Asperger Syndrome Workup
- Author: James Robert Brasic, MD, MPH; Chief Editor: Caroly Pataki, MD more...
Approach Considerations
Neuropsychologic testing and event potential studies can be used to uncover characteristics of Asperger syndrome. Magnetic resonance imaging (MRI) and positron emission tomography (PET) scanning can reveal brain anomalies associated with the condition.
CT Scanning
Computed tomography (CT) scanning cannot be used either to diagnose or to rule out Asperger syndrome, because no consistent findings are evident in people with this condition. Rather, CT scanning can aid by excluding treatable conditions in the differential diagnosis, such as neurologic disorders (eg, tumors).
Head analysis inconsistently reveals enlargement of the third ventricle and diminution of the caudate nucleus.
MRI
MRI can reveal various deficits, but results are inconsistent.
MRI helps to demonstrate cortical defects in the right-central perisylvian area and incomplete formation of the posterior-inferior frontal gyrus (ie, pars opercularis, pars triangularis).
MRI demonstrates the following:
- Hypoplasia of the inferior precentral gyrus and the anterior portion of the superior temporal gyrus, resulting in a widening of the sylvian fissure and a partial exposure of the insular cortex
- Hypoplasia of the right temporo-occipital cortex
- Small gyri of the posterior parietal lobes
- Enlargement of the right lateral ventricle
- Diminished size of the midbrain and medulla oblongata
Functional MRI demonstrates that facial expressions of fear, disgust, happiness, and sadness produce reduced activation of the fusiform and extrastriate cortices of people with Asperger syndrome compared with healthy, normal control subjects.[22]
In response to fearful faces, people with Asperger syndrome demonstrate greater activation in the anterior cingulate gyrus and the superior temporal cortex, whereas control subjects demonstrate greater activation in the left amygdala and the left orbitofrontal cortex.[23]
Herrington and colleagues reported less activity in the inferior, middle, and superior temporal regions in people with Asperger syndrome in response to a task typically interpreted as human movement.[24]
PET Scanning
PET scanning reveals multiple deficits in some individuals.
With F-18 2-deoxyglucose, the anterior rectal gyrus of some people with Asperger syndrome is larger on the left than on the right, opposite the asymmetry seen in most people.
Other patients exhibit an increased glucose metabolic rate in the right posterior calcarine cortex and a decreased glucose metabolic rate in the left posterior putamen and left medial thalamus.
For more information, see PET Scanning in Autism Spectrum Disorders.
Event-Related Potentials
Event-related brain potentials have demonstrated anomalies in people with Asperger syndrome. Event-related potentials are a tool to determine the errors in cortical auditory discrimination of people with Asperger syndrome. Mismatch negativity in event-related brain potentials demonstrate how well a person determines changes in sounds against the other sounds of the environment. People with Asperger syndrome are hypersensitive to detect changes in sounds.[25, 26]
On the other hand, O'Connor and colleagues demonstrated that, compared with healthy control subjects, people with Asperger syndrome are slower to recognize faces.[27]
Neuropsychologic Testing
Consult a neurologist for examination and neuropsychologic testing.
Neuropsychologic assessments should focus on simple and complex problem-solving tasks, using such tests and scales as the Wisconsin Card Sorting Test, the Trail-Making Test, and the Stanford-Binet Scale. Such diagnostic measures can demonstrate marked deficits in verbal and nonverbal functioning and intelligence level.
Neuropsychologic assessment is likely to demonstrate frontal system dysfunction.
Other Tests
Dziobek and colleagues have reported elevations of total cholesterol and low-density lipoproteins in people with Asperger syndrome.[28]
Audiography is indicated to rule out auditory discrimination deficits.
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