agree with your sentiment.

On one hand, I'm a competent software engineer. I think I'm fairly good at problem solving -- not great and really only learn by example as opposed to creating novel solutions on my own. I have learned, anecdotally, that I may have a better biographical memory (including world events happening at the time when recalling life experiences) than some of my peers. On the other hand, I feel like I lack certain skills that most adults have or are expected to have (whether it be due to impulse control, etc.).

And then there are more abstract things, like abstract visualization as you mention. I realized (thanks to a BBC article [1] on Hacker News a number of years ago) that people generally are able to visualize images in their head to various degrees. Some can represent images with picture- perfect quality, say of a loved one. Others at the very least can conjure up an image of, say, a crowded beach on a summer day. I on the other hand can't visualize anything at all, which I realized impacted my score on an IQ test after my TBI in which I was told a series of numbers and was expected to visualize them sequentially in my head. Whether it has anything to do with my TBI, I'm not sure. But I would love to find out more all these years later.

1. https://www.bbc.com/news/health-34039054

Lots of people think differently without having brain injuries.

There are people with no internal monolog, for example. They don't "talk" internally.

Another example is that while I "see" things easily, they are very abstract. It doesn't relate to world world things, but they can create intuitive connections. I can't really think that well without "day dreaming" and staring off into the distance.

However I can't really "hear" things internally. Sometimes, rarely, I can listen to music in my brain as if I am hearing it, but it's a fluke. It is extremely unusual.

Were as I have had musician friends that can record and playback every note internally. I remember back in the day when Little Caesars had "Simon Says" style musical game were you could win a free pizza... the owner of the store would get so angry at my friend for effortlessly beating it that he would just hand him a free pizza and tell him to leave every time we would show up with a handful of quarters. He would have to lose on purpose so we could win just a free soda to go along with the free pizzas.

My girlfriend, when she hears a catchy song, can have it playing so loudly in her head that it will keep her up at night. It is not something she has lot of control over. I am banned from playing certain songs around her because it will fuck up her sleep schedule. It is not even related to whether she likes the song or not.

According to her the most evil song that ever created is 4 Non Blondes' "What's Up".

I think the idea that "we need to be cautious" in regards to the article is missing the point. It's not trying to claim that "If you get head injury everything will be alright".

I think the main point is something more along the lines of:

We don't know how the brain works. When people talk about "language centers" and this part of the brain does that... They are factually wrong. They don't know that.

They know that MRIs can show different parts of the brain getting more or less blood flow when people see different things or carry out different tasks, and there is some correlation between different types of brain injury and different types of cognitive impairment, but the ultimate meaning behind all that is still largely a mystery.

>They know that MRIs can show different parts of the brain getting more or less blood flow

I always wondered about this as a casual person with a heavy consumption rate of neuroscience. I fallen in to thinking of the "active" brain areas similar to lakes. places where activity seems to collect. if you remove the lake bed (fill it in? analogy breaks down here) then the activity will just collect itself in a different location. It might look / act a bit different from how it was before, but would still fit the profile overall - hence 'retraining' being possible.

disclaimer: just personal thoughts, not backed by anything specific

I came to believe that this types of skills, especially visualization, are learnable. For some people it looks like this skills are somehow natural but this can be just an accident of upbringing and time allocation.

The thing that convinced me that they are not innate is my own journey with drawing and guitar playing. At first (around 15 years ago) I thought that I have some brain deficiency that makes it impossible to visualize things that I draw and remember simple melodies (I even thought that I was tone deaf). But when I invested a lot of time in it (thousands of hours probably) something clicked and suddenly those mysterious abilities materialized in ma head. There surly is some element of talent to it - there are people that would get there a lot quicker, but I believe that for most deliberate practice and a lot of time would do wonders.

>Over the years, she says, doctors have repeatedly told EG that her brain doesn’t make sense. One doctor told her she should have seizures, or that she shouldn’t have a good vocabulary—and “he was annoyed that I did,” she says. (As part of the study at MIT, EG tested in the 98th percentile for vocabulary.) The experiences were frustrating; they “pissed me off,” as EG puts it. “They made so many pronouncements and conclusions without any investigation whatsoever,” she says.

This pisses me off, too. The hubris of doctors and scientists is so profound, that they will complain to a person who challenges their preconceptions. Disgusting.

I think it's less them complaining more them sort of perplexed. I've been "annoyed" at things that go completely different then I expected when I have no explanation for why.

Definitely poor patient interaction from the doctors, but I don't think it's their hubris. Just that they're people like anyone else.

A scientist, encountering evidence contradicting theory, thinks that's interesting...

MDs don't practice science; they apply science.

I almost edited my comment along those lines. Except I was going to say the people who reject interesting exceptions don't practice science, they practice scientism. And I think that's bad in anyone, especially an MD (who AFAIK are trained as scientists who don't know everything, which is why they call it "practicing" medicine).

What do you call the person who graduated last in medical school? Doctor.

But they won’t practice unless they pass the board exam.

OK fine, let's build on the joke.

What do you call the person who graduated last in their medical school AND passes the USMLE (United States Licensing Exam) steps with the lowest passing score?

Doctor.

See? Now it’s funny!

What do you call someone who thinks they’re smart enough to understand the human body but have trouble understanding a joke? Doctor.

Yes, and it is a feature. A) it protects them legally and mentally (you just follow the current standard)

B) you do not want your doctor to have a scientific mindset, which would mean experimenting with your condition with the aim to learn more about nature

At most you want the detective mindset (aka House MD), if you have something uncommon, but you do not want it all the time.

So many doctors have an origin story that's rooted in Illusion of Control.

I became an oncologist because my mother died of cancer. I became an neurosurgeon because my cousin died of a brain tumor. They built a whole personality around a scared kid who vowed that one day they would know what is in the darkness and defeat it. But the darkness is vast and our time is very short.

We are just beginning to talk about how many doctors are walking around with PTSD they got on the job. Nobody is talking about the ones who already had it before they even got accepted into college.

That's cynical. They might wish to help others avoid their misery which is an admirable goal. Just like many people who have been starving are very keen to share food.

It might well be cynical; but it is nonetheless true that many doctors suffer from the stress of the job. A very smart schoolfriend of mine studied medicine and became a general practitioner. He stuck to it for about ten years before giving up because the weight of responsibility was too much for him; he moved into bespoke software for medical practices instead.

You have a better explanation for the constant stream of complains about doctors shooting the messenger? If so a bunch of people are dying to hear it.

They’re doctors and have been through several years of academic rigor which should prepare them for reassessing their assumptions when those turn out to be wrong. I’m hardly qualified to assess this patient’s brain, but I’m family with several people who are quite qualified for this kind of reassessment of facts and I… frankly stop talking to them about things when it’s clear they’re overconfident in their assumptions. Yeah they’re human. But having a doctor tell you the reality you experience is absurd and impossible is quite a lot worse than having a lay person do the same.

Doctors are generally poor at questioning their assumptions. You constantly hear of cases where many doctors missed the actual problem for a long time.

Most cases come under standard frameworks and diagnosis will be correct, however if you are the exception then tough luck in getting a right diagnosis on time

Doctors are taught not to look for rare things, despite rare things happening all the time. And many of those rare things wouldn’t be considered rare in the first place if they bothered looking for them.

I get annoyed when code I write spits out unexpected responses to input. Very annoyed. I can sometimes be heard shouting at my computer. It "pisses me off". I'll sometimes make pronouncements and conclusions before I investigate further.

Disgusting hubris.

Well, yes.

Luckily, I know that you can tell the difference between a computer and another human being. That makes the distinction easier to understand.

I kind of wonder - these are probably not very experienced neurologists....which if she went to research-heavy academic centers like MGH, it is not uncommon. They spend most of their time writing grants or studying rats in the lab. They know a lot about rats...but I recall a steady stream of misdiagnoses coming from that place, probably because their faculty only do something like 1 clinic day a month.

Hubris? What hubris? They are annoyed that their theories don't hold on her case. They operate by these theories and if the theories don't hold they can't help.

She is not a car, they can't simply take her apart and investigate what is causing this unexpected behavior.

It's very unlikely that a doctor will investigate a patients condition and will tear apart all the theories, build new ones based on the findings and cure her(if needed).

What is more realistic is that some scientist working on theories about how something it the brain works will see her case and adjust the theories accordingly and write a paper about it. Some day, when enough work is done to make the theories precise enough someone will figure out why that's happening.

Sure, what you said is true, but it baffles me that they would complain directly to the patient. Save the frustration for later IMO.

I have found that I can get the doctor where I want by stating the opposite. It works surprisingly well. For example, my sciatic nerve kills me again, I have had that for 10 years now. Doctor moved, so new doctor. Normally, even if it's the same practice, it takes a while for the new doctor to come to the same conclusion. Which is good, he's doing his homework.

But, if I make carefully chosen assertions, which the doctor will always contradict, I get him where I want him much quicker.

In a sense, it works for me, but it's a testament to the relationship doctors have with their patients: patients are so stupid, the reflex is to contradict then each time.

Not sure it qualifies as hubris, but it's close.

sounds like an episode of House.

This may work for many things but beware: if you mention 'stress' or 'anxiety' your doctor will almost certainly not contradict you!

What are you doing to manage te sciatic pain? I have it also but I have no ideas how to treat it

Look very closely and suspiciously into your doctors eyes and slowly say "I don't have sciatica." I have no idea what jedi mind tricks this guy is using.

That's more of a human problem in general. We don't like having our preconceptions challenged. It might mean we have to rethink our understanding of the world.

A classic post by Peter Watts: https://www.rifters.com/crawl/?p=6116

"What scared me was the fact that this virtually brain-free patient had an IQ of 126."

The image of the brainless skull looks more like one of this man with an IQ of 75: https://www.reuters.com/article/us-brain-tiny-idUSN193051002...

He’s scared because of a third-hand anecdote about a score on an unknown test decades ago with no reproduction?

I’ve always been concerned about the lack of critical thinking skills in people who post about IQ scores.

Have you seen the picture of that brain? Quibbling about the measure of intelligence used was the last thing on my mind because I was amazed the person was alive at all. That said,

> He had a first-class honors degree in mathematics. He presented normally along all social and cognitive axes. He didn’t even realize there was anything wrong with him until he went to the doctor for some unrelated malady, only to be referred to a specialist because his head seemed a bit too large.

does the very next paragraph assuage your concerns?

I agree it’s impressive, but it’s a funny thing to lead with the number. If they were still around and wanted to contribute to science, an fMRI would be interesting for curiosity’s sake; maybe “stress makes their brain work harder” also means it ages differently too?

Or counting their neurons, but presumably they have to not be around anymore for that one.

The lower lizard brain is enough yo keep you alive

I think given that humans evolved to make trade-offs in order to have large brains is a sign that humans generally having large brains is useful, but the usual idea that a large brain is strictly necessary for human intelligence doesn't necessarily follow from that. It could be that what we think of as human intelligence doesn't need all that much brain matter to exist inside of, but having more brain matter increases redundancy and the chance of survival if you starve or get some brain damage, adds potential capacity that isn't always necessary, or it increases the chance of usual human thought processes developing somewhere within the brain to begin with. Maybe having more brain matter is more important as a very young child in order to help the brain bootstrap itself, but then after that most brain matter is redundant.

Wild theory: most of the human brain is there to harness untrammelled intelligence to the organism's best interests.

There is so much, because intelligence needs a complex cage - without the cage becoming sentient itself. A bit like a finite state automaton containing a Turing machine. People can still escape, but it's hard. Disorders like autism represent failure of the cage.

I think this is a nice example of why the folded surface of our brain matters so much.

Couldn't add anything to that case myself:

https://www.gwern.net/Hydrocephalus

Yep everyone in this thread should read the whole page. I'll dump the last paragraph:

>Conclusion: No Evidence

>So to sum up: people have claimed that hydrocephalus destroys most of the brain yet having only a fraction of the brain is consistent with normal or above-average intelligence, and may even increase it. This is extremely implausible based on everything we know about intelligence and evolution and population distributions and is a bad description of what hydrocephalus does (conflating distribution & volume with brain matter). On average, hydrocephalus and similar things like hemispherectomy do (as expected) induce many deficits ranging from mild to severe, which can be accommodated to some degree by neural plasticity, individual differences, extensive environmental interventions, and freedom from natural selection . Claims to the contrary, aside from failing to deal with the many objections that this is implausible, turn out to be based on undocumented, fraudulent, or misleadingly described cases, and primarily pushed by cranks. Ultimately, hydrocephalus does not appear to present any particular challenge to the standard understanding of intelligence as being caused by a material brain whose efficiency at cognitive tasks is driven by neuron count, wiring patterns, neural integrity, and general health: not only is the evidence extraordinarily inadequate to justify the extraordinary claims made by some authors, it is unclear how much, if any, evidence there at all.

A few of these case studies have been used to argue the extraordinary claim that brain volume has little or nothing to do with intelligence; authors have argued that hydrocephalus suggests enormous untapped cognitive potential which are tapped into rarely for repairs and can boost intelligence on net, or that intelligence/ consciousness are non-material or tapping into ESP.

The thing about this "counter-argument" is it's conflating a basic point - some people, maybe only a few, are able to exhibit normal human intelligence with a much reduced brain size - with a host of apparently idiotic position people have taken in response to this situation. But of course dismissing the basic on this basis is fallacious.

I wonder if it’s the brain’s neurons offloading some functionality to other types of cells.

The title is click-bait as hell and is actively misleading.

Damage to prefrontal cortex (PFC) — the region of the brain that's important for emotion regulation, cognition, impulse control, planning, etc — can be very subtle. Visibly, someone with an impaired PFC, or other parts of the brain, might behave "rationally", but emotionally they can be severely broken[0].

This topic of is now abundantly studied by leading neuroscientists such as Antonio Damasio and others. FWIW, here's some references[1][2][3], if you're not actively studying neuroscience.

[0] https://news.ycombinator.com/item?id=31037882

[1] Descartes' Error, by Antonio Damasio

[2] Behave, by Sapolsky

[3] On Task, by David Badre

They got quite a way into that before mentioning that her sister is also missing her right temporal lobe

Why would they not mention that more prominently?

Talk about burying the lede…

Because it doesn't impact the body of the article. EG's story is a framing device around the broader (and for this article primary) subject of the brain's adaptability and research into that topic. EG missing part of her brain (and her sister as well) just gives a "human interest" touch to the article.

It changes it in the sense that the theorized cause of her temporal lobe being missing (a stroke in infancy) is quite possibly false, and it's actually some sort of genetic trait. Of course, perhaps they were both predisposed to strokes in that lobe, but in either case it adds an extra dimension to the context in which the brain is still very functional with unconventional biology.

Quite right. My comment was too flippant. Yours provided the detail I left out.

Without question, it is a worthwhile study and very interesting.

But, losing a lobe in infancy and then having the brain compensate is much different, I would think, than having a brain develop in the womb without a lobr.

The sibling’s missing lobe, to my mind, is far more indicative of some genetic abnormality as opposed to some acute event in infancy. But, who knows? Either way, she’s a useful data point and hopefully will advance our meager knowledge of the brain.

It’s like a Gift of the Magi for the modern era.

A relative of mine grew up with essentially half of his brain after he underwent surgery at a very young age to control his epileptic seizures.

A book was written about his case and the incredible recovery results, titled "half a brain is enough".

https://www.amazon.com/-/en/Antonio-M-Battro/dp/0521783070

i once worked with a clinical pipeline for epilepsy resections and was always amazed at how much tissue they'd remove.

they'd take extreme care to not remove anything that results in functional deficits, but would often resect near entire lobes.

i was shocked, but they said recovery was robust and that stopping disease progression was a much more important goal for long term wellbeing.

epilepsy can be progressive in intractable cases, the untreated endpoint is not a good one.

I remember seeing a documentary, I'd say something like 20 years ago, about a kid (I think) who was shot in the head, survived, had close to half of his brain gone, and his brain had figured ways to make it all work after a while, rearranging neural pathways. He was functioning more or less as if he had his full brain, except for the obvious hole in his skull. I don't remember much more details, though.

Ahad Israfil perhaps

https://en.m.wikipedia.org/wiki/Phineas_Gage

Is the seminal example of the brain's adaptability. A more recent example is a teen in the US who was accidentally shot in the head with a spear gun used for fishing. He was awake and talking with his doctors while they initially triaged him- apparently, getting over the abject, visceral reaction of seeing someone with feet of spear sticking out either side of their head was the first difficulty the doctors faced.

this makes alzheimer's disease even more pernicious ..

There was an adult man, I think in France, who was living a perfectly normal life. It was discovered that he basically did not have a brain cortex, which is what is supposed to contain all our higher functions. So there's a lot going on that we don't fully understand in how our brains can compensate.

I had a small part of brain removed (not an elective procedure). Surprisingly, it hasn't really affected by cognition AFAIK.

Are you sure?

I’m guessing the “by” was a joke?

I have a relative who got into a serious car accident. Brain was severely damaged and surgery was more a practice... doctor personally took out damaged brain part that does the speech. He was 22. He is alive and well and able to speak, work and everything. Without that part of the brain. You can't tell he had any problems, apart from seam on his head and very rare seizures that started many years after accident.

He got married 2 years after that. So he recovered rather quickly.

No-one expected him to live except the people who very much prayed for him. (I don't want anyone arguing here on religious beliefs, I provide that for the "full picture" and I wanted to provide this data point about this man as it very much relates to article.)

I've heard the doctor doing surgery on him, wrote a publication about him. However I can't confirm - haven't ever searched for that paper.

So whats amazing here is that he wasn't a child where article points out that at that stage brain gets rewired.

Phineas Gage was missing a chunk of his brain due to a mining accident involving an iron bar through the frontal lobe. His personality was drastically different post-accident.

https://en.wikipedia.org/wiki/Phineas_Gage

Well…maybe.

https://en.wikipedia.org/wiki/Phineas_Gage#Mental_changes_an...

The extent of the changes were known to be hugely exaggerated by charlatans at the time, and, his personality seemingly returned to something resembling his pre-accident state after about 3 years.

https://www.npr.org/sections/health-shots/2017/05/21/5289661...

You also…well, you can’t ethically have a control group in this case, and taking out a chunk of your brain probably does something, but there’s the small matter of the dude got a giant chunk of metal through his skull. Hard to fully distinguish between brain trauma and awful PTSD from getting a giant chunk of metal through your skull.

> You also…well, you can’t ethically have a control group in this case, and taking out a chunk of your brain probably does something

I couldn't disagree more strongly. There is no ethical problem with having a control group. The ethical problem would be the experimental group.

Haha, yeah, fair point.

But maybe only temporarily, as the same Wikipedia article suggests with some evidence further down.

Check out the book Livewired [1] for more interesting stories like this, plus a futuristic take on how the brain could be plugged into various kinds of peripherals.

1: https://www.amazon.com/Livewired-Inside-Story-Ever-Changing-...

I’m curious how much plasticity the neurons in the gut may have to be able to pick up the slack, particularly in cases such as the Peter Watts link.

one point which I think some have missed -- the "missing chunk" is probably due to a stroke the patient suffered as a baby; recovery from damage that occurred when the brain is still extremely plastic might be very different from damage suffered later, or through physical trauma.

Probably not intentional, but the title sounds like a pun. "Matter" as in "brain matter".

How . . . did something like the brain evolve from the primordial soup?

4 billion years of iteration gets you a long way.

you get a lot of atomic hydrogen and given enough time

Well, some functions that the brain performs in higher animals are present even in single-celled bacteria (sensing, decision making), so it's not that hard to imagine a path from a generalized capacity for computation to a cell that is more and more specialized in this, and also to an entire tissue achieving the same. In the end, it's not harder to imagine than muscles or intestine lining or blood evolving.

It's physics. Any system responding to a stochastic driving system can be considered computing. In fact any system that retains information about past environmental fluctuations must have information that is predictive of future ones for the system to be thermodynamically efficient.

https://arxiv.org/abs/1203.3271

This physics creates complexity. It selects for increasingly complex thermodynamically efficient structures with predictive power. Stars die, they become entropy, but until they run out of fuel they drive the creation of localized complexity maxima.

It's not the size that matters, but how you use it

isnt this what a stroke does

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